War-Related-PTSD | Treatment Manual

War-Related PTSD
Home
Home About the Manual

About the Manual

How to use this manual:Ideally, you would use the manual as part of a treatment program, with a Psychologist, Psychiatrist, or Social Worker guiding you through the program in a group therapy format. The manual can also be used for individual therapy (you and your provider), or simply as a tool to learn more about your physical and mental reactions following combat experiences. Printing instructions:This manual is available in PDF format, which can be printed on any standard printer. It is recommanded that you print the manual-due to its size and the fact that a large amount of the manual consists of worksheets that you would need to fillout on paper. For providers using this in thier practices-I recommend using a spiral-bound format for easy access to the workbook forms and scales in the back of the manual.
This manual was written by an active duty psychologist treating combat veterans who have served in OIF/OEF and are struggling with Post Traumatic Stress Disorder. This manual's basis is Cognitive Behavioral Therapy (CBT), which is widely recognized as the most effective form of treatment for anxiety disorders, and specifically for PTSD. CBT for PTSD has been endorsed in practice guidelines for PTSD by the DoD, the Department of Veteran's Affairs, the American Psychological Association, and other orginazations.This manual was reviewed by the Navy's specialty leaders for psychiatry and clincal psychology, as well as the head of Combat and Operational Stress Control and approved for distribution to all Navy psychologists. Whats is covered in the manual:The first part of the manual is broken down into 6 sessions, covering information about what PTSD is, what causes it, and proven therapy techniques for eliminating PTSD. The second part of the manual has several Modules that cover information on topics like Medications, Insomnia, Guilt, Anger management, and other issues that affect persons with PTSD.
Table of Contents

Class #1: Program Introduction & Learning About PTSDIntroduction to the programWhat is Post-traumatic Stress Disorder (PTSD)? How PTSD DevelopsFight or Flight: How the body responds to a threatTriggersWhat Keeps PTSD AroundClass#2: Cognitive Therapy, Part IQuestions for self study / Review Corrective Thinking Generalization of Triggers Class #3: Cognitive Therapy, Part IIQuestions for self study / Review Challenging Your ThinkingCorrective Thinking and Conditioned ResponsesClass #4: Exposure Therapy, Part IQuestions for self study / ReviewExposure Therapy ExplainedTypes of Exposure TherapyClass #5: Exposure Therapy, Part IIQuestions for self study / Review Safety AidesInteroceptive ExposureClass #6: Wrap-up and Looking AheadQuestions for self study / Review Maintain Your GainsWhen Symptoms Return: Preventing Relapse Appendix A: Additional ModulesModule 1: Relaxation TechniquesModule 2: Improving Sleep Module 3: Managing AngerModule 4: Managing Dissociation & Re-experiencing SymptomsModule 5: Managing GuiltModule 6: Alcohol and PTSDModule 7: Medications for PTSDModule 8: Other Types of TreatmentList of Figures1.1 Pavlovs Dog Experiment..81.2 Fear Conditioning Experiment..91.3 Conditioned Fear in Laboratory....101.4 Fear Conditioning and PTSD (IED Blast example) ....111.5 Conditioned Fear following IED blast....121.6 Changes to our bodies during Fight or Flight Response...131.7 Example Triggers from different types of trauma....151.8 Varying Strengths of Triggers..171.9 Potential Triggers following a Firefight..171.10 Potential Triggers following a Mortar Attack181.11 Potential Triggers following a Rape.181.12 Potential Triggers following a Motor Vehicle Accident..191.13 Fear Incubation231.14 Fear Incubation-Forming New Triggers..252.1 Table listing Probability and Severity of Risks...352.2 Generalization of Conditioned fear reactions.402.3 Generalization example- Conditioned fear of gunshots.412.4 Generalization Examples of how different triggers can generalize out...423.1 Corrective Thinking for Common Combat Related Thinking Patterns...473.2 Conditioned Fear to Triggers..493.3 Impact of Anxious Thinking on Anxiety Levels...503.4 Impact of Corrective Thinking on Anxiety Levels...504.1 Fear Conditioning in Laboratory ....534.2 Repeated Exposure of Trigger makes Conditioned Fear fade away...544.3 Example Triggers following IED attack.554.4 P.O. Richard's Exposure Therapy Regimen....564.5 Extended Exposure to Triggers should lower anxiety..574.6 Effects of Repeated Exposure to same situation..584.7 Danger of leaving Exposure Situations early..594.8 Fear Incubation in P.O. Richards example..605.1 When Anxiety Doesnt Go Down in Exposure Therapy...........78
Preview Contents

PTSD manual cover.jpg
Pics of pages from manual 2.jpg
Pics of pages from manual 3.jpg
Pics of pages from manual 4.jpg
Pics of pages from manual 5.jpg
Pics of pages from manual 6.jpg
Pics of pages from manual 7.jpg

Download

Disclaimer

This manual is a self-help tool that was created by a licensed psychologist. The manual may be used for educational information regarding PTSD, and is available at no cost. This site itself does not and will not provide any medical, psychological or professional services to any of its users. The information on the site and the PTSD manual are not intended to provide a diagnosis or take the place of in-person consultation or advice from a health care professional. For an accurate diagnosis of a mental health problem, users should be seen by a qualified mental health professional.

By downloading the PTSD Manual from this site, you are acknowledging the following:

1) The Manual author shall not be liable for any claims or damages, and

expressly disclaims any and all liability of any nature for any action, or

non-action, taken as a result of the information given in this manual.

2) I acknowledge that the author is not providing treatment. I do not

hold them responsible for any aspects of my health, either physical or

emotional.

CBT for C-R PTSD MANUAL.pdf

Author

Dr. Jeffrey H. Cook

Jeffrey H. Cook, PhD, USN (Ret) is a 20+year military veteran, who has served as a Marine reservist, an active duty Navy Corpsmen, and a Navy Psychologist. Enlisting in the Marine reserves in 1987, he later converted to Active Duty as a Corpsman. After serving six years as a Corpsman, he was selected into Uniformed Services University of the Health Sciences’ Clinical Psychology Ph.D program. He received his Doctoral Degree in clinical psychology from USUHS in 2001. During his career as a psychologist, LCDR Cook has held a variety of positions in operational and clinical assignments. He served as the Division Officer for the Mental Health Department in Okinawa, Japan. He subsequently served as the Ships Psychologist for the USS George Washington, ported out of Norfolk, VA. Upon leaving the USS G.W., LCDR Cook served as a Staff Psychologist at the National Naval Medical Center, Bethesda MD. During this tour he deployed to Camp Fallujah, Iraq with CLB-8, serving as a Combat Stress Control psychologist. Upon his return from Iraq, he served as the Department Head for the Psychological Health and Traumatic Brain Injury Program at the National Naval Medical Center Bethesda MD, where he coordinated the PTSD and brain injury treatment for Wounded Warriors.

Other Publications-Cook, J.H., Phillips, J.M. (2011, March). Poster presentation: A Comparison of Treatment Manuals for Combat-related Post-traumatic Stress Disorder. Armed Forces Public Health Convention, Hampton VA. Phillips, J.M., Bridge, D., Cook, J.H. (2011, March). Poster presentation: The OIF/OEF Safety Behaviors Scale (OSBS): A Comparison to the Post-Traumatic Stress Disorder Checklist (PCL). Armed Forces Public Health Convention, Hampton VA. Jones, David E.; Perkins, Kenneth; Cook, Jeffrey H.; Ong, Adeline L. (2008). Intensive Coping Skills Training to Reduce Anxiety and Depression for Forward-Deployed Troops.Military Medicine, Volume 173, Number 3, pp. 241-246(6).Carrie H Kennedy and Jeffrey H Cook and Daniel R Poole and Christopher L Brunson and David E Jones. (2005) Review of the First Year of an Overseas Military Gambling Treatment Program. Military Medicine, Volume 170, Number 8, pp. 683-687.Cook, J.H.,Eiche, K. (2001). Prevention of Dental Phobias; A Learning Theory Based Approach. Naval Postgraduate Dental School, Clinical Update, Volume 22, No. 11.Schmidt, N.B., Woolaway-Bickel, K., Trakowski, J., Santiago, H., Storey, J., Koselka, M., & Cook, J. (2000). Dismantling cognitive-behavioral treatment for panic disorder: Questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology, 68, 417-424.Joiner, T.E., Jr., Schmidt, N.B., Lerew, D.R., Cook, J.H., Gencoz, T., & Gencoz, F. (2000). The differential roles of depressive and anxious symptoms and gender in defensiveness. Journal of Personality Assessment, 75, 200-211.Schmidt, N.B., & Cook, J.H. (1999).Effects of anxiety sensitivity on anxiety and pain during a cold pressor challenge in patients with panic disorder. Behavior Research and Therapy, 37, 313-323.
Future additions

Additional Modules that are in development:

Dealing with the stigma of PTSD/Mental health treatment: Coming forward and getting help for PTSD, Depression, or alcohol problems can be one of the toughest things a service member does. Unfortunately, many people who are in your chain of command and even buddies don't understand how real PTSD and depression are-and may make it harder to come in for care. This module will provide real-world, practical advice on how to handle situations like supervisors or friends giving you flack for seeking help. It also addressed some of the myths and misconceptions about mental health care. Assertiveness training for OIF/OEF veterans: How many of you have dealt with the following situations? A guy at a bar finds out you were deployed, and asks..."So, how many people did you kill when you were over there?" Your wife keeps insisting that you talk about the things that happen on deployment, even though you know she couldn't understand what you saw and the things you had to do. Assertiveness is a set of easy to learn techniques for shutting down unwanted conversations without starting fights, and for protecting your rights in general without getting in trouble. Behavioral Activation: A well-proven treatment for Depression, Behavioral Activation has been used successfully to help patients with PTSD as well. Behavioral Activation is an easy to implement program for increasing a person's activity level. This module will cover behavioral activation, adapted for PTSD. This technique will be especially helpful if you have depression with PTSD, or significant levels of PTSD-related avoidance.Concussion and mild TBI-relationship to PTSD: Many service members who have PTSD following a deployment were also exposed to concussions, due to direct blows to the head or to being near a blast. This module will discuss concussions, especially how some of the persistent symptoms of concussion syndrome overlap with symptoms of PTSD and depression. Rebuilding Trust: After experiencing combat and the constant danger of being in a war zone, many service members find that they can't turn off the constant sense of paranoia about others. Even people you have no reason to doubt are automatically distrusted. The deep belief that "The world is out to get me" feeds this kind of thinking. Many service members would rather not lose this part of the disorder-believing that this constant alertness and distrust of people will keep them safer. This module will help give you tools for letting go of these beliefs and thinking patterns to speed up your recovery.
Evidence Base

Evidence Base for CBT for PTSD

Article 1
Article 2
Article 3

Article 1

VA/DoD Clinical Practice Guidelines

Selected information from the VA/DoD Clinical Practice Guidelines on PTSD covering CBT for PTSD: "Strongly recommend that patients who are diagnosed with PTSD should be offered one of the evidence-based trauma-focused psychotherapeutic interventions that include components of exposure and/or cognitive restructuring; or stress inoculation training.""The core components used in the vast majority of A-level interventions have involved combinations of exposure (particularly in-vivo and imaginal/oral narrative), cognitive restructuring, relaxation/stress modulation techniques, and psychoeducation.""Exposure-based therapies (ET) emphasize in-vivo, imaginal, and narrative (oral and/or written) exposure, but also generally include elements of cognitive restructuring (e.g. evaluating theaccuracy of beliefs about danger) as well as relaxation techniques and self-monitoring of anxiety. Examples of therapies that include a focus on exposure include Prolonged Exposure Therapy,Brief Eclectic Psychotherapy, Narrative Therapy, written exposure therapies, and many of the cognitive therapy packages that also incorporate in-vivo and imaginal/narrative exposure." "Cognitive-based therapies (CT) emphasize cognitive restructuring (challenging automatic or acquired beliefs connected to the traumatic event, such as beliefs about safety or trust) but also include relaxation techniques and discussion/narration of the traumatic event either orally and/or through writing. Examples include Cognitive Processing Therapy and various cognitivetherapy packages tested in RCTs"
CGP cover.jpg

Article 2

Selected information from the Institute of Medicine's report on the Treatment of Posttraumatic Stress Disorder:

"Psychotherapeutic interventions for posttraumatic stress disorder (PTSD) vary in their emphasis on reexposure to trauma-related memories and stimuli, cognitive restructuring of the trauma experience, expression and management of emotion, training in stress management (including relaxation training), and general social and vocational support. Although a number of these treatments emphasize one of these components, many combine more than one either implicitly or by design, and relatively few studies dismantled effective components of the psychotherapy. ""The committee noted that virtually all of the recent literature on psychotherapies for PTSD examines interventions that some experts consider components of cognitive-behavioral therapy (CBT). For example, Harvey et al. (2003) describe four basic components of CBT: psychoeducation, exposure, cognitive restructuring, and anxiety management training.""The committee judged that the quality of the overall body of evidence supporting exposure therapies is moderate to high, with the best studies all pointing in the same direction with an important clinical benefit. The committee is confident in both the presence of a positive effect and in its clinical significance. Further research is likely to refine estimates of the effect in different settings and populations, but is unlikely to change confidence in the overall estimate of effect.Conclusion: The committee finds that the evidence is sufficient to conclude the efficacy of exposure therapies in the treatment of PTSD."

Article 3

Information from the National Center for PTSD

From the VA's National Center for PTSD website (retrieved on 16 Dec, 2011, from http://www.ptsd.va.gov/public/pages/treatment-ptsd.asp)"Types of cognitive behavioral therapyWhat is cognitive therapy?In cognitive therapy, your therapist helps you understand and change how you think about your trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your symptoms worse.You will learn to identify thoughts about the world and yourself that are making you feel afraid or upset. With the help of your therapist, you will learn to replace these thoughts with more accurate and less distressing thoughts. You will also learn ways to cope with feelings such as anger, guilt, and fear.After a traumatic event, you might blame yourself for things you couldn't have changed. For example, a soldier may feel guilty about decisions he or she had to make during war. Cognitive therapy, a type of CBT, helps you understand that the traumatic event you lived through was not your fault.What is exposure therapy?In exposure therapy your goal is to have less fear about your memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event.By talking about your trauma repeatedly with a therapist, you'll learn to get control of your thoughts and feelings about the trauma. You'll learn that you do not have to be afraid of your memories. This may be hard at first. It might seem strange to think about stressful things on purpose. But you'll feel less overwhelmed over time.With the help of your therapist, you can change how you react to the stressful memories. Talking in a place where you feel secure makes this easier.You may focus on memories that are less upsetting before talking about worse ones. This is called "desensitization," and it allows you to deal with bad memories a little bit at a time. Your therapist also may ask you to remember a lot of bad memories at once. This is called "flooding," and it helps you learn not to feel overwhelmed.You also may practice different ways to relax when you're having a stressful memory. Breathing exercises are sometimes used for this."

About

ABOUT

Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Fusce tempor arcu ac urna. Fusce congue eleifend mi. Pellentesque metus sem, elementum eu, rhoncus sed, gravida sit amet, nulla. Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean condimentum, odio quis pharetra dignissim, diam nisl dignissim diam, eu interdum magna erat sit amet felis. Etiam non felis at urna tempus luctus. In ullamcorper nisl congue elit. In convallis nibh vitae justo. Quisque ac lectus vitae sem consequat sagittis. interdum magna erat sit amet felis. Etiam non felis at urna tempus luctus. In ullamcorper nisl congue elit. In convallis nibh vitae justo. Quisque ac lectus vitae sem consequat sagittis.lorem ipsum dolor sit amet, consectetuer adipiscing elit. Fusce tempor arcu ac urna. Fusce congue eleifend mi. Pellentesque metus sem, elementum eu, rhoncus sed, gravida sit amet, nulla. Lorem ipsum dolor sit amet. Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Fusce tempor arcu ac urna. Fusce congue eleifend mi.

Feedback

Contact the Author

For providers-please take the time to give your thoughts on the manual's content---especially any insights or suggestions for improving the document.

If you are a service member or the spouse of a service member and have found that the information in the manual helped-please consider writing to say what worked for you....and any suggested changes to the manual

About the Manual

Table of Contents

Preview Contents

Download

Author

Future additions

Evidence Base

Feedback

Home pageAbout PTSDOther Resources