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a number of specific trauma-focused cbt interventions can be classified as cbt, and cbt for trauma and traumatic stress reactions typically includes multiple techniques/components. it is also usually trauma-focused (i.e., focused on helping clients address traumatic experiences). for example, in their review of cbt for trauma, cahill et al. (2009) evaluated seven different techniques/therapies, which they labeled as cbt: et, stress inoculation training, cognitive processing therapy (cpt), cognitive therapy, relaxation training, dialectical behavior therapy (dbt), and acceptance and commitment therapy (act). cbt is a well-studied approach cahill et al. (2009) review included 64 randomized, controlled trials and many more nonrandomized trials. cbt is also generally recommended in the treatment of ptsd. although much of the research has focused on cbts use in treating ptsd, a cochrane review of treatments for asd also found cbt to be more efficacious than waitlist controls or supportive counseling ( roberts et al., 2010 ).
this provider’s opinion is based on a review of the current literature on the effects of childhood trauma on adult ptsd. this opinion is not necessarily representative of the position of the veterans health administration or the department of veterans affairs. it is not intended to be used as a substitute for the medical judgment of a physician. a history of trauma, including physical and sexual abuse, is a well-established risk factor for the development of ptsd. recent studies indicate that adverse childhood experiences such as early trauma, abuse, and neglect are associated with an increased risk for ptsd. while the evidence is largely consistent, one study suggests that the association between childhood trauma and ptsd may be moderated by genetic factors ( williams et al., 2009 ). in general, the risk of ptsd appears to be higher in those who have experienced multiple traumatic events ( breslau et al. the association between adverse childhood experiences and ptsd appears to be even stronger among women. women who have experienced childhood trauma are about 20 times more likely to have ptsd than other women ( holman, hietala, & hill, 2010 ).
some researchers have questioned whether ptsd can be reliably diagnosed among people with substance use disorders ( cisler & smith, 2004 ). dsm-iv-tr lists substance use disorders as additional criteria for the diagnosis of ptsd (apa, 2000). for example, a veteran who is depressed or experiences a trauma while in the throes of a substance use disorder may not fulfill criteria for a ptsd diagnosis if he or she did not experience these symptoms while sober. this may lead to a situation in which a person with ptsd may not seek treatment because he or she is embarrassed to disclose the diagnosis (cisler & smith, 2004). a 2004 study using the national comorbidity survey found that veterans were less likely than nonveterans to receive a ptsd diagnosis if they had substance use disorders (cisler & smith, 2004).
the physiological basis of psychotherapy outcome is not clear. most studies of psychotherapy outcome have demonstrated that people who are randomly assigned to psychotherapy treatment (especially if they are also in drug treatment) get better, on average, regardless of who they are ( wampold et al., 2010 ). thus, people in psychotherapy and drug treatment are at risk of being in psychotherapy for the wrong reasons, the only reasons that really matter are those that are truly therapeutic, not those that are socially desirable. for example, “i need to talk” is a very common reason for people to see a therapist, but this is a socially desirable rather than a therapeutic reason to see a therapist. people in psychotherapy for the wrong reasons may get better than people not in psychotherapy, as long as they are getting treated for the correct reasons. the level of improvement in psychotherapy is related to motivation, but it is not well understood. motivation is a dynamic, complex, and multidimensional construct, often impeding the discovery of the mechanisms that underlie the link between motivation and outcome. in some cases, motivation can be raised by providing a meaningful reason for doing the therapy; in other cases, motivation can be lowered or diminished by a mismatch between the nature of the therapy and the person’s ability and motivation to do it ( laban & heatherton, 1989 ).
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