E-ISSN 2636-8765 | ISSN 2146-9490
 

Review Article 


PROLONGED EXPOSURE THERAPY FOR POST TRAUMATIC STRESS DISORDER

Levent Sütçigil, Selçuk Aslan.

Abstract
Post-traumatic Stress Disorder (PTSD) is a psychiatric illness that usually develops after an event that threatens one's life and body integrity and it affects quality of life and impairs social functioning significantly. Many studies have shown therapeutic effect of cognitive behavioral therapies on posttraumatic stress disorder, so that these therapies take part in the first step of treatment guides.

Exposure is a practice that is generally used to reduce pathological fear and related emotions common in posttraumatic stress disorder (PTSD) and other anxiety disorders. During exposure, patients intentionally confront with feared objects, situations, thoughts and similar stimuli in order to reduce anxiety level. Exposure can be divided into two main techniques as in vivo exposure or imaginal exposure.

Prolonged exposure therapy is a specialized treatment program configured for the treatment of posttraumatic stress disorder and it is based on emotional processing theory. Program is comprised of four main components: (a) Psycho-education about trauma and posttraumatic disorders, (b) Training for breathing exercises, (c) repeated facing with objects, persons, situations and thoughts which causes re-experience about trauma (In vivo exposure) and (d) Patient are instructed for telling repeatedly and loudly about traumatic experiences (Imaginal exposure). Prolonged exposure usually involves 9 to 12 sessions, each lasting about 60-90 minutes, administered once or twice a week. In the light of experience gained about cognitive-behavioral treatments for anxiety disorders, prolonged exposure therapy was started to be implemented since the 1980s, during this period the effectiveness of the therapy has been shown in various empirical studies.

Key words: Posttraumatic Stress Disorder, Cognitive- Behavioral Therapy, Exposure Therapy



TRAVMA SONRASI STRES BOZUKLUĞUNDA PROLONGED EXPOSURE TERAPİSİ

Ozet
Travma sonrası stres bozukluğu, kişinin yaşamını ve beden bütünlüğünü tehdit eden bir olay sonrası gelişen, kişinin yaşam kalitesini ve sosyal işlevselliğini önemli ölçüde etkileyen psikiyatrik bir bozukluktur. Birçok araştırmada, bilişsel-davranışçı terapilerin, travma sonrası stres bozukluğunda ki tedavi etkisini gösterilmiştir. Bu nedenle tedavi kılavuzlarında ilk basamak tedavi seçenekleri arasında yer alırlar.

Alıştırma (exposure), travma sonrası stres bozukluğu ve diğer anksiyete bozukluklarında sık görülen “patolojik korku”yu ve bununla ilişkili duyguları azaltmaya yönelik bir uygulamadır. Exposure uygulamasında, anksiyete düzeyini azaltma amacıyla, hastalar kontrollü olarak, korkulan objeler, durumlar, düşünceler ve benzer uyaranlarla karşılaştırılırlar. Exposure uygulaması “Gerçek Yaşamda Alıştırma” (In Vivo Exposure) ya da “İmgesel Alıştırma” (Imaginal Exposure) olarak iki farklı teknikle yapılabilir.

Uzun süreli alıştırma tedavisi (prolonged exposure therapy) ise travma sonrası stres bozukluğu tedavisi için tasarlanmış özel bir tedavi programıdır ve “Duygu işleme kuramı”na dayanır. Tedavi programı 4 ana bölümden oluşur; (a) Travma ve travma sonrası ortaya çıkan bozukluklar hakkında psiko-eğitim, (b) Nefes egzersizi eğitimi, (c) Travmayı hatırlattığı için kaçınılan nesne, kişi, durum ve ortamlarla tekrarlayıcı şekilde yüzleştirme (In vivo exposure), (d) Hastanın travmayla ilgili hatırladıklarını tekrarlayan şekilde yüksek sesle anlattırmak (Imaginal exposure). Program haftada bir ya da iki kez sıklığında yapılan, 60-90 dakikalık görüşmelerden oluşur ve toplam 9-12 hafta sürer. Prolonged exposure terapisi, anksiyete bozukluklarının bilişsel davranışçı tedavilerinden edinilen tecrübeler ışığında 1980’li yıllardan itibaren uygulanmaya başlanmış, geçen sürede çeşitli ampirik çalışmalarla etkinliği gösterilmiştir.

Anahtar Kelimeler: Travma Sonrası Stres Bozukluğu, Bilişsel-Davranışçı Terapi, Exposure Terapi


 
ARTICLE TOOLS
Abstract
How to cite this articleHow to cite this article
Citation Tools
Related Records
 Articles by Levent Sütçigil
Articles by Selçuk Aslan
on Google
on Google Scholar
Article Statistics
 Viewed: 3586
Downloaded: 51

REFERENCES
American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed). Washington: DC.
Amir N, Stafford J, Freshman MS, Foa EB. (1998) Relationship between trauma narratives and trauma pathology. J Trauma Stress, 2:385-392
Rothbaum BO, Millie CA, Marsteller F (2005) Prolonged Exposure versus Eye Movement Desensitization and Reprocessing (EMDR) for PTSD rape victims. J Trauma Stress 18 (6):607-616
Bradley R, Grene J, Russ E, Dutra L, Westen D (2005) A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162: 214-227
Cahill SP, Foa EB, Hembree EA, Marshall RD, Nacash N (2006) Dissemination of exposure therapy in the treatment of PTSD. J Trauma Stress, 19 (5): 597-610
Foa EB, Kozak MJ (1985). Treatment of anxiety disorders: Implications for psychopathology. In A. H. Tuma & J D Maser (Eds.), Anxiety and the anxiety disorders . Hillsdale, NJ: Erlbaum. pp. 421-452
Foa EB, Kozak MJ (1986) Emotional processing of fear: Exposure of corrective information. Psychological Bulletin, 99:20-35
Foa EB, Rothbaum BO, Riggs DS, Murdock TB (1991). Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. J Consult Clin Psychol, 59(5):715-723
Foa EB, Riggs DS (1993). Post-traumatic stress disorder in rape victims. In J. Oldham, M. B. Riba, & A. Tasman, Annual review of psychiatry, Vol.12. Washington, DC: American Psychiatric Association. pp. 273-303
Foa EB, Molnar C, Cashman L (1995) Change in rape narratives during exposure therapy for posttraumatic stress disorder. J Trauma Stress, 8(4):675-690
Foa EB, Dancu CV, Hembree EA, Jaycox LH, Meadows EA, Street GP (1999) A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. J Consult Clin Psychol, 67(2):194-200
Foa EB, Davidson JRT, Frances A, Editors (1999). Expert Consensus Guidelines Series, Treatment of Posttraumatic Stress Disorder. Journal of Clinical Psychiatry; 60 (suppl 16).
Foa EB, Cahill SP. Psychological therapies: Emotional processing. In: Smelser NJ, Bates PB, editors. International Encyclopedia of Social and Behavioral Sciences. Oxford: Elsevier; 2001. pp. 12363-12369
Foa, EB, Zoellner LA, Feeny NC, Hembree EA, Alvarez-Conrad J (2002) Does imaginal exposure exacerbate PTSD symptoms? Journal of Consulting and Clinical Psychology, 70(4): 1022-1028
Foa EB, Rothbaum BO, Furr JM (2003) Augmenting exposure therapy with other CBT procedures. Psychiatry Annals, 33(1): 47-53
Foa EB, Hembree EA, Cahill SP, Rauch SAM, Riggs DS, Feeny NC, Yadin E (2005) Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73(5):953-964
Iþýklý S (2009). Travma Sonrasý Stres Bozukluðunda Bilgi Ýþleme Süreçleri. Ed.Metehan Irak. Psikopatolojilerde Bilgi Ýþleme Süreçleri(179-209). HYB Basýn Yayýn, Ankara.
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry, 52(12):1048-1060
Kilpatrick, DG, Resnick HS, Freedy JR. (1991). The Potential Stressful Events Interview. Unpublished instrument. Charleston, SC: National Crime Victims Research and Treatment Center, Department of Psychiatry, Medical University of South Carolina.
Kleine RA, Hendriks GJ, Kusters WJ, Broekman TG, van Minnen A (2012) A Randomized Placebo-Controlled Trial of d-Cycloserine to Enhance Exposure Therapy for Posttraumatic Stress Disorder. Biol Psychiatry, 1;71(11):962-968
Resick PA, Nishith P, Weaver TL, Astin MC, Feuer CA (2002) A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. J Consult Clin Psychol, 70(4):867-879
Rothbaum BO, Astin MC, Marsteller F (2005) Prolonged Exposure versus Eye Movement Desensitization and Reprocessing (EMDR) for PTSD rape victims. J Trauma Stress, 18(6):607-616
Wolpe J (1958). Psychotherapy by reciprocal inhibition. Stanford CA. Stanford University Press, p . 239..

How to Cite this Article
Pubmed Style

Levent Sutcigil, Selcuk Aslan. [PROLONGED EXPOSURE THERAPY FOR POST TRAUMATIC STRESS DISORDER]. JCBPR. 0; 0(0): -. Turkish.


Web Style

Levent Sutcigil, Selcuk Aslan. [PROLONGED EXPOSURE THERAPY FOR POST TRAUMATIC STRESS DISORDER]. http://www.jcbpr.org/?mno=21407 [Access: March 28, 2020]. Turkish.


AMA (American Medical Association) Style

Levent Sutcigil, Selcuk Aslan. [PROLONGED EXPOSURE THERAPY FOR POST TRAUMATIC STRESS DISORDER]. JCBPR. 0; 0(0): -. Turkish.



Vancouver/ICMJE Style

Levent Sutcigil, Selcuk Aslan. [PROLONGED EXPOSURE THERAPY FOR POST TRAUMATIC STRESS DISORDER]. JCBPR. (0), [cited March 28, 2020]; 0(0): -. Turkish.



Harvard Style

Levent Sutcigil, Selcuk Aslan (0) [PROLONGED EXPOSURE THERAPY FOR POST TRAUMATIC STRESS DISORDER]. JCBPR, 0 (0), -. Turkish.



Turabian Style

Levent Sutcigil, Selcuk Aslan. 0. [PROLONGED EXPOSURE THERAPY FOR POST TRAUMATIC STRESS DISORDER]. Journal of Cognitive-Behavioral Psychotherapy and Research, 0 (0), -. Turkish.



Chicago Style

Levent Sutcigil, Selcuk Aslan. "[PROLONGED EXPOSURE THERAPY FOR POST TRAUMATIC STRESS DISORDER]." Journal of Cognitive-Behavioral Psychotherapy and Research 0 (0), -. Turkish.



MLA (The Modern Language Association) Style

Levent Sutcigil, Selcuk Aslan. "[PROLONGED EXPOSURE THERAPY FOR POST TRAUMATIC STRESS DISORDER]." Journal of Cognitive-Behavioral Psychotherapy and Research 0.0 (0), -. Print.Turkish.



APA (American Psychological Association) Style

Levent Sutcigil, Selcuk Aslan (0) [PROLONGED EXPOSURE THERAPY FOR POST TRAUMATIC STRESS DISORDER]. Journal of Cognitive-Behavioral Psychotherapy and Research, 0 (0), -. Turkish.