Megan A. Larson, MA, LMFT

CBT is one of the most widely studied forms of psychotherapy, and it has been shown to be extremely effective for a variety of mental illnesses. Some of the issues that respond well to CBT include mood disorders, personality disorders, eating disorders, substance abuse, sleep disorders, and psychotic disorders. In some cases, CBT has been shown to be as effective or even more effective than medication. One of the interesting things that the scientific study of CBT has shown is that CBT actually changes the way the brain works, physically improving its function.

CBT differs from traditional psychotherapy in a few key ways. One of the most important distinctions is the emphasis on the power and responsibility of the patient in CBT. The patient will be encouraged to be the one asking the questions in CBT therapy, and most patients are assigned homework to complete outside of therapy sessions. There is a concept in CBT that everyone has power the power to change how they feel, even if they cannot control the situation, and this can be very empowering for patients. Because of this power shift, the therapist-client relationship is not as critical to success in CBT as it is in other modes of therapy. Patients should still get along well with their therapists, but they do not need a deep, dependent emotional connection to them. Finally, because CBT often treats a specific issue or problem, it is usually shorter in duration than traditional therapy. While some therapies may continue for years, CBT lasts on average just 16 sessions.

During an EMDR therapy session, patients are encouraged to access upsetting memories and to reprocess them. Reprocessing is achieved by repeated and rapid bilateral (side to side) eye movements, tapping one's chest and face, and auditory and visual stimulation. These techniques can desensitize patients to their traumatic memory. By reframing how a patient interprets a memory, EMDR is believed to weaken the fight-or-flight response and to rebalance the nervous system. For patients with PTSD, EMDR can treat recurring flashbacks and triggers by reducing the hyperarousal response and promoting emotional regulation.

EMDR patients are first asked to identify a specific memory to reprocess, called the ?target event.? Patients can discuss their feelings, sensations, and beliefs about the event, and may share a picture or use descriptive imagery. Therapists usually employ a set of measurements called the Subjective Units of Disturbance (SUD) scale to assess the patient's distress. Later on, therapists and patients may compare the patient's initial SUD score to their score following an EMDR session. Unlike other forms of therapy, EMDR patients are not prompted to analyze and reflect on details of their traumatic memory at length.

With a target event having been selected, therapists may begin the desensitization process. They instruct patients to perform eye movements, body taps, or sounds while capturing the target event in their mind. These techniques are called dual attention bilateral stimulation (BLS) and can help a patient feel calm and aware, while simultaneously invoking the brain's processing system. Patients may continue these techniques until their SUD distress level has decreased. Patients are then asked to derive a positive thought or affirmation about the target event, and to repeat or strengthen it until it feels sincere. A final ''body scan'' is where patients focus on both the target event and positive cognition to evaluate their physical response and identify any remaining distress. If the traumatic incident is not fully processed in one session, patients are asked to contain the memory and to avoid returning to it until their next EMDR session.

EMDR may greatly improve quality of life in people who suffer from latent trauma and adverse life experiences. EMDR may also be effective for those whose prior experience with talk therapy was unsuccessful.

• Accidents
• Sexual or physical assault
• Combat
• Childhood abuse
• Domestic abuse
• Natural disasters
• Torture and kidnapping

People who have experienced significant and repeated trauma are more likely to develop PTSD. Those who have disorders like depression or a family history of depression may also be more prone to PTSD. PTSD symptoms typically begin one month to one year following the traumatic event. There are four main categories of PTSD symptoms:

• Intrusive memories: Intrusive memories include unwanted memories, feelings of reliving the traumatic event, distressing nightmares, and emotional disturbances from triggers (signs that serve as reminders of the traumatic event). Intrusive memories can lead to elevated heart rate, anxiety, combativeness (fight), withdrawal (flight), and many other responses.
• Avoidance: Avoidance is an attempt to avoid speaking or thinking about an upsetting event. People with this response might also try to avoid certain people or locations that prompt memories of an event.
• Changes in physical and emotional reactions: These changes may include difficulty sleeping, hypervigilance, self-destructive behavior, and feelings of guilt and irritability.
• Alterations in cognition and mood: Alterations can cause negative self-beliefs, depression, shame, and detachment from others.

The intensity and frequency of these symptoms can vary over time. PTSD symptoms may suddenly return after disappearing for years. Many PTSD patients find treatment helps to gradually reduce their symptoms over time.

The most common treatments for PTSD are psychotherapy and oral medications. Psychotherapy for PTSD can include cognitive therapy (therapy to change thought patterns), exposure therapy (therapy to confront memories of the traumatic incident) and eye movement desensitization and reprocessing therapy (EMDR). EMDR integrates exposure therapy with guided eye movements to help patients confront and process their trauma. Certain oral medications may help with PTSD, such as antidepressants and anti-anxiety medications. Self-care, support groups, and relaxation may also benefit those with PTSD.

The path to overcoming PTSD can be long and challenging and people with PTSD can benefit greatly by seeking professional treatment from a mental health care provider. Treatment can reduce PTSD symptoms, provide essential coping strategies, and improve one's quality of life.