Progressive Counting (PC)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Low
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Progressive Counting (PC) has been rated by the CEBC in the area of: Trauma Treatment (Adult).

Target Population: Adults who have experienced trauma; has been used with teens and children ages 6 and up

Brief Description

PC is a psychotherapy procedure for resolving trauma or loss memories via memory reconsolidation. Briefly, it entails guiding the client to imagine a movie of the distressing memory, from beginning to end, while the therapist counts aloud first from 1-10, then 1-20, then 1-30, etc., to a maximum of 100. As the distress level goes down, the movies get shorter. This continues until no memory-related distress remains. PC can be done as a stand-alone treatment or within the context of a comprehensive phase model of trauma-informed treatment.

Program Goals:

The goals for Progressive Counting (PC) are:

Primary goal:

  • Help the client to fully process the targeted distressing memory, so that the memory is no longer distressing

Secondary goal:

  • Reduce or eliminate the client’s presenting problems, to the extent that such problems may have been caused or exacerbated by the distressing memory

Essential Components

The essential components of Progressive Counting (PC) include:

  • PC is preferably done within a phase model of trauma-informed treatment, so that the client understands the rationale of trauma work, and is sufficiently motivated, stable, and strong as to be likely to be successful with PC.
  • PC is done individually, with one person at a time.
  • The memories to be targeted with PC are systematically identified as relevant to the client’s presenting problem.
  • If more than one memory is to be treated with PC, the memories are treated in chronological order, once the client is judged to be capable of doing this.
  • The therapist guides the client to identify a beginning and ending of the movie, each of which (beginning and ending) are not part of the distressing event, but rather outside the event, and part of the broader life story.
  • The therapist counts aloud from 1-10 (then 1-20, etc., as per the PC system) while the client watches the movie of the distressing memory, in imagination, from beginning to end each time.
  • The therapist briefly obtains feedback from the client including a current distress rating. The feedback guides the therapist’s next step.
  • The therapist recognizes when the client is stuck (as per the PC system) and utilizes a range of possible interventions (as per the PC system) to assist the client in getting unstuck and continuing to make progress.
  • The therapist persists with PC until the client reports no remaining distress associated with the memory, and no further changes in memory-related thoughts, emotions, or physical sensations.
  • The therapist follows up with the client to determine whether any memory-related distress remains, and if so, treats it with PC.
  • When PC is used with parents in conjunction with parenting-focused intervention, it is typically used to treat those memories which are presumed to interfere with the parent’s capacity to parent up to the level of their natural competence. For example, a parent who is short-tempered with the child might be treated for his or her own history of abuse, which tends to lead to calmer parenting

Adult Services

Progressive Counting (PC) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Posttraumatic stress disorder (PTSD), posttraumatic stress symptoms, grief, and a wide range of presenting emotional or behavioral problems for which unresolved trauma/loss may be a contributing factor

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care
  • Hospital
  • Outpatient Clinic
  • Residential Care Facility
  • School

Homework

This program does not include a homework component.

Languages

Progressive Counting (PC) has materials available in languages other than English:

Dutch, Hebrew, Spanish, Turkish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Any room or other space suitable for conducting individual therapy

Minimum Provider Qualifications

Master’s level or higher mental health professional

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Training is provided on site and is also available to individual therapists who can register for advertised trainings in various locations.

Number of days/hours:

Five full days of 6.5 training hours/day

Implementation Information

Since Progressive Counting (PC) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Progressive Counting (PC).

Formal Support for Implementation

There is formal support available for implementation of Progressive Counting (PC) as listed below:

Ongoing group consultation via web-based videoconference is available.

Fidelity Measures

There are fidelity measures for Progressive Counting (PC) as listed below:

A treatment fidelity checklist to evaluate the treatment fidelity of the research therapists is available to researchers only by request.

Implementation Guides or Manuals

There are implementation guides or manuals for Progressive Counting (PC) as listed below:

Greenwald, R. (2013). Progressive Counting within a phase model of trauma-informed treatment. New York: Routledge.

Research on How to Implement the Program

Research has not been conducted on how to implement Progressive Counting (PC).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Greenwald, R., & Schmitt, T. A. (2010). Progressive Counting: Multi-site group and individual treatment open trials. Psychological Trauma: Theory, Research, Practice, and Policy, 2, 239-242.

Type of Study: Pretest/posttest
Number of Participants: 251

Population:

  • Age — Not stated
  • Race/Ethnicity — Not stated
  • Gender — Not stated
  • Status — Participants were therapists participating in Progressive Counting training.

Location/Institution: Germany, Greece, Israel, Singapore, Turkey, and the United States

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The aim of the present study was to report on participants who experienced Progressive Counting (PC) while in trauma training programs from the summer of 2007 through the spring of 2008. Participants experienced a brief Group PC treatment—average about 5 minutes of exposure—of a minor upsetting memory during the course of their participation in trauma treatment workshops. Outcomes are reported for two separate studies. Measure utilized was the Subjective Units of Distress Scale (SUDS) for both studies. Results indicate that 232 participants had usable data for the pretreatment and posttreatment assessments for Study 1 showed a significant reduction in symptoms related to outcomes reported by the SUDS measure. For Study 2, 128 of the Study 1 participants partnered with other workshop participants to provide and receive a more typical, untimed, individual PC session. Results indicated that 36 participants had usable data for pretreatment and posttreatment assessments for Study 2 showed a significant reduction in symptoms related to outcomes reported by the SUDS measure. Limitations include nonblind assessment using a single measure, high attrition rate, nonrandomization of participants, and lack of comparison group.

Length of postintervention follow-up: 1 week and 1 month.

Greenwald, R., McClintock, S. D., & Bailey, T. D. (2013). A controlled comparison of Eye Movement Desensitization & Reprocessing and Progressive Counting. Journal of Aggression, Maltreatment, & Trauma, 22, 981-996.

Type of Study: Randomized controlled trial
Number of Participants: 15

Population:

  • Age — Mean=41.6 years
  • Race/Ethnicity — Not specified
  • Gender — 67% Female and 33% Male
  • Status — Participants were individuals with traumatic experiences recruited via website and fliers.

Location/Institution: Not stated

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The objective of this study was to compare Eye Movement Desensitization and Reprocessing (EMDR) and Progressive Counting (PC). Measures utilized include the Posttraumatic Stress Diagnostic Scale (PDS), Dissociative Experiences Scale (DES), Subjective Units of Distress Scale (SUDS), and the Problem Rating Scale (PRS). Following the pretreatment evaluation, the participants were assigned to the geographically nearest therapist, and then block-randomly assigned to the treatment condition, either EMDR or PC. Results indicated that brief PC and EMDR treatment did not significantly differ in effect size, efficiency, or client acceptability, for participants with and without posttraumatic trauma stress disorder (PTSD). The low power, limited therapist experience with PC, and lack of evaluation of treatment fidelity make these findings inconclusive. Limitations include small sample size, lack of evaluation of treatment fidelity, inconclusive results, and lack of follow-up.

Length of postintervention follow-up: 1 week and 12 weeks.

Greenwald, R., McClintock, S. D., Jarecki, K., & Monaco, A. (2015). A comparison of eye movement desensitization & reprocessing and progressive counting among therapists in training. Traumatology, 21(1), 1-6.

Type of Study: Pretest/posttest with a control group
Number of Participants: 109

Population:

Location/Institution: Not stated

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The objective of this study was to compare Eye Movement Desensitization and Reprocessing (EMDR) and Progressive Counting (PC). Therapists in either EMDR or PC training programs worked on several of their own upsetting memories in practicums during the course of the training. Measures utilized include the Subjective Units of Distress Scale (SUDS) and the Treatment Difficulty Rating Scale. Results indicated that participants in both conditions reported large and significant reductions in memory-related distress, which persisted at 2 weeks and 10 weeks posttreatment. Results also indicate that there were no differences in effect size or maintenance of gains. PC was 37.5% more efficient than EMDR, and was rated as being less difficult. Limitations include nonrandomization of participants, lack of evaluation of treatment fidelity, and lack of follow-up.

Length of postintervention follow-up: 2 weeks and 2 months.

References

Greenwald, R. (2009). Treating problem behaviors: A trauma-informed approach. New York: Routledge.

Greenwald, R. (2013). Progressive Counting within a phase model of trauma-informed treatment. New York: Routledge.

Contact Information

Name: Ricky Greenwald, PsyD
Agency/Affiliation: Trauma Institute & Child Trauma Institute
Website: www.childtrauma.com
Email:
Phone: (413) 774-2340

Date Research Evidence Last Reviewed by CEBC: July 2017

Date Program Content Last Reviewed by Program Staff: May 2017

Date Program Originally Loaded onto CEBC: November 2015