Month: November 2019

Post Traumatic Stress Disorder and Addiction 

By Britt Gottlich, Psy.D.

I often meet with people who say they are unsure of whether they have experienced trauma or not. So what is trauma? Most people define trauma based on how trauma is portrayed in the media. But in reality it is a very subjective experience. Something that may be traumatic for one person may not be traumatic for another. The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape or natural disaster.”

The way I like to understand trauma is based on an individual’s interpretation of the event. As children we live under the assumption that ‘good things happen to good people and bad things happen to bad people.’ When we experience a trauma, often our interpretation of this rule becomes clouded and confused. For example, it could change to, ‘if good things happen to good people, and this happened to me, then I must be bad.’ Therefore, a person’s reaction to a traumatic experience often affects the way they see themselves, other people, and the world around them.

We can’t change or erase a traumatic experience, unfortunately. But what we can do is change the way we interpret it and ultimately the way we understand the world around us as a result of that event. This is where Cognitive Processing Therapy (CPT) can be a useful treatment modality. It helps us identify the cognitive distortions that are derived from our traumas, and using evidence and facts, combat those thoughts with rational ones. 

CPT has been a very effective treatment modality which is often used in treating Veterans with Post Traumatic Stress Disorder or PTSD. CPT is a 12 session behavioral psychotherapy. It has been found to be highly effective in treatment for PTSD. A study conducted in 2017 that studied the effectiveness of CPT on Veterans found that Veterans who completed the 12 session treatment had a significant difference in their symptoms and had a decline in Post Traumatic Stress Disorder Checklist scores than Veterans who did not complete or comply with treatment. Other treatments that are used for PTSD are Eye Movement Desensitization & Reprocessing (EMDR) and Prolonged Exposure (PE). In my experience and training with all the above modalities, I have seen the most improvement and success with CPT.

While there are treatments such as CPT that are very effective in treating trauma, one of the most important pieces in this type of therapy is rapport. It is important in all therapy to have a positive relationship with your therapist where you feel comfortable and not judged. But especially when disclosing a trauma, and going deep into the event, feelings, and cognitions related to it, it is important that you feel trusting of the person providing that treatment.

From my experience working at a VA and currently here at Fifth Avenue Psychiatry, I see that there is a high comorbidity for substance abuse and PTSD, especially when PTSD goes undiagnosed or untreated. VA statistics note that more than 2 out of 10 Veterans with PTSD also have a substance use disorder, and 1 out of 3 Veterans seeking treatment for substance use disorders also meet criteria for PTSD. The American Addictions Center reported that 55-60% of individuals who suffer from PTSD have comorbid addiction or alcoholism. They also note that “people who suffer PTSD are between two and four times more likely to also battle addiction than their peers who do not also struggle with PTSD.”

Again, traumas are not something that can be erased, but they can be something you can learn to live with. You can begin to see the world, people, and yourself in healthier ways again. You may never fully believe that ‘good things happen to good people,’ but eventually you may believe that ‘bad things sometimes happen to good people.’

https://journals.sagepub.com/doi/abs/10.1177/0033294117727746?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=prxa

https://americanaddictioncenters.org/ptsd

Cognitive Behavior Therapy (CBT) for Addiction and Alcoholism, An Evidence Based Treatment

By Tracey Basset, PsyD

Making the decision to seek help for a substance use problem is challenging enough.  On top of that, for a lot of people, they face the challenge of choosing where to go, who to see, and what type of therapy will benefit them most.  This can be a very confusing and daunting process.  My aim for this post is to provide some useful information about the benefits of one type of therapy, my favorite type of therapy, Cognitive Behavioral Therapy, or CBT.  

CBT is based on the notion that the way we think influences how we feel, and then subsequently how we behave.  Think of it like a domino effect- something happens, you have a thought or a belief about that event, that thought creates a feeling and that feeling creates an action.  For example, if you try to reach out to a friend or family member and they do not have time to see or talk to you, then you might think that you are not important to them, that you are not worthy of their time, or maybe that you are not good enough.  That thought can lead to feelings of loneliness, rejection, sadness, or even anger.  Those feelings could lead to the desire to escape, which could ultimately lead to using a substance.  Then substance use leads to more isolation and less connection.  The cycle starts again, and builds.  

In CBT, we explore these triggering events and identify patterns.  We explore the thought patterns, or belief systems, and we challenge those patterns that may be problematic.  Some beliefs are true and we work to problem solve and change them.  Others are not true, and are simply believed to be true, because they have been ingrained for a very long time.  We learn to explore where beliefs come from and we learn to challenge them.  In CBT we learn strategies to cope with the uncomfortable feelings, and strategies to help reduce the likelihood that certain feelings will trigger use.  

This is just one example of how CBT can play out in therapy.  There are dozens more.  CBT can be a great therapy for individuals struggling with substance use along with co-occurring anxiety and/or depression because it provides tools, strategies and a roadmap for how to gain control when you feel out of control. If you are someone that struggles with anxiety and/or depression in addition to substance use, it may feel like there are too many things to tackle, and you may even feel stuck, helpless or hopeless.  However, CBT works on exploring, challenging, and changing the relationship between symptoms of depression, anxiety and substance use.  Therefore, it is a very practical, effective and efficient approach to tackling co-occurring substance and mental health needs that feel complex in nature. 

So, why is CBT my favorite type of therapy?  Because there is a lot of evidence to show that it works.  CBT is empirically based, meaning that there are a lot of research studies that consistently show that it helps individuals to reduce anxiety and depression, and successfully address substance use.  

In closing, I will leave you with a quote.  It is one that I recently stumbled upon in my personal life and I instantly connected with it because it just made so much sense to me given my predisposition to think of life through the lens of CBT.  So, despite what you may be going through, and my guess is that it may be something quite challenging since you are here reading this page, the good news is that at any time you can choose to take the steps to change your destiny.  

“Watch your thoughts; they become words. 

Watch your words; they become actions. 

Watch your actions; they become habits. 

Watch your habits; they become character. 

Watch your character; for it becomes your destiny. 

– Upanishads”

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