An Outline with a Structured Protocol:
Step 1: Establishing Safety and Trust This initial phase involves building rapport, outlining therapeutic goals, and ensuring that the veteran feels secure in sharing their experiences. Assessment: The therapy begins with a thorough assessment of the veteran's PTSD symptoms and the traumatic experiences that underlie these symptoms. This assessment helps to identify the specific events and memories that are causing distress.
A. Explanation of Adaptive Disclosure Therapy
B. The neurobiological impact of trauma on the brain
C. The role of the RAS, Amygdala, Hippocampus, and the limbic system in PTSD, PFC in storytelling, memory retrieval and consolidation, cognitive processing of traumatic events.
Step 2: Psychoeducation on Trauma and ADT Veterans are provided with information about PTSD, its symptoms, and the rationale for engaging in adaptive disclosure therapy. This psychoeducation helps individuals better understand the purpose of the therapy and what to expect. Educate the veteran about trauma, its effects on the mind, and the principles of Adaptive Disclosure Therapy. Provide a clear understanding of how ADT works and what the process entails. This transparency is crucial for fostering a sense of control and agency in the healing journey.
A. Assessing the veteran's PTSD symptoms
B. Introduction to the therapy process and neurobiological goal
C. Understanding the impact of trauma on the RAS, Amygdala, Hippocampus, and the limbic system
Step 3: Building Emotional Regulation Skills Before delving into traumatic memories, equip the veteran with emotional regulation skills. This includes techniques for managing anxiety, stress, and overwhelming emotions. Mindfulness practices, deep breathing exercises, and grounding techniques are often incorporated at this stage. Purpose: Equips veterans with skills to manage overwhelming emotions associated with traumatic memories. Before directly addressing traumatic memories, veterans are taught coping skills to manage anxiety, stress, and emotional regulation.
A. Teaching stress reduction techniques (diaphragmatic breathing, progressive muscle relaxation)
B. Regulation of emotional responses (targeting the amygdala, insula, limbic and PFC)
C. The role of the RAS and limbic system in emotional regulation
Step 4: Narrative Creation Guide the combat veteran in creating a comprehensive narrative of their traumatic experiences. This step involves constructing a chronological account of events, emotions, and thoughts associated with the trauma. The therapist assists in structuring the narrative to facilitate the disclosure process. Veterans are asked to write a detailed account of their traumatic experiences. This narrative allows them to confront and organize their thoughts and emotions related to the trauma.
A. Encouraging the veteran to write a detailed account of their trauma
B. Discussing how revisiting the trauma can affect the Amygdala's response
C. Stressing the importance of RAS involvement in focused attention during the writing process
Step 5: Gradual Exposure to Traumatic Memories Unlike traditional exposure therapy, ADT emphasizes gradual and adaptive exposure. Begin with less distressing aspects of the trauma narrative and gradually progress to more challenging elements. This gradual exposure helps prevent overwhelming reactions and promotes adaptive processing. Purpose: Unlike traditional exposure therapies, ADT emphasizes a gradual and adaptive approach to exposure, reducing the risk of overwhelming reactions. The therapy involves gradual and controlled exposure to the traumatic memories. Veterans review and discuss their written accounts with the therapist and, over time, share these accounts with trusted individuals such as friends or family.
A. Reviewing and discussing the written account with the therapist
B. Exploring the role of the Amygdala in fear conditioning and response
C. Encouraging the gradual adaptation of the Amygdala to the traumatic memories (reducing activation of fear/sympathetic dominance, hippocampus memory processing)
Step 6: Cognitive Restructuring Integrate cognitive restructuring techniques to challenge and modify maladaptive beliefs associated with the trauma. Identify and reframe distorted cognitions, fostering a more balanced and realistic appraisal of the traumatic experiences. Purpose: Involves challenging and modifying maladaptive beliefs associated with trauma. Cognitive-behavioral techniques are incorporated to help veterans challenge and reframe negative or distorted beliefs related to their trauma. This step aims to alter how they perceive and make sense of the traumatic events.
A. Challenging and reframing negative beliefs about the trauma
B. Discussing how cognitive changes can influence the Amygdala and limbic system (PFC cognitive processing, restructuring fragmented thoughts, time and space integrating parts of the brain and reducing cognitive distortions)
C. Reducing the Amygdala's hyperactivity in response to trauma-related thoughts
Step 7: Enhancing Coping Strategies Work collaboratively to develop and enhance coping strategies. This may involve identifying healthy outlets for stress, improving interpersonal relationships, and reinforcing positive behavioral patterns. Strengthening coping mechanisms is pivotal for sustained resilience. The therapist and veteran work together to process the emotions and reactions that arise during exposure and cognitive restructuring. This phase encourages the integration of the traumatic experience into the individual's life narrative.
A. Reflecting on emotions and reactions during the therapy process
B. Explaining how the Hippocampus helps integrate new information
C. Promoting the integration of traumatic experiences into a broader life narrative
Step 8: Integration and Closure As the veteran progresses through the therapy, facilitate the integration of the therapeutic work into their daily life. This phase involves summarizing the progress made, acknowledging achievements, and planning for continued growth beyond therapy. Purpose: Facilitates the integration of therapeutic work into daily life, acknowledging progress and planning for continued growth. Adaptive disclosure therapy often includes follow-up sessions and support for veterans to ensure that the gains made during therapy are maintained.
A. Providing ongoing support and follow-up sessions
B. Monitoring the neurobiological effects and improvements in the RAS, Amygdala, Hippocampus, and limbic system
C. Encouraging the overall calming down of sympathetic dominance, PFC reflective processing, supporting the integration of therapeutic insights, co-regulation Polyvagal Theory)
