quiet coyote's profile
Info
Name: Emily
Joined: October 28, 2010
About
What's the deal with your nickname? How did you get it? If your nickname is self-explanatory, then tell everyone when you first started using the internet, and what was the first thing that made you say "wow, this isn't just a place for freaks after all?" Was it a website? Was it an email from a long-lost friend? Go on, spill it.
Ears alert, mouth closed.
--
A COMPENDIUM OF INFO ABOUT TRAUMA AND PTSD (In progress)
Please note that the following represents my research-informed opinions as a licensed clinical psychologist and researcher with expertise in these topics; they don't represent the position of my university or the federal entities who fund my work. Also, IANYT. But I can help you find one- memail me! I'm also happy to email you paywalled journal articles that you want access to.
The two gold-standard treatments for PTSD are Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). They are considered gold-standard because they have the most evidence supporting their ability to resolve symptoms in a short timeframe, with lasting impact: their effects endure even at 5-10 year follow-up. Both are types of cognitive behavioral therapy, but CPT puts more emphasis on the cognitive part and PE puts more emphasis on the behavior part. They are designed to take about 12 sessions. Both have set agendas for what you do in sessions (although it's completely tailored around you specifically) and involve daily homework assignments.
Prolonged Exposure
*How exposure works, theoretically speaking
*You can search for PE therapists on the Psychology Today therapist finder.
Cognitive Processing Therapy
*This American Life episode about Cognitive Processing Therapy
*You can search for CPT therapists on the Psychology Today therapist finder. There's a non-exhaustive CPT therapist finder here.
EMDR
*Why I don't recommend EMDR as a front-line option
*EMDR appears to be, essentially, Prolonged Exposure plus a placebo in the form of eye movements (or lateral tapping, noises, vibrations, fist clenching, etc.- the fact that there are such varied stimuli used by practitioners to "reprogram trauma memories" should itself cast doubt on the existence of a valid mechanism of action that operates across these stimuli in trauma processing).
*EMDR is NOT empirically supported as a treatment for conditions other than PTSD--in fact, there is evidence that it performs worse than CBT and no better than control in treating phobias--and it's a red flag regarding a provider's competence if they tell you it's a treatment for other conditions.
Coping with anxiety and trauma symptoms:
*Coping skills for panic attacks (and why benzos are a bad long-term idea)
*Why benzos are contraindicated for phobia
*There are some general principles from CBT that I typically suggest for coping with traumatic stress:
1. I suggest people notice any ***objectively safe*** things they're avoiding because those things remind them of what happened, or bring up negative emotions, and practicing confronting/doing those things until the intensity of their emotion comes down. As a general rule, if you would have done the thing before a trauma, but now it feels too scary/sad, it's a good idea to do it. Avoid avoiding! Generally, the idea is to find ways to sit with difficult feelings so they can burn themselves out. People tend to find this hard at first and then really empowering as time goes on. It works very well, and often fairly quickly, to rewire the conditioned associations that brains develop when a trauma happens. If you need help sticking with upsetting feelings, you can try nonjudgmentally observing/describing emotions. This can include watching the clock and rating your distress from 0-100 every 5 or so minutes. You can also close your eyes and scan your body for where you feel the stress in your body, what the symptoms are (e.g., heart racing), what spots feel hot vs. cold, etc. The key here is to not try to change the emotions, push them away, or judge yourself for having them- just notice them.
2. I also recommend people pay attention to the thoughts that they're having about (a) why the trauma happened, (b) themselves, (c) others, or (d) the world that are bringing up a lot of negative emotions. Trauma tends to shift these kinds of thoughts in extreme directions, and it takes some work to recalibrate them. A lot of people find it helpful to write down the thoughts and then pick them apart like a scientist- write down evidence for/against them, other ways of looking at the situation, what they would say to a friend in their exact situation having that thought, etc. Then write down a recalibrated thought.
3. Aside from trauma-specific stuff, it's generally good mental health maintenance (kinda the teeth brushing of well-being) to find ways to get yourself to keep doing the things that you value, not avoid things that are important for you to do, and maintain the relationships that are important to you. Some people set small, specific goals around those kinds of things daily.
Information on CBT
*In contrast to unstructured, open-ended talk therapy, which could take years (but is fine imo if you don't have a mental disorder like anxiety or depression), CBT should be short-term and involve worksheets/homework and structured sessions with collaborative agenda setting between you and your therapist.
*CBT should not place an emphasis on trying to make your emotions go away or telling you your thoughts are "wrong"- it's focused on experiencing your emotions, fighting against the urge to not do things because they trigger depression/anxiety, and testing out your thoughts rather than necessarily treating them as facts.
Does this therapist *really* do CBT?
*As CBT gets more credence as the gold standard for depression/anxiety, a lot of therapists will say they do it when what they mean is they work on cognitions and behaviors- which literally every therapist does.
*People who do good-quality CBT usually refer to CBT a lot in their materials
*People who do good-quality CBT tend to be guided by research evidence in selecting a treatment approach. As a result, they do not typically offer other approaches that don't have much research support like hypnosis, psychodynamic therapy, etc.
*In your consultation, a CBT therapist should be able to tell you a week-by-week plan for the treatment, exactly how the agenda for each week will target the mechanisms maintaining the disorder, and a narrow range of how many weeks it will take to complete. They should also be systematically tracking symptoms week-by-week to understand whether treatment is working and assigning homework after every session.
How to find a CBT therapist:
*If you're near a university with a clinical psychology PhD program, they typically have a sliding-scale training clinic. Student trainees are very closely supervised and get a lot of pre-training before they see clients.
*The ABCT therapist finder, which I prefer to Psychology Today
*Seattle-specific info
*If you're overwhelmed by Psychology Today
How pressure to disclose trauma right after the event can affect memory and other symptoms:
*Part 1
*Part 2
Resources for supporting a trauma survivor:
*A really nice video on the concept of acknowledgment
Ears alert, mouth closed.
--
A COMPENDIUM OF INFO ABOUT TRAUMA AND PTSD (In progress)
Please note that the following represents my research-informed opinions as a licensed clinical psychologist and researcher with expertise in these topics; they don't represent the position of my university or the federal entities who fund my work. Also, IANYT. But I can help you find one- memail me! I'm also happy to email you paywalled journal articles that you want access to.
The two gold-standard treatments for PTSD are Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). They are considered gold-standard because they have the most evidence supporting their ability to resolve symptoms in a short timeframe, with lasting impact: their effects endure even at 5-10 year follow-up. Both are types of cognitive behavioral therapy, but CPT puts more emphasis on the cognitive part and PE puts more emphasis on the behavior part. They are designed to take about 12 sessions. Both have set agendas for what you do in sessions (although it's completely tailored around you specifically) and involve daily homework assignments.
Prolonged Exposure
*How exposure works, theoretically speaking
*You can search for PE therapists on the Psychology Today therapist finder.
Cognitive Processing Therapy
*This American Life episode about Cognitive Processing Therapy
*You can search for CPT therapists on the Psychology Today therapist finder. There's a non-exhaustive CPT therapist finder here.
EMDR
*Why I don't recommend EMDR as a front-line option
*EMDR appears to be, essentially, Prolonged Exposure plus a placebo in the form of eye movements (or lateral tapping, noises, vibrations, fist clenching, etc.- the fact that there are such varied stimuli used by practitioners to "reprogram trauma memories" should itself cast doubt on the existence of a valid mechanism of action that operates across these stimuli in trauma processing).
*EMDR is NOT empirically supported as a treatment for conditions other than PTSD--in fact, there is evidence that it performs worse than CBT and no better than control in treating phobias--and it's a red flag regarding a provider's competence if they tell you it's a treatment for other conditions.
Coping with anxiety and trauma symptoms:
*Coping skills for panic attacks (and why benzos are a bad long-term idea)
*Why benzos are contraindicated for phobia
*There are some general principles from CBT that I typically suggest for coping with traumatic stress:
1. I suggest people notice any ***objectively safe*** things they're avoiding because those things remind them of what happened, or bring up negative emotions, and practicing confronting/doing those things until the intensity of their emotion comes down. As a general rule, if you would have done the thing before a trauma, but now it feels too scary/sad, it's a good idea to do it. Avoid avoiding! Generally, the idea is to find ways to sit with difficult feelings so they can burn themselves out. People tend to find this hard at first and then really empowering as time goes on. It works very well, and often fairly quickly, to rewire the conditioned associations that brains develop when a trauma happens. If you need help sticking with upsetting feelings, you can try nonjudgmentally observing/describing emotions. This can include watching the clock and rating your distress from 0-100 every 5 or so minutes. You can also close your eyes and scan your body for where you feel the stress in your body, what the symptoms are (e.g., heart racing), what spots feel hot vs. cold, etc. The key here is to not try to change the emotions, push them away, or judge yourself for having them- just notice them.
2. I also recommend people pay attention to the thoughts that they're having about (a) why the trauma happened, (b) themselves, (c) others, or (d) the world that are bringing up a lot of negative emotions. Trauma tends to shift these kinds of thoughts in extreme directions, and it takes some work to recalibrate them. A lot of people find it helpful to write down the thoughts and then pick them apart like a scientist- write down evidence for/against them, other ways of looking at the situation, what they would say to a friend in their exact situation having that thought, etc. Then write down a recalibrated thought.
3. Aside from trauma-specific stuff, it's generally good mental health maintenance (kinda the teeth brushing of well-being) to find ways to get yourself to keep doing the things that you value, not avoid things that are important for you to do, and maintain the relationships that are important to you. Some people set small, specific goals around those kinds of things daily.
Information on CBT
*In contrast to unstructured, open-ended talk therapy, which could take years (but is fine imo if you don't have a mental disorder like anxiety or depression), CBT should be short-term and involve worksheets/homework and structured sessions with collaborative agenda setting between you and your therapist.
*CBT should not place an emphasis on trying to make your emotions go away or telling you your thoughts are "wrong"- it's focused on experiencing your emotions, fighting against the urge to not do things because they trigger depression/anxiety, and testing out your thoughts rather than necessarily treating them as facts.
Does this therapist *really* do CBT?
*As CBT gets more credence as the gold standard for depression/anxiety, a lot of therapists will say they do it when what they mean is they work on cognitions and behaviors- which literally every therapist does.
*People who do good-quality CBT usually refer to CBT a lot in their materials
*People who do good-quality CBT tend to be guided by research evidence in selecting a treatment approach. As a result, they do not typically offer other approaches that don't have much research support like hypnosis, psychodynamic therapy, etc.
*In your consultation, a CBT therapist should be able to tell you a week-by-week plan for the treatment, exactly how the agenda for each week will target the mechanisms maintaining the disorder, and a narrow range of how many weeks it will take to complete. They should also be systematically tracking symptoms week-by-week to understand whether treatment is working and assigning homework after every session.
How to find a CBT therapist:
*If you're near a university with a clinical psychology PhD program, they typically have a sliding-scale training clinic. Student trainees are very closely supervised and get a lot of pre-training before they see clients.
*The ABCT therapist finder, which I prefer to Psychology Today
*Seattle-specific info
*If you're overwhelmed by Psychology Today
How pressure to disclose trauma right after the event can affect memory and other symptoms:
*Part 1
*Part 2
Resources for supporting a trauma survivor:
*A really nice video on the concept of acknowledgment