Trauma Treatment (Adult)

CPT was originally developed for use with rape and crime victims, but it is used with a variety of trauma populations, including both military and civilian samples. CPT focuses on identifying and challenging maladaptive beliefs that develop about, and as a result of, the traumatic event. The therapist helps the client to identify problem areas (i.e., stuck points) in their thinking about the traumatic event, which have impeded their recovery. Therapists then use Socratic dialogue, a form of questioning that encourages clients to examine and evaluate their own beliefs rather than being told in a directive way, to help clients challenge their stuck points. Throughout the treatment, worksheets and Socratic dialogue are used to help clients replace maladaptive beliefs with more balanced alternative statements. CPT can be delivered individually or in a group format.

Note: When CPT was originally developed and for many years after that, it included a trauma narrative as part of the intervention. Since 2011, a number of research studies using CPT without the trauma narrative (known as CPT-C) have been published. In 2017, the developer of CPT made the decision to no longer include the trauma narrative as part its intervention as the primary therapy format (the exceptions are if the clients want to write an account or if they are highly dissociative to piece together the event). Research is being conducted on both versions of the therapy but there is more on CPT than CPT+A (with accounts).

EMDR therapy is an 8-phase psychotherapy treatment that was originally designed to alleviate the symptoms of trauma. During the EMDR trauma processing phases, guided by standardized procedures, the client attends to emotionally disturbing material in brief sequential doses that include the client’s beliefs, emotions, and body sensations associated with the traumatic event while simultaneously focusing on an external stimulus. Therapist directed bilateral eye movements are the most commonly used external stimulus, but a variety of other stimuli including hand-tapping and audio bilateral stimulation are often used. EMDR is also highlighted on the CEBC website in the Trauma Treatment – Client-Level Interventions (Child & Adolescent) topic area, click here to go to that entry.

Narrative Exposure Therapy (NET) is a culturally universal intervention. Given its focus on the autobiographical elaboration of traumatic experiences, NET is particularly suited for populations affected by multiple and continuous traumatic experiences, such as organized violence, torture, war, rape, and childhood abuse. NET has been developed as a standardized short-term approach. It is designed so that three to six sessions should be sufficient to provide considerable relief and reinstate individual functioning, even for patients who suffer from severe and chronic traumatization in areas of on-going adversity and recent disasters. Beyond its focus on healing the wounds of trauma, NET aims to account for the human rights abuses suffered by survivors. Beyond the core components of classic NET described in this entry and on which the CEBC has rated the program, there are newly developed treatment modules for the rehabilitation of traumatized children (KIDNET), as well as Forensic Offenders (FORNET) as well as a module on the theory and practical management of dissociation.

PE consists of 8 -15 treatment sessions that are 60-90 minutes each. Clients are encouraged to repeatedly approach situations or activities they are avoiding because they remind them of their trauma (in vivo exposure) as well as to revisit the traumatic memory through retelling it (imaginal exposure). Psychoeducation about common reactions to trauma as well as breathing retraining exercises are also included in the treatment. The aim of in vivo and imaginal exposure is to help clients emotionally process their traumatic memories through the imaginal and in vivo exposures. Through these procedures, clients learn that they can safely remember the trauma and experience trauma reminders, that the distress that initially resulted from confrontations with these reminders decreases over time, and that they are capable of tolerating this distress. Prolonged Exposure Therapy for Adolescents (PE-A) is also highlighted on the CEBC website in the Trauma Treatment - Client-Level Interventions (Child & Adolescent) topic area, please click here to see that entry.

Seeking Safety is a present-focused, coping skills therapy to help people attain safety from trauma and/or substance abuse. The treatment is available as a book, providing both client handouts and clinician guidelines. The treatment may be conducted in group or individual format; with females and males; and in various settings (e.g., outpatient, inpatient, residential, home care, schools). Seeking Safety consists of 25 topics that can be conducted in as many sessions as time allows, and in any order. Examples of topics are Safety, Asking for Help, Setting Boundaries in Relationships, Healthy Relationships, Community Resources, Compassion, Creating Meaning, Discovery, Recovery Thinking, Taking Good Care of Yourself, Commitment, Coping with Triggers, Self-Nurturing, Red and Green Flags, and Life Choices. Seeking Safety is also rated on the CEBC in the Substance Abuse Treatment (Child & Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent) topic areas, click here to go to this entry.

Beyond Violence: A Prevention Program for Criminal Justice-Involved Women (BV) is a manualized curriculum for women in criminal justice settings (jails, prisons, and community corrections) with histories of anger, aggression and/or violence. It deals with the violence and trauma they have experienced, as well as the violence they may have committed. It is based on a four-level model of violence prevention which considers the complex interplay between individual, relationship, community, and societal factors. This is a 20-session (40-hour) intervention that consists of a facilitator guide, participant workbook, and DVD. The facilitator's manual is a step-by-step guide for running groups and includes the DVD, What I Want My Words To Do To You by Eve Ensler. BV utilizes a variety of therapeutic strategies (e.g., psycho-education, role playing, mindfulness activities, cognitive-behavioral restructuring, and grounding skills for trauma triggers).

The 16-session Brief Eclectic Psychotherapy for PTSD (BEPP) protocol starts with psychoeducation on posttraumatic stress disorder (PTSD). The patient and his/her partner learn to understand the symptoms of PTSD as dysfunctional, and caused by the traumatic event. The patient will then receive 4-6 sessions of relaxation and imaginary exposure, focused on the suppressed intense emotions of sorrow.

Memorabilia are used to stimulate remembrances of the traumatic event and the patient is tasked to write a letter to a person or an institution blamed for the traumatic incident. The letter is specifically used to express aggressive feelings. Symptoms will then typically disappear and the patient will be able to concentrate on the impact of the trauma on his/her view of self and the world. The treatment is ended with a farewell ritual.

Creating Change is a past-focused model for trauma and addiction for a very broad range of clients. It can be conducted in individual or group format by any provider. The program is designed to be highly accessible, flexible, and engaging from a public health standpoint. Each treatment topic helps clients face their past by addressing a theme, for example:

• Honor Your Survival
• Break the Silence
• Emotions and Healing
• Relationship Patterns
• Influences: Family, Community, Culture
• Power Dynamics
• Why Addiction?
• Darkness and Light
• Listen to Your Body
• What You Want People to Understand
• Deepen Your Story

Creating Change has the same format and compassionate tone as Seeking Safety (a present-focused model for trauma and/or addiction) and can be used with that model if desired.

EEG Neurofeedback is a type of biofeedback therapy (also known as EEG Biofeedback) that involves monitoring and regulating brain activity to improve cognitive function, emotional regulation, and overall well-being. It is a noninvasive therapy that helps individuals train their brain to function more efficiently. EEG Neurofeedback is based on the principle that the human brain can adapt and change, a concept known as neuroplasticity. By using technology that provides real-time visual and auditory feedback, individuals ideally learn to regulate their brain activity.

Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People is the 2nd edition of the Exploring Trauma curriculum. This edition reflects the expanded definition of gender responsive to include the experiences of transgender and nonbinary people. This new material has inclusive pronouns, as well as examples of traumatic events and focus questions specific to this group. The facilitator guide and participant workbook are on a flash drive which allows for easy duplication. There are introductory materials for the facilitator and then detailed instructions (specific lesson plans) for the sessions. The session topics include: the process of trauma, the Adverse Childhood Experiences (ACE) questionnaire, power and abuse, grounding and self-soothing, the risk of victims becoming victimizers, understanding shame, and healthy relationships. There is a strong emphasis on grounding skills. This material can also be used for training staff on the gender-responsive issues related to trauma.

ILF Neurofeedback is a noninvasive form of brain training that is designed to help clients of all ages improve self-regulation of emotional, behavioral, and physical functioning and manage stress more effectively. ILF Neurofeedback targets extremely low frequencies in foundational neural networks. In addition to having experienced trauma, ILF Neurofeedback can be used with clients with high ACE scores, numerous psychosocial stressors, and multiple co-occurring challenges.

A model of online training and clinical support was developed to ensure clinical quality and client safety and an online, HIPAA-compliant Results Tracking System (RTS).

Infra-Low Frequency (ILF) Neurofeedback has been used with populations other than adults and for conditions other than trauma, but the CEBC has not reviewed it for these populations or conditions.

Mom Power®: A Strong Roots™ Curriculum is an integrated mental health and attachment-based parenting program that incorporates a manualized intervention delivered by 2 facilitators across 13-sessions (3 individual and 10 group sessions), with corresponding parent- and child-group curricula. Mom Power® is intended for, but not limited to, mothers with young children (ages 0-6) and histories of adversity and/or trauma who may also present with depression, anxiety, posttraumatic stress, and/or high levels of distress. Mom Power® utilizes a multigenerational approach and applies attachment theory, cognitive-behavioral and dialectical behavioral strategies to facilitate growth and new skills. The group format is designed to facilitate social support, and the nurturing environment and individual sessions are designed to enhance access to care. The program seeks to nurture resilience through strengthening protective factors, improving mental health, and promoting sensitivity and responsive parenting. Although the CEBC has not yet reviewed these, there are adaptations of the Mom Power® curriculum specifically tailored for military families, fathers, and families involved in the child welfare system.

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.

STAIR/MPE is a sequential, two-phase treatment based in a developmental model which is designed to be sensitive to the disturbances in attachment, emotion regulation, and interpersonal functioning that survivors of childhood or chronic interpersonal violence often bring to treatment. Phase 1: Skills Training in Affective and Interpersonal Regulation (STAIR) is designed to enhance day-to-day functioning by building emotion regulation capacities and interpersonal skills and provides a window of opportunity for client and therapist to develop a strong therapeutic alliance. Phase 2 of treatment is a modified version of prolonged exposure (MPE). After the exposure work is completed, emotions arising from the narrative should be able to be identified and modulated through grounding techniques. In addition, client and therapist review the taped narratives for interpersonal schemas about self-and-others regarding themes of rejection, betrayal, shame, failure and loss. STAIR/MPE has been shown to provide improvement in emotion regulation, self-efficacy, anger expression, interpersonal problems, and perceptions of social support.

The Center for Mind-Body Medicine (CMBM) Small Group Model for Adults is an approach designed to heal psychological trauma, relieve stress, reduce symptoms of chronic illness, and increase resilience. Working in small groups of 8–10 people, facilitators teach a variety of self-care techniques drawn from the world’s healing traditions as well as modern medicine to help participants learn to move through emotions and experience their own capacity for self-healing. Trained facilitators guide the experience, helping participants discover their own answers.

TARGET is an educational and therapeutic intervention designed to prevent and treat traumatic stress disorders (including PTSD, severe anxiety disorders, depression, and dissociative disorders), co-occurring addictive, personality, or psychotic disorders, and adjustment disorders related to other types of stressors.

TARGET teaches a seven-step sequence of skills, the FREEDOM Steps, designed to enable participants to recognize, understand, and gain control of stress reactions by enhancing their strengths/abilities for mental focusing, mindfulness, emotion regulation, executive function, and interpersonal engagement/interaction.

TARGET provides a systematic approach to processing traumatic and other critical memories that does not require memory processing

TARGET provides a manualized protocol for brief (4-session), time-limited (10-14 sessions), and extended (26+ sessions) individual, group, or couple/family education and therapy. TARGET can be delivered in community, outpatient, inpatient, residential treatment, shelter, workplace, correctional, or healthcare settings.

TARGET has been adapted to be gender-specific, culturally responsive, and attuned to the unique needs of adults who have experienced (or are currently experiencing) childhood trauma, sexual trauma, domestic violence, community violence, traumatic losses, disaster trauma, medical trauma, racism-related trauma, sexual identity-related trauma, or military trauma.

TARGET for Adolescents is highlighted in the Trauma Treatment (Child & Adolescent) topic area on the CEBC as well.

TREM is a fully manualized 24- to 29-session group intervention for women who survived trauma and have substance use and/or mental health conditions. This model draws on cognitive–behavioral, skills training, and psychoeducational techniques to address recovery and healing from sexual, physical, and emotional abuse. TREM consists of three major parts. The first section, on empowerment, helps group members learn strategies for self-comfort and accurate self-monitoring as well as ways to establish safe physical and emotional boundaries. The second component of TREM focuses more directly on trauma experience and its consequences. In the third section, focus shifts explicitly to skills building. These sessions include emphases on communication style, decision-making, regulating overwhelming feelings, and establishing safer, more reciprocal relationships.