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Published Online: 8 July 2020

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Publication: Treatment of Stress Response Syndromes

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Page numbers printed in boldface type refer to tables and figures.
Acute stress disorder,
8
case examples,
6–8, 38–40
Adjustment disorder,
8
case examples,
4–5, 22, 40–41, 60–61, 72–75
Alcohol, excessive use of,
33
Anger,
5, 12, 52, 58, 62
Anxiety,
2, 8, 12, 30, 38, 51, 55
Self-report scales of,
77
Behavior
angry,
59
prosocial,
29
renarration and,
58
risky,
3, 17,
Bereavement
. See Grief
Case examples
bereavement-induced acute stress disorder,
38–40
bodily injury,
4–5
configurational analysis,
20–22
confronting dissociated self-states,
65–67
death of a child,
40–41
death of a parent,
22, 72–75
friend killed in combat,
47–49
marital physical abuse,
44–45
mother’s bereavement and theme of revenge,
59–60
PTSD,
15
resentment after an injury,
60–61
responsibility,
20–22
stranger assault,
46–47
survivor guilt,
30–32
trauma after a fire,
6–8
trauma from an amputation,
67–70
Child,
34, 71
adverse childhood events,
6, 12, 23, 62, 64–65, 85, 86
case example of death of,
40–41
childhood attachment models,
61
childhood schemas,
58
Clinicians
identifying the hard topics,
51–52, 5354
imperative questions for patients,
34
language between patient and,
57–58
patient dialogue with,
38
phases of therapy and,
9
scripts for role-playing techniques,
51
support for patient,
27–30
Cognitive processing, trauma and,
3–5
Communication
. See also Renarration
patient-clinician,
37–38. 57–58
role-playing techniques,
51
Complex PTSD (CPTSD),
8, 23, 62, 64–65
Configurational analysis, of stress response syndromes,
19–22, 19
case examples of,
20–22
Coping skills
case examples of
death of a parent,
73–74
marital physical abuse,
44–45
stranger assault,
46–47
decision tree for improving coping,
49, 50
identifying the hard topics,
51–52
improving rational decision-making,
52, 55
obstacles to therapy,
46
distorting reality for self-enhancement,
49, 49
switching between attitudes to avoid emotion,
47, 48
habitually inhibiting ideas about emotional topics,
46, 47
overview,
43–44
reducing phobic anticipations and alarm reactions,
50–51
COVID-19, global stress response syndromes and,
viii
CPTSD
. See Complex PTSD
Death
. See also Grief
case examples
bereavement-induced acute stress disorder,
38–40
death of a child,
40–41
death of a parent,
22, 72–75
friend killed in combat,
47–49
mother’s bereavement and theme of revenge,
59–60
survivor guilt,
30–32
Decision tree
for exploration of meanings,
38, 39
for improving coping,
49, 50
for providing support,
29, 29
for reschematization,
68
Denial,
1, 4, 5, 27, 84
Depersonalization,
1, 4, 23, 62, 66
Derealization,
1, 4, 23, 35, 62
Desensitization,
vii, 3, 29, 46
Disavowal,
4, 14
Dissociation,
4, 35, 48, 62
DSM-5, diagnostic criteria for PTSD,
1618
Emotions,
9, 13, 14, 16, 21, 25, 29, 39, 43–44, 54, 62, 6364, 70, 71, 73–75, 84–86
avoidance of,
47–49, 48, 50,
coping with,
14, 45–47
distortion of,
49
emotional blunting,
2–3, 55
emotional flooding,
4, 46
emotional numbing,
40
emotional regulation,
2, 5, 8, 23–24, 28, 33, 51, 83
evaluation of stress response syndromes and,
11–12
imaginal exposure and,
50
reschematization and,
64
Extinction learning,
3
Family
as part of support system,
24, 29
psychoeducation and,
30
trauma and,
3, 13
Fear,
1, 12, 31, 66, 70
Five Ds,
4
GAD-7
. See Generalized Anxiety Disorder 7-item scale
Generalized Anxiety Disorder 7-item (GAD-7) scale,
77
Grief
. See also Death
bereavement-induced acute stress disorder,
38–40
clinician’s questions about,
34
complex PTSD and,
23
death of parent and,
22, 72–75
Kübler-Ross stages of,
5
persistent complex bereavement disorder,
23
revenge and,
59–60
Guided imagery,
46
Guilt,
2, 12, 18, 40, 52, 55, 58–59, 66
Habituation,
3
ICD-11, diagnosis of PTSD,
23
Identity,
vii, 6, 7, 56, 82, 86. See also Self-schemas
adverse childhood events and,
23
and attachment, models of,
57
case example of consequences of death of a parent,
72–75
coherence of,
61, 63, 78
disturbances in,
2, 23–24, 62
integration of,
38
as psychological factor in PTSD,
18
relationships and,
19, 20, 21, 45
schemas and,
60, 61, 83
sense of after injury,
4–5
IES
. See Impact of event scale
Impact of event scale (IES),
77–78, 7980
Journal writing,
52, 53
Kübler-Ross stages of grief,
5
Language, between clinician and patient,
57–58
Marriage
effects of loss of child on,
40–41, 59–60
physical abuse in,
44–45
Meditation,
46
Memories,
1, 83. See also Case examples
Adverse childhood events and,
66, 69
alternative,
58
dissociated,
64
fragmentary,
12, 37–38, 56, 57, 84
Impact of Event Scale and,
79
integration of,
27, 85
intrusive,
3, 6, 15, 16, 85
recurrent,
3, 69
renarration and,
57–58
sensation memories,
13
stressors and,
33, 37–38
support phase and review of,
28
of trauma and loss events,
2, 5, 12, 56
therapeutic approach and,
47, 49
traumatic,
16, 24, 31
Mindfulness,
29, 30, 33, 46, 51
Models
based on childhood adversity,
62, 64–65
biopsychosocial model of PTSD,
15–19
observe, formulate, act,
12
self and relational models,
58–59
Mood and anxiety syndromes,
8
Patient Health Questionnaire (PHQ-9),
77
Patient
clinician questions for,
34
coping with emotion,
45–46
defensiveness of,
43–44
denial and avoidance of trauma,
27
dialogue with clinicians,
38
evaluation of,
11–13
language, clinician, and,
57–58
mind-brain interactions,
33–34
phases of therapy and,
9
schemas and,
58–59, 61–62, 67
self-blame and,
65
self-medication of,
32–33
state of mind of,
19–20, 43–44
symptom description of,
13
support for,
13, 27–30
Persistent complex bereavement disorder,
23. See also Grief
Personality
case example of confronting dissociated self-states,
65–67
coping and,
45–46
current level of functioning,
62–67, 6364
personality functioning and complex PTSD,
23
trait assessment,
12, 45–46, 86
trauma and,
6, 7
Phobias, coping with,
50–51
PHQ-9
. See Patient Health Questionnaire
Positive States of Mind Scale (PSOMS),
77, 78, 81
Posttraumatic stress disorder (PTSD),
vii–viii, 8, 23. See also Complex PTSD
adverse childhood experiences and,
12
assessment and treatment,
13
biological factors of,
15, 18
biopsychosocial model of,
15–19
case examples of
crisis of responsibility,
20–22
death of a child,
40–41
dissociated self-states,
65–67
DSM-5 criteria,
15
friend killed in combat,
47–49
DSM-5 diagnostic criteria for,
1618
evaluation and treatment planning flowchart,
25
identity disturbances,
23–24
as pathological syndrome,
8
psychological factors of,
18
social factors of,
18–19
treatment formulation,
15–18, 24–25
treatment guidelines for,
viii
PSOMS
. See Positive States of Mind Scale
Psychotherapy
configurational analysis and,
19–20
counteracting avoidance,
45–46
decision tree for exploration of meanings,
39
dialogues in,
28, 38, 52, 56, 57–58, 61–62, 65
identity disturbances and,
24
obstacles to,
46, 47, 48, 49
phases of change during,
8, 9
pressing questions in,
34
sequence of,
84–85
supportive,
18–19, 24, 29, 31–32
termination of,
71–72
PTSD
. See Posttraumatic stress disorder
Rage,
2, 31, 44, 52, 5964, 74
Relationships
. See also Self-schemas; Therapeutic relationship
case example after death of a parent,
72–75
complex PTSD and,
23
disturbances in,
2
identity and,
19, 20, 21, 83
personality functioning and,
63
reschematization and,
68, 70
schemas for,
6, 61–62, 85
Renarration,
38, 55. See also Communication
case example,
74–75
decision tree,
68
description of,
57–58
Reschematization
case examples
death of a parent,
74–75
mother’s bereavement and theme of revenge,
59–60
resentment after an injury,
60–61
decision tree,
68
goal of,
64
overview,
58–59
Resilience,
86
Response to traumas and losses, phases of,
5
Sadness,
2, 12
Self-medication and patient support,
32–33
Self-reporting,
77–80
Impact of Event Scale,
77–78, 7980
overview,
77
Positive States of Mind Scale,
78, 81
Sense of Self-Regard Scale,
78, 82
Self-schemas,
61–62. See also Identity; Relationships
case examples,
65–70
self in the future
case example of trauma from an amputation,
67–70
overview,
67
Sense of Self-Regard Scale,
78, 82
Shame,
2, 12, 18, 21, 31, 40, 44, 47, 49, 52, 55, 74
Sleep, disruption in stress response syndromes,
33–34
Somatic patterning retraining,
46
Startle reaction,
13, 14, 17, 33
States of mind,
1, 2, 3, 12, 13, 21, 29, 50, 53, 62, 64, 65, 69
avoidant,
14, 39, 85
calm,
46, 50–51
configurational analysis and,
19, 19–20
hyperarousal,
14
intrusive,
14, 85
observational stance toward,
43
supportive therapy and,
31
uncontrolled,
59
under-modulated,
30, 39, 45
well-modulated,
74, 85
Stressors
. See also Memories
autonomic nervous system and,
33
case examples of,
4–5, 6–8
DSM-5 PTSD criteria,
16
five Ds and,
4
hyperarousal from chronic stress,
33
meaning of,
29, 38, 41, 46, 54, 70
nonpathological reactions to,
3
reschematization of,
58–59, 61
Stress response syndromes
. See also Posttraumatic stress disorder (PTSD)
alarmed reactions and,
3–4
biological factors,
83
configurational analysis of,
19–22, 19
coping with emotions,
45–46
description of,
2, 9–10
diagnosis of,
1–2
patient support,
13
self-medication for,
32–33
sleep disruption in,
33–34
symptom description,
13, 14
treatment for,
8
case example of death of a parent,
72–75
common phases of therapy,
9
evaluation,
11–13
evaluation and treatment planning flowchart,
25
overview,
11
termination of,
71–75
types of,
8
Substance use disorders,
8
Support
case example of survivor guilt,
30–32
clinical decision tree for providing support,
29, 29
mind-brain interactions,
33–34
overview,
27–30
for the patient,
13
after death of a parent,
73
self-medication and,
32–33
TBI
. See Traumatic brain injury
Therapists
. See Clinicians
Therapeutic relationship,
9, 28, 29, 65, 75
relationship patterning and,
60–61
Therapy, phases of,
8, 9
Transference,
61, 62, 65, 71, 85
Trauma
. See also Case examples; Posttraumatic stress disorder (PTSD)
cognitive processing of,
3–5
with comorbidities,
8
denial of,
1
development of responses to,
6, 7
imaginal exposure and,
28, 50–51
memories and loss events of,
2
occurrence of,
1–2
pathological syndromes and,
8
patient denial and avoidance of,
27
personality factors and,
6
phases of response to,
5
symptoms of
avoidance,
2–3
intrusive,
3
Traumatic brain injury (TBI),
8, 83
12-step group-oriented therapy program,
32

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Go to Treatment of Stress Response Syndromes
Treatment of Stress Response Syndromes
Pages: 93 - 97

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Published in print: 8 July 2020
Published online: 5 December 2024
© American Psychiatric Association Publishing

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