Post One Approach Chosen and Why Cognitive processing therapy (CPT) is an

Post One
Approach Chosen and Why
Cognitive processing therapy (CPT) is an evidenced-based manualized modality created for the treatment of posttraumatic stress disorder (PTSD), created and the primary treatment used by the U.S. Department of Veterans Affairs (Cognitive Processing Therapy for PTSD, n.d.).  When looking at the treatment of PTSD, it is important to follow lead of both the research as well as organization who provide treatment to large amounts of individuals suffering with PTSD and trauma.  When looking at the top three empirically supported treatment approaches such as CPT, prolonged exposure therapy (PET), and eye movement desensitization and reprocessing therapy (EMDR), what does the VA use primarily and what is most accessible to the public.  CPT is both effective for treatment but also more accessible to treating master’s level clinicians in the field in the civilian world.  EMDR at times can be perceived as the gold standard but it requires a significant amount of time and money for a clinician to become effectively trained which limits treating provides for PTSD.  These play a factor in the interest in learning more and discovering more accessibility to training clinicians in the CPT treatment modality.
3 Keys Aspects of the Model and Christian Worldview Integration
            Although one critique for Cognitive Processing Therapy is due to his manualized structure, there is flexibility within the manual.  Unlike EMDR and PET, CPT can be used with either individuals or groups and within a combination of both groups and individuals.  Additionally, the 12-session protocol can be shortened or extended to meet the needs of the individual or the group, while maintaining its effectiveness (Galovski, Blain, Juliette, Elwood, & Houle, 2012). 
When individuals struggle with trauma, there is often a search for meaning in the experience leading to the trauma or for support in the recovery process.  This search for meaning and support is spiritual in nature, of the three primary treatment modalities for trauma, only CPT provides individuals with the search for this within the modality structure.  Spirituality (and for many Religion) is a coping skill that helps with a range of emotional difficulties including an increase sense of meaning, purpose, resilience, satisfaction, and happiness (Sherman, Harris, & Erbes, 2015).  When looking at how much spirituality and the recovery from trauma are linked, the need to understand statistics is important.  The statistics states that “92% of Americans believe in the existence of God or a universal spirit, 72% believe in life after death, and 41% of individuals who are not affiliated with a particular spiritual or religious tradition state that spirituality or religion is somewhat important in their lives (Wade, 2016).” CPT “references forgiveness as part of the cognitive processing, which can set the stage for explicit interventions related to spiritual struggle (e.g., allowing clients to explore concerns about forgiving themselves) (Sherman, Harris, & Erbes, 2015).”  
            Finally, another key component of CPT that is inviting to those seeking recovery from the PTSD symptoms they are experiencing is knowing potential outcomes.  Although CPT similar to both PET and EMDR has aspects about it that is exposed-based in nature it is primarily focused on the thoughts and changing beliefs about the events as well as a variety of other areas such as (safety, trust, power/control, esteem, and intimacy) rather than a focus on the events themselves (Hundt & Barrera, 2017).   CPT can offer insight to individuals of what is to be expected from the process due to his manualized nature which can help individuals throughout the process and understand if symptom reduction is not occurring early on it may decrease later.  Additionally, there is additional supplemental interventions that can be offered to individuals who are at risk for a slower or less impactful treatment response (Roberge, Weinstein, & Bryan, 2019).
Experience with Trauma Clients
            In my personal experience with working with clients with trauma, the use of cognitive behavioral therapy combined with psychoeducation has been an effective route to take.  Although I have not yet worked with individuals with complex trauma, and as part of my training I plan to increase my use to various trauma treatment modalities is improving.  I have been trained in EMDR but was unable at the time to put it into practice and no longer feel comfortable utilizing this modality.  As a result, I had begun looking into alternative treatment modalities and CPT and PET have come up in the research. This learning model allows to further education and research into the three main trauma treatment modalities while allowing for the time to spend researching one primarily to best help clients in practice.  It is best to have more than one way to treat clients and to understand multiple modalities in order to best educate self and clients of their options for care.
References
Cognitive Processing Therapy for PTSD. (n.d.). Retrieved from U.S. Department of Veteran Affairs: https://www.ptsd.va.gov/understand_tx/cognitive_processing.asp
Galovski, T. E., Blain, L. M., Juliette, M. M., Elwood, L., & Houle, T. (2012). Manualized therapy for PTSD: Flexing the structure of cognitive processing therapy. Journal of Consulting and Clinical Psychology, Vol.80(6), pp. 968-981.
Hundt, N. E., & Barrera, T. L. (2017). “It’s Worth It in the End”: Veterans’ Experiences in Prolonged Exposure and Cognitive Processing Therapy. Cognitive and Behavioral Practice, Vol.24(1), pp.50-57.
Roberge, E. M., Weinstein, H. R., & Bryan, C. J. (2019). Predicting response to cognitive processing therapy: Does trauma history matter? Psychological Trauma: theory, research, practice and policy, DOI: 10.1037/tra0000530.
Sherman, M. D., Harris, I. J., & Erbes, C. (2015). Clinical Approaches to Addressing Spiritual Struggle in Veterans with PTSD. Professional Psychology: Research and Practice, Vol.46(4), pp. 203-212.
Wade, N. R. (2016). Integrating Cognitive Processing Therapy and Spirituality for the Treatment of Post-Traumatic Stress Disorder in the Military. Social Work and Christianity, Vol.43(3), pp. 59-72.
Post Two
Which empirically supported treatment approach did you decide to focus on for this class and why?
I choose to focus on eye movement desensitization and reprocessing (EMDR) for this class. EMDR treatment unlike some other therapies focuses on memories that impact the individual and cause them problematic symptoms (Shapiro et. al., 2016). I choose to study this treatment approach because it is something that I would like to get trained in. Like other therapeutic approaches, EMDR has the clinician and individual identify the negative experience(s) that have set their issues into action (Shapiro et. al., 2016). What I like about EMDR is that it focuses not only on distant memories, but also on current and possible future events that an individual might endure. EMDR according to Shapiro et. al. (2016), allows for an individual to emerge from therapy understanding a bigger picture than even what they originally sought therapy for.
What are 3 key things you are learning in studying this model? Apply class resources as appropriate in justifying your choice of these 3 things as key.
The first thing I learned about EMDR is that it can rapidly recondition an individual suffering, by replacing their fear(s) with powerful relaxation responses (Shapiro et. al., 2016). EMDR essentially does this, by having the individual recall their earliest experiences that cause them negative responses and then uses eye movements to restore the memory and desensitize it (Van Der Kolk, 2015). The second thing I learned was that EMDR is guided by the idea that negative memories are stored in the mind and are identified as central to the mental health problem (Shapiro 2018). And that according to the EMDR process, they can be stored in memory and hold emotions and body sensations. The last thing I learned was that EMDR treatment unlike cognitive behavioral treatment and other behavioral approaches does not include homework, direct challenging of beliefs, extended exposure, and detail description of the event (Shapiro et. al., 2016).
How well do you see this particular treatment model integrating with a Christian worldview? Why?
EMDR treatment in my opinion, coincides with the Christian worldview if applied to a Christian therapy session. EMDR focuses on helping the individual accept the full truth of his positive statements. When incorporating Scripture with EMDR, a clinician can discuss the truth that God provides to his people. In the Bible, James asks the people who determines wisdom, truth and understanding? James is essentially saying to the people, where your focus lies determines how you live out your life. “Who is wise and understanding among you? Let them show it by their good life, by deeds done in the humility that comes from wisdom (James 3:13).” Lastly, in an article I found, EMDR was used for women who had endured PTSD and essentially lost their trust in their faith even though they knew intellectually what it was, they reported not being able to feel what it was (Loewenthal, 2019). EMDR helped restore their trust in their religion and enable feelings of faith that were once gone (Loewenthal, 2019).
If you have experience doing therapy with trauma clients, share how learning this treatment approach is influencing how you conceptualize or intervene with such clients. If you do not have experience with such clients, share how learning this model is influencing how you will approach working with such clients.
I currently do not have a ton of experience with trauma clients. However, I can see how this treatment would be useful for a multitude of different disorders such as phobias, anxiety, depression, and post-traumatic stress disorder. I can see how EMDR is very useful in helping clients understand how their past might be impacting their present and even future. I worked in the past with a client who would not address her past traumas and sadly continued to suffer negative responses due to certain stimuluses because of it. So, I could see how EMDR could provide a path to having a client open up.
References
Loewenthal, K. M. (2019). EMDR – eye movement desensitization and reprocessing therapy and religious faith among orthodox Jewish women. Israel Journal of Psychiatry and Related Sciences, 56(2), 20-27.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (Third ed.). Guilford Press.
Shapiro, F. & Forrest, M. S. (2016). EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma. New York, NY: Basic Books.
Van Der Kolk, Bessel (2015). The body keeps the score: brain, mind, and body in the healing of trauma. Penguin Books.