Front Matter
Publication: Treatment of Stress Response Syndromes
TREATMENT OF
STRESS RESPONSE SYNDROMES
SECOND EDITION
TREATMENT OF
STRESS RESPONSE SYNDROMES
SECOND EDITION
Mardi J. Horowitz, M.D.
Distinguished Professor of Psychiatry
School of Medicine and Weill Neuroscience Center
University of California, San Francisco
Note: The author has worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family.
The author has indicated that he has no financial interests or other affiliations that represent or could appear to represent a competing interest with his contributions to this book.
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Copyright © 2021 American Psychiatric Association Publishing
ALL RIGHTS RESERVED
Second Edition
Manufactured in the United States of America on acid-free paper
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Library of Congress Cataloging-in-Publication Data
Names: Horowitz, Mardi Jon, 1934– author. | American Psychiatric Association, issuing body.
Title: Treatment of stress response syndromes / Mardi J. Horowitz.
Description: 2nd edition. | Washington, D.C. : American Psychiatric Association Publishing, [2020] | Includes bibliographical references and index.
Identifiers: LCCN 2020022173 (print) | LCCN 2020022174 (ebook) | ISBN 9781615373055 (paperback) | ISBN 9781615373673 (ebook)
Subjects: MESH: Stress, Psychological—therapy | Life Change Events | Stress Disorders, Post-Traumatic—therapy
Classification: LCC RC455.4.S87 (print) | LCC RC455.4.S87 (ebook) | NLM WM 172.4 | DDC 155.9/042—dc23
LC record available at https://lccn.loc.gov/2020022173
LC ebook record available at https://lccn.loc.gov/2020022174
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Preface to the Second Edition
Acknowledgments
1 Principles of Psychological Responses to Stressor Events
2 Assessment and Treatment Planning
3 Providing Support
4 Linking the Meanings of Stressor Events to the Self
5 Improving Coping Skills
6 Renarration and Reschematization
7 Terminating
8 Assessing Change
9 Conclusion
References
Index
Preface to the Second Edition
IN DSM-5, THE AMERICAN PSYCHIATRIC ASSOCIATION (2013) introduced a new grouping of diagnoses called trauma- and stressor-related disorders. These include PTSD, acute stress disorder, and adjustment disorders. That clustering was envisioned in Stress Response Syndromes (Horowitz 1976) and in the first edition of this book (Horowitz 2003). This second edition updates treatment recommendations for these disorders and emphasizes formulation for determining appropriate therapeutic strategies.
I take an integrative and transtheoretical approach in this second edition. Unlike treatment guidelines for PTSD and acute stress disorder issued by such organizations as the U.S. Department of Veterans Affairs/Department of Defense (VA/DoD), the American Psychiatric Association, and the American Psychological Association, this work does not compartmentalize its recommendations into treatment modalities such as cognitive-behavioral therapy, prolonged exposure, cognitive processing therapy, eye movement desensitization and reprocessing, dialectical behavior therapy, interpersonal therapy, short-term dynamic therapy, and cognitive-dynamic therapy. Research studies confirm that these modalities are effective but also can be improved on (Brom et al. 1989; Merz et al. 2019). I describe an integrated approach based on repeated assessments and formulations that lead to individualized plans for the patient.
This assessment-based approach can be used throughout all phases of treatment and leads to the possibility of enhancing emotional control, advancing attachment models, and consolidating identity. It addresses conscious contents and unconscious structures of memory and meaning. This book and these treatment methods will be useful for clinicians who are already familiar with diagnosing and treating patients but who want to advance their techniques for providing psychotherapy.
Many treatment guidelines for PTSD focus on brief therapy. In the final section of a review of treatment guidelines by a committee of the VA/DoD (Ostacher and Cifu 2019), the authors emphasized the need to improve psychotherapies and pointed out a conflict of interest. They noted that their selection of brief treatments related to the fact that they had to operate within a projected limited budget for delivering care in the VA system and the needs of the DoD to keep military personnel on active duty in a fighting force. I do not share that bias toward brief treatment. In contrast, my values lead to supporting therapies of whatever length is required in order to provide full benefit to patients and lead to personality growth.
Readers specializing in the field of stress response syndromes might find a historical perspective on the diagnosis of PTSD to be helpful. The relevant background may be found in Stress Response Syndromes, 5th Edition (Horowitz 2011), Essential Papers on Posttraumatic Stress Disorders (Horowitz 1999), and PTSD: A Short History (Horwitz 2018).
Note Concerning COVID-19
While this book was in production, the world was impacted by global stress imposed by the coronavirus disease 2019 (COVID-19) pandemic and the related economic recession. As complex and collective threats unfold, individuals may need help in three areas. The first area is heightened demand for self-care and family and community support. I wish for the readers of this book and their patients that they have resilience, courage, stamina, and connection to others. However, description of how to attain those attributes is beyond the scope of this work. The second area of concern is that patients with preexisting psychiatric disorders, including psychoses, mania, and serious depression, who are under stress may develop exacerbations of their symptoms, leading to immobilization and suicidality. The third area is the focus of this book: Some patients may develop stress response syndromes related to the COVID-19 pandemic and the failing economy. The chapter on renarration and reschematization will be especially relevant to clinicians who are treating this group of patients.
Severe stress can lead to adaptive and maladaptive states of mind. Focusing attention on realistic appraisals of threats and developing useful coping strategies is adaptive. In contrast, extreme anger that focuses blame on others or oneself can be maladaptive. States of righteous indignation or self-disgust interfere with the ability to effectively deal with crises. My hope is that readers of this book will be able to help their patients move from maladaptive states of mind to more adaptive ones.
Mardi Horowitz
San Francisco, April 2020
Acknowledgments
I AM GRATEFUL FOR THE SUPPORT FOR MY RESEARCH ON stress response syndromes provided by the National Institute of Mental Health (NIMH) and the John D. and Catherine T. MacArthur Foundation. I am also thankful for the encouragement given to me by awards such as both the Pioneer and Lifetime Achievement Awards (International Society for Traumatic Stress Studies), the Strecker Award (Institute of Pennsylvania Hospital), the Royer Award (University of California), and both the Hibbs and Foundations Fund Awards (American Psychiatric Association).
I would like to thank Zachary Vanderbilt, who did an excellent job of bibliographic research, editing, and word processing. William Zhu, M.D., contributed content ideas and editing. Edwin Flores complemented this work with his excellent figures. Steven Walsh, M.D.; Beverly Lehr, Ph.D.; Andreea Seritan, M.D.; Renee Binder, M.D.; Earth Hassari, M.D.; and the San Francisco Veterans Administration Medical Center’s PTSD treatment team led by William Wolfe, M.D., and Brian Molenhoff, M.D., also contributed valuable ideas and edits.
Information & Authors
Information
Published In
Treatment of Stress Response Syndromes
Pages: i - ix
History
Published in print: 8 July 2020
Published online: 5 December 2024
© American Psychiatric Association Publishing
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