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Behavioral Approaches to PTSD

Cognitive-Behavioral Therapy for PTSD. Early behavioral conceptual models of PTSD were largely based on the two-factor learning theory of psychopathology originally proposed by Mowrer. As applied to PTSD, two-factor conditioning models posit that fear and other aversive emotions are learned through association via mechanisms of classical conditioning. Such fear conditioning is the first factor in the acquisition of aversive emotions characteristic of PTSD. The second factor involves principles of instrumental conditioning in that persons with PTSD will learn to escape from and to avoid cues that stimulate aversive emotions.

Through the process of fear conditioning, neutral cues associated with a traumatic (or otherwise aversive) event acquire the capacity subsequently to evoke a conditioned emotional (fearful) response in the absence of the aversive stimulus. First described by Pavlov and associates, this psychological mechanism, it is posited, preserves information about exposure to previous threats to promote future survival. More recent conceptual models have emphasized the role of cognitive factors in developing and maintaining PTSD symptoms. Information processing theory has been proposed as an explanation of the ways in which information associated with traumatic experiences is encoded and recalled in memory. Foa et al., for example, offered a model based upon the concept of a fear structure, which they describe as a network in memory that includes three types of information:

(1) information about the feared stimulus situation; (2) information about verbal, physiological, and overt behavioral responses; and (3) interpretive information about the meaning of the stimulus and the response elements of the structure . Foa and colleagues proposed that during periods of extreme distress, information processing is interrupted, and traumatic memories are consequently fragmented and disorganized. Nevertheless, persons with PTSD are assumed to have an attentional bias toward threat cues  that is hypothesized to account for the reexperiencing phenomenon of PTSD. Foa and her colleagues proposed that treatment should be based upon activating and correcting information in fear structures by prolonged exposure (PE) to traumatic stimuli and cognitive restructuring, respectively. According to Foa and colleagues, exposure within and across trials is an opportunity to integrate traumatic memories with the individual’s existing conceptualization of safety versus danger. Foa and colleagues further hypothesize that this exposure can result in organizing trauma memory. The information processing model has yielded a productive, theoretically grounded approach to research into the clinical efficacy of cognitive-behavioral therapy (CBT) for PTSD.

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