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This is a fantastic YouTube video that walks through the affects of trauma on the brain; the limbic portion of the brain that evokes the fight or flight response.

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This is a YouTube video from a sexual assault survivor describing the trauma and support needed.

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This blog  on Good Therapy discusses the cost of therapy.

This is an argument against CBT due to higher cost of counseling vs taking antidepressants which may be more easily covered by insurance.

Good Therapy blog confirms that, "Therapy generally ranges from $65 per hour to $250 or more. In most areas of the country, a person can expect to pay $100  -  $200 per session."

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Cost is one of the greatest barriers to mental health treatment. Although the Affordable Care Act and other regulatory reforms sought to improve access to behavioral and mental health services, many people worry about the costs of therapy. While the cost of therapy is a very real concern, it is often possible for people to access free or low-cost therapy, especially if they live in large metropolitan areas or near a teaching university.

Average Cost of Therapy

Therapy generally ranges from $65 per hour to $250 or more. In most areas of the country, a person can expect to pay $100-$200 per session. Some factors that can affect the price of therapy include:

The therapist's training. Highly trained and very experienced therapists typically charge more.

The location of therapy. Therapists in large metropolitan areas and regions with high costs of living must charge more to pay their bills.

The therapist's reputation. Well-known therapists who are highly in demand often charge more.

Insurance coverage. People whose therapy is covered by insurance tend to pay less.

Length of the therapy session. The longer the session is, the more a client typically will pay.

Specialization. Therapy tends to be more expensive when the therapist is an expert in a highly specialized field or treats an unusual or challenging condition.

Some therapists also charge more for a longer initial consultation.

How Much Does Therapy Cost With Insurance?

Under the Affordable Care Act, all insurance plans must cover mental health care. Additionally, plans must not impose different rules on mental health clients or fund mental health care at lower rates.

This means people with insurance usually have some coverage for therapy. In most cases, they must choose a therapist within their network. They may also have to meet other criteria, such as having a mental health diagnosis, meeting a deductible, or getting a referral for treatment. Consequently, even people with insurance may opt to pay for their therapy out of pocket.

When people pay for therapy through insurance, they typically must pay a co-pay. Insurance co-pays vary widely, from just a few dollars to $50 or more.

How to Pay for Therapy

For many people, insurance offers the best option for funding therapy. Try calling your insurer to ask about mental health coverage and to get a list of in-network providers.

If you don't have insurance, you may be eligible for insurance through your state's Medicaid program or through the Healthcare.gov marketplace.

Some employee assistance and benefit programs also offer help paying for therapy.

Many universities offer free or sliding-scale therapy programs to people pursuing training as therapists. Try calling schools near you to ask about access to low-cost therapy.

Additionally, some therapists offer therapy on a sliding-scale basis. Consider asking about this option when you interview therapists. Some therapists may also offer payment plans that allow you to pay for therapy over time.

Many therapy practices also employ novice therapists who need experience. These interns or apprentices may offer free or low-cost mental health care.

Telehealth services, which offer counseling online or on the phone, may also be more affordable.

Is There a Way to Get Free Therapy?

A number of clinics are working to expand access to health care services, including mental health services, by offering free or discounted treatment. The National Association for Free and Charitable Clinics, for example, offers free and low-cost care.

Some other options for finding free therapy in your area include:

Contacting your state's department of public or community health. Many offer community mental health clinics or referrals to free or low-cost services.

Enrolling in studies for mental health conditions. If you have a specific diagnosis, your local college or university may be researching your diagnosis. You can often get free care, including medication and therapy, by enrolling in such a study.

Seeking care at a college or university clinic. If you are a student, you may be eligible for free care at your college or university. If you are not a student but are located near a university that has a mental health care program, students in that program may offer free treatment to meet licensure requirements.

What Therapists Say About the Costs of Therapy

Lisa M. Vallejos, MA, LPC, NCC: Therapy costs have an extremely wide range. I know clinics that charge as little at $5 per session and others that charge $300 per session. It really is dependent on the therapist, your location, and the going rate for therapy in your area. There are many things to consider in addition to the cost that I would like to address.

Another factor to consider is whether you plan on using your insurance for therapy. In that case, you will likely be limited to however many sessions your insurance will pay for, which can vary. Also to consider if you are using your insurance, is whether there are only certain types of therapy that are covered, such as cognitive behavioral therapy. If you are paying for therapy with insurance, also consider that to be covered by insurance you must have a "covered" diagnosis. Your therapist will diagnose you and will list that diagnosis on your reimbursement paperwork. You will likely have a co-pay to pay when you seek insurance-reimbursed therapy, so be sure to find out how much that is as well.

Many therapists elect not to take insurance to avoid having to diagnose and the challenges that come with working with insurance companies, so it may be worth your while to ask the potential therapist to work with you on a fee that you can afford to bypass insurance.

Finally, many therapists will work on a sliding fee scale, but they do not always advertise that. A sliding scale is a payment structure that is based on your income. You can ask your potential therapist if they do, and if they do not, would they consider doing it for you.

Marla B. Cohen, PsyD: The price of therapy varies. Many insurance plans cover psychotherapy, and if you choose to work with a provider within your network, you will only need to pay your typical co-payment. Should you choose to see a therapist outside of your insurance network, you will find that therapists charge different rates depending on their office location, level of education, and degree of expertise in their field.

Some therapists may charge as much as $200 or more per session, but most will charge $75-$150 a session. Many therapists work with a sliding scale fee schedule, which means their fee will depend on your income level. If you have out-of-network benefits with your insurance plan, you may be reimbursed for the majority of what you pay the therapist. Your therapist's office can create a ledger for you to submit to your insurance company for reimbursement. If costs are an issue, many areas have community mental health agencies that provide therapy at a reduced fee.

Stacey Fuller, LMFT: When it comes to the cost of therapy, there is no set industry standard. The cost of therapy can vary widely depending on a number of factors.

Some therapists are part of a panel of providers who accept a particular insurance. In this case, the cost of therapy may only be a co-pay and/or deductible payment determined by the insurance company. Typically, insurance companies will limit the number of sessions they pay for in a calendar year so it is important to check with your insurance provider prior to initiating therapy to determine how much of the cost of treatment will be covered.

Some therapists choose to not accept insurance and instead offer fee-for-service (otherwise known as private pay) only. How private pay therapists set their rates is dependent on a number of factors: area, specialization and specialized training, number of years of experience, how in demand they are in the community, etc. In my area private pay therapists are typically priced anywhere from $65 on up to $250 a session. In other areas of the country, the prices may be quite different. Checking out some GoodTherapy therapist profiles in your area will give you a general sense of the cost of private pay therapy.

Free or low-cost therapy is often available for people with limited financial means through local clinics, hospitals, and community agencies. Frequently these providers are students in training or mental health interns who provide therapy at a low rate or free of charge in exchange for experience hours towards licensure.

Getting Help

Therapy can be expensive, particularly when you look only at the price tag and not the total value. Yet therapy can also confer significant benefits, including an improved financial outlook or better career prospects. People who are less productive because of depression, who suffer from creative blocks, who struggle to identify the right career path, who engage in compulsive shopping or gambling, and who experience problems at work may ultimately have more money as a result of therapy. Even when therapy does not offer a direct economic benefit, it can greatly and permanently improve a person's life.

People considering therapy should consider the overall value of therapy, not just the cost. To find a therapist who can bring real value to your life, click here.
References:

1. Gold, J. (2017, November 30). Health insurers are still skimping on mental health coverage. Retrieved from https://www.npr.org/sections/health-shots/2017/11/29/567264925/health-insurers-are-still-skimping-on-mental-health-coverage

2. Mental health and substance abuse health coverage options. (n.d.). Retrieved from https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage

3. Rowan, K., Mcalpine, D. D., & Blewett, L. A. (2013). Access and cost barriers to mental health care by insurance status, 1999-2010. Health Affairs, 32(10), 1723-1730. doi: 10.1377/hlthaff.2013.0133

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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How Much Does Therapy Cost? - GoodTherapy.org Therapy Blog

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Cost is one of the greatest barriers to mental health treatment. Although the Affordable Care Act and other regulatory reforms sought to improve access to behavioral and mental health services, many people worry about the costs of therapy.

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Negative Side Effects of Antidepressants

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Negative Side Effects of Antidepressants

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This article  by Harvard Health discusses the side effects of taking antidepressants.

This supports the fact that CBT may be a better alternative for treatment.

According to the article minimal side effects could include "insomnia, skin rashes, headaches, joint and muscle pain, upset stomach, and a lessening of sexual desire."

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Though common in use, SSRIs are not without their side effects.

Since the late 1980s, America and the world have been enjoying the benefits of the selective serotonin reuptake inhibitors (SSRIs). These antidepressants - fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro) - are among the world's most widely prescribed medications. The range of their uses has expanded from depression to anxiety, obsessive-compulsive disorder, eating disorders, and many other psychiatric conditions.

These types of antidepressants are generally safe, but no medical treatment is without risk.

SSRI antidepressant side effects

Some patients taking SSRIs develop insomnia, skin rashes, headaches, joint and muscle pain, stomach upset, nausea, or diarrhea. These problems are usually temporary or mild or both. A more serious potential problem is reduced blood clotting capacity because of a decreased concentration of the neurotransmitter serotonin in platelets. Patients are at slightly increased risk for internal bleeding, especially if they are also taking aspirin or another NSAID, such as ibuprofen or naproxen..

Sexual effects from SSRIs

For many patients, SSRIs diminish sexual interest, desire, performance, satisfaction, or all four. In men, SSRIs can delay or inhibit ejaculation, and in women, delay or prevent orgasm.

Lowering the dose of the SSRI antidepressant may help, although the patient may lose the drug's benefit. Another solution is adding or substituting bupropion (Wellbutrin), which works by a different mechanism and does not generally cause sexual side effects.

Drug interactions

SSRIs are broken down in the liver by a group of enzymes known as the cytochrome P450 system. Many other drugs are also metabolized by this same system. Depending on the interaction, there may be a higher or lower blood level of the two drugs. Sometimes only a dose adjustment is necessary, or it may be best to avoid one of the two drugs.

If an SSRI is taken along with another drug that enhances serotonin activity, a rare condition called the serotonin syndrome may develop - racing heart, sweating, high fever, high blood pressure, and sometimes delirium. In particular, SSRIs should not be mixed with certain other medications, especially the herbal remedy St. John's wort, monoamine oxidase inhibitors such as phenelzine (Nardil), and clomipramine (Anafranil). The serotonin syndrome has also been reported when an SSRI is combined with lithium, the standard treatment for bipolar disorder.

Use of SSRI antidepressants in older people

SSRIs are safer than tricyclic antidepressants for older people because they do not disturb heart rhythms and rarely cause dizziness that results in falls. But liver function is less efficient in older people, so there is a greater risk of drug interactions involving the cytochrome P450 system. For that reason, older people do best with rapidly metabolized drugs like sertraline.

Loss of antidepressant effectiveness

Any antidepressant may lose its effect after months or years, sometimes because the brain has become less responsive to the drug (tolerance). Solutions include increasing the dose and switching to another antidepressant with a different mechanism of action.

SSRI antidepressant discontinuation symptoms

Symptoms that may occur on suddenly stopping an SSRI include dizziness, loss of coordination, fatigue, tingling, burning, blurred vision, insomnia, and vivid dreams. Less often, there may be nausea or diarrhea, flu-like symptoms, irritability, anxiety, and crying spells. "Discontinuation syndrome" is a better description than "withdrawal reaction," a phrase associated with addiction. The syndrome is usually mild, but can be severe.

Although none of these types of antidepressants should be stopped abruptly, paroxetine tends to produce the most intense discontinuation symptoms. Here is a place where the longer-lasting drugs have an advantage; some clinicians switch to fluoxetine before gradually lowering the dose.

SSRI antidepressants and pregnancy

Potential risks to the fetus such as premature delivery and lower birth weight must be weighed against the considerable risks of untreated depression to both mother and child. More seriously depressed women are more likely to need antidepressant drugs while pregnant.

Breast-feeding

Similar cautions apply to nursing mothers. Paroxetine and sertraline may be preferred as they do not appear to reach significant levels in breast milk.

Suicide

The risk that antidepressants will incite violent or self-destructive actions is the subject of continuing controversy. In 2004, the FDA first initiated a Black Box Warning on SSRIs - its strongest available measure short of withdrawing a drug from the market. The warning is still placed on package inserts for all antidepressants in common use. It mentions the risk of suicidal thoughts, hostility, and agitation in children, teens and young adults.

The number of antidepressant prescriptions for children and teens, which rose rapidly throughout the 1990s, fell precipitously after the Black Box Warning was issued. However, there is the other side of under treatment of depression. The lifetime suicide rate of people with major depression is 15%, and depression can also be lethal in other ways; for example, a history of major depression doubles the risk of heart disease.

Regular follow-up and close monitoring can help prevent a bad outcome. Patients should be warned that there is a slight chance they will feel worse for a while, and they should let their prescribing clinicians know immediately if they begin to feel worse or develop new symptoms, especially after changing the medication or the dose.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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What are the real risks of antidepressants? - Harvard Health

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Since the late 1980s, America and the world have been enjoying the benefits of the selective serotonin reuptake inhibitors (SSRIs). These antidepressants - fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro) - are among the world's most widely prescribed medications.

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This paper compares Internet CBT (iCBT) to face to face CBT and found them both effective for  treatment of PTSD patients.

This was an important paper as face to face CBT may be too costly for some people and iCBT provides a less expensive option. In addition, provides an alternative for people that are not comfortable traveling or meeting face to face.

The authors of this article confirm that, "only a minority of individuals with PTSD symptoms receive the necessary treatment after experiencing a traumatic event."

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This New York Times article identifies CBT and antidepressants as equally effective with both altering the brain function.

This supports my idea that CBT can be used as an alternative to medication.

According to the article by Dr. Friedman, "...a 12 week trial that compared an S.S.R.I., Paxil, to interpersonal psychotherapy, Dr, Arthur Brody, also at U.C.L.A., found that depressed patients who responded to either treatment had nearly identical changes in their brain function...."

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After six years of twice-weekly psychotherapy sessions, Eric had plenty of insight. But his anxiety level had barely changed.

He was still bedeviled by a ceaseless urge to wash his hands and shameful and repetitive violent thoughts. Out of desperation and against the wishes of his therapist, he visited my office to discuss the possibility of medication.

''I thought I could understand my way out of my obsessive compulsive disorder,'' he recalled recently. ''I wanted to be able to do it on my own, without medication.''

What he did not remember was his vehement opposition to psychotropic medication on the ground that it was not natural and would change his brain chemistry.

Of course, he was right. Like Eric, many patients and therapists share the view that psychotherapy is preferable to pharmacotherapy because it is more ''natural'' and because it supposedly gets to the root of the patient's problem. They are convinced that self-understanding will bring relief, whether the problem is anxiety, depression or obsessional thinking.

Insight is a prerequisite of happiness, the theory goes, and well-being achieved without the hard work of psychotherapy is artificial and inauthentic.

But new evidence suggests that the talking cure and psychotropic medication have much more in common than had been thought. In fact, both produce surprisingly similar changes in the brain.

Take Eric's obsessive compulsive disorder. It hobbles patients with unwanted thoughts, often violent or sexual, that play in the mind like a broken record. Owing to the sometimes lurid nature of the thoughts, the treatment mainstay had for years been psychoanalytically oriented therapy to unlock the sexual and aggressive conflicts presumed to underlie the symptoms.

There was just one problem. That form of psychotherapy rarely, if ever, worked for those patients, a point now widely accepted by most psychoanalysts themselves.

But two seemingly different treatments can be highly effective: a form of talk therapy called cognitive-behavior therapy and a class of antidepressants called selective serotonin reuptake inhibitor antidepressants, or S.S.R.I.'s, drugs like Prozac and Zoloft. It is well known that patients with the disorder have altered serotonin function compared with normal controls.

Brain imaging that uses PET scans, or positron emission topography, has shown that the disorder is associated with functional hyperactivity of the caudate nucleus, a structure buried beneath the cerebral cortex. Some researchers hypothesize that the caudate is part of a subcortical circuit that acts as a kind of filter, sifting out extraneous thoughts and impulses.

In obsessive compulsive disorder, they theorize, the subcortical filter malfunctions, allowing the unwanted thoughts to reach the cortex and then on to consciousness.

In a study by Dr. Lewis Baxter at the U.C.L.A. School of Medicine, patients with the disorder who responded to either a reuptake inhibitor like Prozac or cognitive behavior therapy over 10 weeks showed virtually the same changes in their brains, decreases in the activities of the caudate nuclei and, thus, changes toward normal function.

When patients improved, the changes in their brains, as shown in the PET scans, looked the same regardless of whether they had received antidepressants or psychotherapy.

An S.S.R.I. works, in part, by enhancing the neurotransmitter serotonin, whose activity is often abnormal in people with obsessive compulsive disorder and depression. Cognitive behavior therapy focuses on changing distorted patterns of thinking.

The intriguing finding from the PET scans is not limited to O.C.D. Two studies of patients with depression, reported last year in The Archives of General Psychiatry, compared the effects of interpersonal psychotherapy with an antidepressant on brain function, as observed in PET scans. In those studies, the depressed patients received interpersonal therapy, a short-term talk treatment that focuses on the effects of social relationships and major life events on mood.

In one study, a 12-week trial that compared an S.S.R.I., Paxil, to interpersonal psychotherapy, Dr. Arthur Brody, also at U.C.L.A., found that depressed patients who responded to either treatment had nearly identical changes in their brain function, a decrease in the abnormally high activity seen in the prefrontal cortex before treatment.

In the second study, Dr. Stephen D. Martin at the research unit of Cherry Knowle Hospital in Sunderland, England, reported that six weeks of Effexor, an antidepressant that enhances both serotonin and norepinephrine, and interpersonal therapy produced similar effects in those depressed subjects who responded either to medicine or to psychotherapy. Each had shown an increase in the activity of the basal ganglia, a subcortical brain structure.

Although the observed changes with psychotherapy and antidepressant were similar in that study, they were not identical. Subjects with interpersonal therapy but not Effexor also had activation of a brain area called the cingulate gyrus, which responds to serotonin in the brain and has a role in regulating mood.

The studies show that pharmacotherapy and psychotherapy can produce remarkably similar effects on functional brain activity. But does that mean that antidepressants and psychotherapy are really equivalent?

In a word, no. Psychotherapy alone has so far been largely ineffective for diseases like schizophrenia, where there is strong evidence of structural, as well as functional, brain abnormalities. So it seems that if the brain is severely disordered, then talk therapy cannot alter it.

But it is clear that talk therapy can alter brain function. The reason may come from the elegant work of a Nobel Prize-winning psychiatrist and neurobiologist, Dr. Eric Kandel. Studying the simple and well-mapped nervous system of a sea slug, Aplysia, Dr. Kandel showed that learning leads to the production of new proteins and, in turn, to the remodeling of neurons.

Sea slugs exposed to the controlled-learning condition that produced long-term memory ended up with double the number of neuronal connections as the untrained animals. In essence, Dr. Kandel has proved that learning involves the creation of new neuronal connections.

The clear implication for humans is that learning literally changes the structure and function of the brain.

Now it may seem a big leap from a snail to a human. But if psychotherapy is thought of as a form of learning, then when therapists talk to patients, they cause them to learn, perhaps changing their brain function and, perhaps, for the long run.

In the end, Eric chose cognitive behavior therapy and improved drastically. Through exposure to those situations that he feared like messy dirty places, he became desensitized to them and lost his compulsion to wash.

Had he chosen an antidepressant, chances are that he would also have improved.

If psychotherapy produces nearly the same brain changes as pharmacotherapy, then the boundary between mind and brain is purely artificial -- even unnatural.

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BEHAVIOR; Like Drugs, Talk Therapy Can Change Brain Chemistry (Published 2002)

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After six years of twice-weekly psychotherapy sessions, Eric had plenty of insight. But his anxiety level had barely changed. He was still bedeviled by a ceaseless urge to wash his hands and shameful and repetitive violent thoughts. Out of desperation and against the wishes of his therapist, he visited my office to discuss the possibility of medication.

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This is a YouTube video that explains Cognitive Behavioral Therapy and how therapist will assist with thinking patterns.

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What is CBT? | Making Sense of Cognitive Behavioural Therapy

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This is a study of sexual assault victims that suffer from PTSD. The study compares Imagery Rehearsal Therapy  (IRT) and CBT vs CBT by itself and finds that both therapy options were equally effective.  The study included research of sleep symptoms such as nightmares, overall PTSD symptoms and quality of life.

This supports CBT as an effective treatment for Sexual Assault Victims that suffer from PTSD.

I did not use a direct quote from this source.

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CBT Clinical trial of sexual assault victims

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The Brain The Story of You
describes how memories can be triggered by smell, colors or events and how your brain can react without consciousness.

This explains how traumatic memories can be triggered due to trauma.

Eagleman explains the trigger as priming where "one thing influences the perception of something else."

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Read 1,725 reviews from the world's largest community for readers. Locked in the silence and darkness of your skull, your brain fashions the rich narrative...

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My special experience was an interview with a sexual assault victim who suffers from Complex PTSD.

She described how CBT has taught her to walk through her triggers and the avoidance of antidepressants due to suicidal thought provocation.
This supports CBT as a treatment option for someone suffering  from CPTSD. It also supports the potential risk of taking antidepressants for some PTSD patients.

According to Brittany, "I felt suicidal when I started taking antidepressants and had to stop taking them."

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This article by The Dawn describes how memories from a traumatic event may be kept within the limbic brain  potentially leaving a person in a fight or flight response mode.

Supports the use of CBT for therapy explaining that a trauma survivor can train their brain to make a conscious connection between reality and perceived threats.

According to the article, "when someone experiences trauma, their bodies and brain change."

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The Dawn Wellness Centre and Rehab Thailand

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Traumatic life events can have a severe impact on anyone who goes through them. However, children and adolescents are especially vulnerable to the effects of trauma. It can quickly take away any feelings of predictability and safety. A traumatic event or chronic ongoing trauma, such as domestic violence, physical or sexual abuse, can make it difficult for them to trust anything or anyone.

Humans often deal with trauma by pretending it did not happen and avoiding any potential reminders. Sadly, this method does not deal with the problem and can actually make things worse over time, resulting in addiction and mental health issues such as anxiety, depression and PTSD. Even if a diagnosable condition does not develop, trauma can cause emotional scars like trust issues and low self-esteem. Reasons such as these are why treating trauma , and early intervention if possible, is essential.

What is Trauma-Focused Cognitive Behavioural Therapy (TF-CBT)?

Trauma-Focused CBT is a type of cognitive behavioural therapy that addresses certain mental and emotional needs of trauma survivors who are having a hard time overcoming the damaging effects of traumatic past events.

Trauma-Focused CBT is one of the most effective types of treatment for a trauma-based disorder, particularly in adolescents and children. It was developed specially to treat people between the ages of 3 and 18. This somewhat short-term therapy model has consistently proven its effectiveness by many clinical studies.

Trauma & PTSD by definition

Trauma can be described as an emotional, psychological response to an experience or event that is deeply disturbing or distressing. It can be referred to as having an injury or illness, being involved in an accident, experiencing a divorce or losing a loved one. Trauma can also include severely damaging experiences like torture or rape.

Even though most of us have experienced some sort of traumatic occurrence in our lifetime, we are all affected by it in different ways. Some people are unable to recover from the event, causing the effects to last longer than usual. As a result, the individual may live with symptoms of trauma until they seek professional help.

Since trauma responses cover such a wide spectrum, psychologists have chosen to categorise different types of trauma, including PTSD. PTSD, or Post-Traumatic Stress Disorder, is the psychological reaction to a very stressful or an extremely threatening event that causes mental health issues like depression, anxiety, suicidal tendencies and flashbacks. People with PTSD often feel scared or anxious, even if they are not actually in danger.

How does trauma affect the brain?

When someone experiences trauma, their bodies and brains change. The brain records sensory details about the event and the memories can come up repeatedly. For many, this results in mood swings and troubling dreams that eventually go away with time. However, people who have developed PTSD will notice their symptoms worsening over time and affect their daily life.

The brain is made up of the reptilian, the mammalian and the neomammalian. Each part plays a role in the way we respond to trauma. The reptilian is our brain stem, which is in charge of our survival instincts. This part of the brain enters reactive mode during a traumatic event. Any process that is not essential gets shut off, and we enter survival mode.

The mammalian or 'midbrain' part of our brain processes learning and emotions. Unique to us mammals, the mammalian does not register thoughts of logic or time. Instead, it sees things as pleasurable (agreeable) or painful/distressing (disagreeable). We survive by repeating pleasure and avoiding pain.

Situated in our brain's limbic section, the amygdala works as a filter by scanning the threat our brain has responded to and deciding whether or not it is an actual threat. If there is no real threat, it offers access to the neocortex. If it senses danger, other areas of the brain activate, resulting in what is known as fight or flight mode. The body then acts according to the instructions of the brain.

Trauma survivors and their limbic system

In normal circumstances, the nervous system turns the body back into its usual status once the threat has passed. It does this by lessening stress hormones and enabling the brain to go back to its normal function. However, that reaction does not happen for some survivors of trauma. Instead, it keeps them in a responsive state.

The traumatic event is never given access to the neomammalian brain, which is the section of the brain that controls decision-making, cognitive processing, self-awareness and memory. It is also the area of the brain that enables us to process traumatic events and enables us to heal. For trauma survivors, the event stays stuck in the limbic brain, and the amygdala remains overly stimulated. Trauma survivor then become trapped in a circle of endless arousal, searching for and sensing threats everywhere.

Since the memory of the traumatic event stays in the limbic brain, which does not recognise the notion of time, events that occurred many years ago can seem as though they are happening right now. That is why people with PTSD continue to relive the trauma through nightmares and flashbacks and appear like they are stuck in the past.

What are the benefits of TF-CBT?

Trauma-Focused CBT is based on the idea that our behaviours and feelings are a result of our thoughts and not external things such as situations, people or events. TF-CBT allows us to change and improve the way we think and act, regardless of what is happening externally. TF-CBT can involve numerous benefits including:

Identifying negative emotions and thoughts

Preventing addiction relapse

Coping with loss and grief

Managing anger

Managing chronic pain

Dealing with PTSD and overcoming trauma

Overcoming sleep disorders

Resolving relationship problems

TF-CBT's underlying concepts are also based on other treatment methods and philosophies, including family therapy, behavioural therapy, cognitive therapy and humanistic psychology.

What are the treatment goals of TF-CBT?

Trauma can impact individuals in various ways. Even though some are resilient and do not develop serious behavioural or emotional problems, that is not the case for everyone. The main focus of TF-CBT is to address the symptoms activated by the trauma, along with any associated issues.

TF-CBT treatment goals include:

What are the main components of TF-CBT?

Help the individual recognise and accept that they are not responsible for the trauma

Decrease the person's sense of shame and embarrassment

Reduce symptoms related to or triggered by the trauma

Assist the person in improving all areas of functioning that were affected by the trauma

Lessen any acting out behaviour connected to the trauma

Help mend and strengthen relationships, including communication and attachment

Trauma-Focused CBT has several main components , which are often represented by using the acronym PRACTICE.

P - Psychoeducation and parenting

The therapist educates the person and help them realise what trauma is and what its effects are, including the behavioural and emotional responses that it tends to trigger in people. This also involves helping them with behaviour management strategies.

R - Relaxation methods

The therapist teaches the individual effective and healthy relaxation methods to reduce and manage stress. These relaxation techniques may include breathing exercises, guided imagery and progressive muscle relaxation.

A - Affective expression and regulation skills

Trauma frequently causes intense emotions including anger, fear and sadness. The therapist addresses this by assisting the person in learning to identify and express these overwhelming emotions. The therapist also helps them develop healthy ways to soothe anxiety and other negative emotions on their own.

C - Cognitive coping skills and processing

People often find trauma to be quite confusing, and they may have a tough time processing things in a healthy way. Therapists can help them understand the link between behaviours, thoughts and feelings along with recognising and rectifying inaccurate thoughts about it.

T - Trauma narrative and processing

Sharing the traumatic event and its effect can be done through verbal, written, artistic or symbolic narratives. This offers the person a way to express and process the trauma and connected experiences. The therapist guides them in creating their narrative by using exposure exercises.

I - In vivo exposure

One of the most effective ways to overcome fear and anxiety is through exposure instead of avoiding anything that is linked to the trauma. In vivo exposure involves gradually exposing the individual to things that remind them of the trauma. This approach helps decrease their negative emotional responses to those reminders. It also helps them find ways to manage their emotional reactions to unexpected or future reminders.

C - Conjoint therapy sessions

These therapy sessions concentrate on creating and maintaining a healthy relationship within a family setting. It gives both parties an opportunity to practice communication skills and talk about the trauma in a therapeutic environment.

E - Enhancing personal safety and future growth

It is crucial for individuals who have experienced trauma to develop personal safety skills and learn how to form healthy relationships. Ways to avoid future trauma and stay safe, as well as means to keep healing and growing, are all discussed.

What should you expect in TF-CBT?

TF-CBT is designed to be a comparatively short-term treatment. Most cases of TF-CBT involve 12 to 18 therapy sessions, though it can also last anywhere from 8 to 25 sessions depending on the case. Likewise, the duration of each session can be from 50 to 90 minutes. In some circumstances, longer treatment may be necessary.

Cognitive behavioural techniques are used to adapt unhelpful or distorted thinking and negative behaviours and reactions. A family therapy may also be used at the same time to examine interactions between family members as well as other family dynamics that could be part of the problem. This approach can also help all parties develop better communication and stress management skills.

How effective is TF-CBT?

Esther Deblinger, Judith Cohen and Anthony Mannarino originally developed trauma-focused CBT, all of whom are experienced doctors of medicine and psychology. The therapeutic treatment method has been carefully studied and polished over the last 25 years. 14 randomised and controlled trials have already been conducted in countries throughout Europe, the US and Africa, comparing the outcomes of completed TF-CBT sessions with those of other therapeutic approaches.

Each one of these studies established that this specific method was superior in providing trauma survivors and their immediate families with the support and direction required to overcome destructive traumatic experiences and associated disorders.

Trauma histories and co-occurring disorders

Dual diagnosis is a term that describes a person who has two independent illnesses, such as addiction and PTSD. Trauma and addiction often co-occur for several reasons. A person with unresolved trauma may develop an alcohol, drug or behavioural addiction as a way to numb their emotions. Studies have found that up to 50% of adolescents with PTSD develop an addiction. Sadly, PTSD often makes it harder for them to quit using, resulting in a vicious cycle.

In cases of dual diagnosis, Trauma-Focused CBT can be used as a part of a more comprehensive treatment plan. Each illness requires a dedicated treatment plan for effective treatment to occur.

Trauma and addiction treatment at The Dawn

The Dawn offers an integrated treatment model to co-treat trauma disorders and addiction. We also have specialist trauma treatment programme that focuses exclusively on PTSD. If you or someone you love are suffering with trauma and PTSD, now is the best time to reach out. today to receive a no-obligation assessment to find out how we can help. You can also call us at +66 63 048 4877 for immediate assistance.

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Trauma-Focused CBT for Effective PTSD & Trauma Treatment

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Traumatic life events can have a severe impact on anyone who goes through them. However, children and adolescents are especially vulnerable to the effects of trauma. It can quickly take away any feelings of predictability and safety. A traumatic event or chronic ongoing trauma, such as domestic violence, physical or sexual abuse, can make it difficult for them to trust anything or anyone.

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This article in Psychology Today discusses  the founding of CBT by Dr. Aaron Beck in the 1960s  as a treatment option as he looked for a better treatment for his clients.

This further supports the use of CBT for PTSD using emotional reasoning.

According to the article , CBT works to "identify and challenge harmful thoughts."

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A typical course of CBT is around 5 to 20 weekly sessions of about 45 minutes each. Treatment may continue for additional sessions that are spaced further apart, while the person keeps practicing skills on their own. The full course of treatment may last from 3 to 6 months, and longer in some cases if needed.

In therapy, patients will learn to identify and challenge harmful thoughts, and replace them with a more realistic, healthy perspective. Patients may receive assignments between sessions, such as exercises to observe and recognize their thought patterns, and apply the skills they learn to real situations in their life.

CBT programs tend to be structured and systematic, which makes it more likely that a person gets an adequate "dose" of healthy thinking and behaviors. For example, a patient with depression may be asked to write down the thoughts he has when something upsetting happens, and then to work with the therapist to test how helpful and accurate the thoughts are. Repeated and focused practice is an integral part of CBT. CBT centers around building new habits-which we may know but need to remember and implement successfully.

Additionally, CBT programs can be standardized and tested so that the mental health field can identify which programs are effective, how long they take, and the benefits that patients can expect.

Research has found the CBT delivered virtually is often equally as effective, and sometimes more effective, than CBT delivered in person. For example, one review study found that online CBT reduced symptoms of anxiety and depression to the same extent or more than in person CBT. Online CBT was also effective in treating post- traumatic stress disorder, panic disorder, and specific phobia. Given that online therapy removes certain barriers, such as travel time or childcare, it's a strong option to consider.
For more, see Online Therapy.

Almost everyone deals with distracting or destructive thoughts at times, but cognitive and behavioral principles can help you overcome them. The first goal is to restructure exaggerations. You can cultivate cognitive flexibility by asking questions like, "What's the evidence for and against this idea?" "Is it possible that another perspective is more accurate?"

The second approach is to problem solve. If your beliefs are rooted in reality, fix the problem or make it more manageable, such as outlining the steps to complete a project that feels overwhelming. The third is to accept what you can't change. You can then move forward and engage in activities that matter, without allowing your thoughts to control you.

Many people pursue therapy because their relationships are suffering. A course of CBT can lead to marked benefits not only for the person in therapy but for those close to him or her. One is less anxiety in the relationship; chronic worry in generalized anxiety disorder frequently leads to tension and irritability, causing conflict between partners. Another is greater presence, because a CBT framework can help translate one's intention to be present into a plan of action to make it happen. Positive mood, better sleep, happier children, and healthier thought patterns, are also ways in which CBT can improve a relationship.

What Conditions Can CBT Treat?

CBT is an effective and lasting treatment for anxiety disorders, research shows. CBT provides the tools to alter the thoughts and behaviors that exacerbate anxiety. For example, someone with social anxiety might think, "I feel so awkward at parties. Everyone must think I'm a loser." This thought may lead to feelings of sadness, shame, and fear, when then lead to behaviors like isolation and avoidance. CBT can help people learn to identify and challenge distorted thoughts, and then replace them with realistic thoughts, changing the cycle of anxiety.

Cognitive Behavioral Therapy for Insomnia, or CBT-I, is a short-term treatment for chronic insomnia. The therapy aims to reframe people's thoughts, feelings, and behaviors around sleep. People with insomnia often enter a cycle of trying to make up the sleep they lost, sleeping poorly the subsequent night, and then becoming anxious about sleeping. These behaviors can include going to bed too early, taking naps, or relying on alcohol to fall asleep. The role of CBT-i is to change those patterns, through techniques such as challenging anxious thoughts and adhering to a set sleep schedule.

Enhanced Cognitive Behavioral Therapy, or CBT-E, is a form of CBT designed to treat eating disorders including anorexia, bulimia, and binge- eating disorder. CBT-E focuses on exploring the reasons the patient fears gaining weight with the goal of allowing the patient to decide for themselves to make a change. CBT-E stands in contrast to Family-Based Therapy, a leading treatment in which the patient's family takes on an important role in addressing the disorder and the person's eating patterns at home.

The creator of cognitive behavioral therapy is Aaron Beck, a psychiatrist at the University of Pennsylvania. In the 1960s, Beck was practicing psychoanalysis. But he came to realize that the approach was failing to treat his depressed patients-entrenched negative thoughts prevented them from overcoming the disorder. So he developed cognitive behavior therapy, rooted in the philosophy of Albert Ellis's rational emotive behavior therapy, to change these harmful patterns of "emotional reasoning" and spark genuine change.

In the 1950s, the psychologist Albert Ellis became discouraged by psychoanalysis. When treating his patients, he discovered that becoming aware of one's beliefs and challenges didn't necessarily change them. Ellis developed what is now called "rational emotive behavior therapy" (REBT). The groundbreaking therapy is based on his core philosophy: that most of our behavioral and emotional problems-from getting over a breakup to handling child abuse-stem from our own irrational beliefs about our situations and how we should be treated. By changing those beliefs, we can change our emotions and behaviors for the better.

Rational emotive behavior therapy later sparked the creation of cognitive behavior therapy. Both encompass the notion that emotions and behavior are predominantly generated by ideas, beliefs, attitudes, and thinking, so changing one's thinking can lead to emotion and behavior change. Yet there are also a few differences between REBT and CBT. Unlike CBT, REBT explores the philosophic roots of emotional disturbances, encourages unconditional self-acceptance, and distinguishes between self-destructive negative emotions and appropriate negative emotions.

Psychoanalytic and psychodynamic therapy, as well as many other approaches, center around exploring the past to gather understanding and insight. CBT is distinct because it focuses on the present. What are you thinking right now? What were you thinking when you began to feel anxious? Are there any harmful patterns that emerge? The goal is to understand what happens in your mind and body in the present to change how you respond.

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Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs. Considered a "solutions-oriented" form of talk therapy, CBT rests on the idea that thoughts and perceptions influence behavior.

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Central Question:  "Could Cognitive Behavioral Therapy (CBT) be a better form of treatment for PTSD than antidepressants?"

This essay walks through how trauma affects the brain, and explores the use of CBT as an effective treatment option for victims with PTSD.  While CBT may be more costly, it does not have the negative side effects that may affect some people while taking antidepressants. It is also shown to alter the brain function, working with patients on long term reasoning skills.  Included in this essay is research for less expensive therapy  iCBT (internet CBT).