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Traditional Cognitive Therapies
Cognitive therapies, and cognitive-behavioral therapies are based upon the premise that our thoughts affect our feelings and behaviors and visa versa. To the extent those feelings and behaviors are problematic, the thoughts that preceded them are also problematic. Cognitive therapies focus on modifying those dysfunctional thoughts so that feelings and behaviors improve. A simple example will illustrate this concept. Suppose a man walks by and steps on my foot. If my thoughts are founded on the belief that the world is a dangerous place, I may become very angry at that foot-stepper who just intentionally assaulted me. Since I'm angry at this unprovoked attack, I'm going to yell at this jerk. Conversely, if my thoughts are founded upon the belief that people are inherently good, then I may interpret the foot-stepper's action quite differently. I may just think he was clumsy. I might even feel sorry for him that he is so uncoordinated. As you can see, my thoughts about the foot-stepper's intention subsequently determined both my feelings and behavior. Because of the circular relationship between thoughts and behavior, some therapies will focus on changing thoughts, while other therapies begin by trying to change behavior first.
Most therapists practicing in this day and age received some basic training in cognitive strategies since cognitive-related models rose to prominence in the last decades of the twentieth century. Many people consider cognitive therapy a form of "talk therapy" and therefore of limited use for trauma. As we explained in the discussion of the brain, this is because "talk" accesses a part of the brain where trauma is not stored. It is important to note that most cognitive therapists do not consider "talk" as central to healing. The "talk" occurs in the therapist's office for the purpose of setting up new experiences inside and outside the therapy session. The healing occurs as a result of these new experiences via specific actions taken by therapy participants during and between sessions (often called homework). These new experiences update the brain's model of the world to be more functional and realistic. It bears mentioning that these strategies have helped many individuals recover from PTSD over the years as supported by the research evidence.
Traditional cognitive-behavioral therapy (CBT), and a newer variant called cognitive processing therapy (CPT), help survivors reorient their thinking around the trauma. These are on the SAMHSA registry. They are also among the favored approaches of the Veterans Administration for PTSD, based upon their understanding of the research.
Another cognitive model is called trauma focused, cognitive behavioral therapy (TF-CBT). It is on the SAMHSA registry of evidence-based practices specifically indicated for PTSD in children and adolescents. It has also been used for adult treatment. As described on the SAMHSA registry:
TF-CBT is a psychosocial treatment model designed to treat posttraumatic stress and related emotional and behavioral problems in children and adolescents. Initially developed to address the psychological trauma associated with child sexual abuse, the model has been adapted for use with children who have a wide array of traumatic experiences, including domestic violence, traumatic loss, and the often multiple psychological traumas experienced by children prior to foster care placement. The acronym PRACTICE reflects the components of the treatment model: Psycho-education and parenting skills, Relaxation skills, Affect expression and regulation skills, Cognitive coping skills and processing, Trauma narrative, In vivo exposure (when needed), Conjoint parent-child sessions, and Enhancing safety and future development. Although TF-CBT is generally delivered in 12-16 sessions of individual and parent-child therapy, it also may be provided in the context of a longer-term treatment process or in a group therapy format.