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Psychodynamic Therapy for ptsd

Psychodynamic Therapy for ptsd
Horowitz et al. present a psychodynamic formulation of stress response syndromes characterized by two psychological states; one is typified by intrusive experiences, the other by denial and numbing. Psychodynamic interventions for PTSD tend to focus on tailoring treatment to symptoms and context and thus vary depending on whether the patient is experiencing intrusive or avoidance symptoms. When intrusive symptoms predominate, the immediate goal of treatment is to bring those symptoms under control. Mild intrusive symptoms may respond to social and informational ‘‘reassurances’’ in the form of relevant educational presentations and debriefing groups. As symptoms become more severe, more individual and intensive approaches are necessary, and ‘‘covering’’ techniques (i.e., reducing exposure) such as supportive measures and stress management approaches are appropriate.
When avoidance symptoms predominate, interventions are aimed at removing blocks to processing and encouraging encounter with the event. As noted by DeWitt, an important aspect of brief dynamic therapy is the concept of dosing, in which the person is encouraged to approach ideas and feelings at tolerable levels for reasonable time periods, turning away and then returning to the traumatic memories until they become more manageable. At this stage, ‘‘uncovering’’ techniques (i.e., increasing exposure) such as psychodrama and imagery are recommended. Once intrusive and avoidance systems are within manageable limits, the full meaning of the event can be explored and worked through. Since its introduction more than two decades ago, Horowitz’s brief phase-oriented approach to treating stress response syndromes has evolved into one of the most frequently employed clinical interventions for PTSD. Two uncontrolled evaluations of this approach reported findings that provide modest support. A randomly controlled trial condition found a significant reduction in PTSD symptoms among patients who completed a course of brief dynamic psychotherapy compared to patients assigned to a wait-list control.
Brom et al. also reported that the efficacy of brief dynamic psychotherapy compared favorably with two behaviorally oriented exposure-based treatment conditions: trauma focused desensitization and exposure in imagination via hypnotherapy. Interestingly, these investigators reported that patients in the two exposure interventions showed superior reductions at posttreatment and follow-up assessment on intrusive symptoms, whereas patients who received brief dynamic psychotherapy showed the best improvement in avoidance symptoms.

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