Group therapy for posttraumatic stress disorder

Anxiety disorders such as depression and posttraumatic stress disorder (PSTD) are serious psychological disorders which can be managed using various approaches. Whether relying on psychodynamic therapy, pharmacological approach, or cognitive-behavioral therapeutic approach, individual or group therapy can be administered. Group therapy in PSTD is particularly gaining popularity due to features that are favorable to the victim and the potential outcomes thereof. Group therapies have been cited as suitable alternatives since they not only have promising benefits in reducing PSTD symptoms but they are also cost-efficient (Beck & Coffey, 2005).

Beck and Coffey (2005) also indicate that group therapy for PSTD becomes cost effective since it incorporates a large number of patients compared to individual-based therapy. Exploring the treatment of PSTD in group settings is therefore an important subject. It is however unfortunate that enough attention has not been given on the effectiveness of group therapy in PSTD (Schnurr et al, 2003). Group therapy and posttraumatic stress disorder Post traumatic stress disorder (PSTD) is classified as an anxiety disorder and it arises from experiencing a traumatizing event.

Berman and Berman-Davis (2005) mention PSTD as almost a sure diagnosis where persons have experienced a traumatic event. Traumatizing experiences include severe injury, being threatened of death (self or others) or any other harmful threat. The most common experience resulting to PSTD is being involved in a motor vehicle accident (Beck & Coffey, 2005). Sexual abuse as well as any form of domestic violence is also important factors that contribute to posttraumatic stress disorder.

A person suffering from PSTD usually experiences recurrent cues that remind the individual of the trauma, the emotions of the individual may get numbed whereas physical arousal heightens. Feelings of fear and a sense of helplessness may overtake the PSTD patient. Mood disorders are also a likely problem accompanying PSTD. As such, the individual may be highly irritable, or easily angered. It should be noted that the above symptoms ought to have persisted for more than one month after being exposed to trauma for one to be said to be suffering from PSTD otherwise the condition is Acute Stress Disorder (Berman & Berman-Davis, 2005).

Patients suffering from PSTD stand a chance to benefit in relieving the symptoms associated with the disorder thereby helping in restoring the individual to normal psychological state. Group therapy involves individuals who share a common background of experiences. Having common experiences makes the group therapy relevant to all the group participants. For instance, a person suffering PSTD due to rape would not fit in a group therapy composed of persons who underwent severe motor vehicle accident.

It is important to note that one can conduct group therapy in addition to individual or couple therapy so as to address issues that may not be well tackled in a group setting. Group therapy in posttraumatic stress disorder became a popular approach post Vietnam War where Vietnam veterans and their families needed help from the trauma suffered during the war. Armstrong and Rose (1997) cite that group psychotherapy to veterans and families was identified as a useful approach of dealing with symptoms of PSTD especially the loneliness experienced among partners to the veterans.

Group therapy is recognized as a way of coming to terms with trauma thereby reducing the symptoms of PSTD. There are three popular forms of group therapy useful in posttraumatic stress disorder. A psychoeducational skill group therapy is mainly an initial therapy for PSTD patients. It is necessary in the initial stages of treatment since it offers skills for coping with most symptoms experienced in PSTD. Among the vital components of this form of therapy include ways to handle anger and stress, understanding PSTD as well as teaching the victim to maintain a sense of wellbeing.

This group is usually flexible with attendance mainly depending on the client’s flexibility (Schein, 2006). In a trauma-based group therapy, the treatment gets more exhaustive thus it is usually highly effective. This therapy allows participants to deal with the specific traumas. Assistance of the group leader may be sought to ensure control and safety in the process since the therapy is quite difficult. A present-centered approach involves empowering participants to move on with life.

It is important to note that group therapy is directed by professional therapist and the group meets over a specified period off time to discuss a certain topic of concern. This kind of an arrangement is called structured therapy. Although there is no standard numbers of participants per group, group made of 9 to 12 members are most desirable and the members meet for about 12 sessions (Becky & Coffey, 2005). It is also notable that some groups may run for a limited time (e. g. the twelve session’s therapy) or in some cases there may be unlimited number of sessions. Instead of putting a time limit, the group focuses on a certain topic.

This is the most desirable group set up for posttraumatic stress disorder. It is recognized that the symptoms experienced in PSTD can exacerbate to a devastating level such that the individual’s daily functioning is severely affected. Having the individual in a structured environment where the risk of exacerbating the effects of the condition is acknowledged. This becomes a good chance to introduce group therapy since the group setting and experiences offer a favorable environment for the individual to cope with the trauma and eventually reduce the symptoms associated with PSTD.

Different therapeutic approaches have different outcomes in group PSTD therapy. For instance, Schnurr et al (2003) have identified that the effectiveness of group therapy is reduced when therapy takes a trauma-focused approach. In a study carried out among Vietnam veterans suffering from posttraumatic stress disorder, use of trauma-focused group therapy was found to be less helpful compared to present-focused group therapy. Friedman and colleagues identified that although trauma-focused group therapy achieved some success in reduction of symptoms related to PSTD, the magnitude by which the symptoms were reduced was very small.

In fact these authors recommended that another approach be considered for Vietnam veterans in place of trauma-focused group therapy. Effectiveness of group therapy using a long-term dynamic-oriented approach in treatment of PSTD symptoms have been explored by Britvick, Radelic and Urlic (2006). In acknowledgment that PSTD is associated with feelings of distrust and isolation, Britvick, Radelic and Urlic (2006) indicate that group psychotherapy is effectual in reducing the magnitude of such PSTD symptoms.

These authors carried out a study among a group of war veterans over a period of five years using a dynamic-oriented approach. Assessments during the second and the fifth year of therapy indicated positive change in PSTD symptoms compared to symptoms registered during initiation of the treatment program. Important to note in this study is that long-term group therapy is efficacious in reducing symptoms of PSTD. However, defense mechanisms such as projection as well as projection encountered in PSTD cases are rarely altered by the long-term group therapy.

This shows that while group therapy is a promising approach for treatment of symptoms of PSTD, defense mechanisms common in war veterans need to be addressed through other approaches. Group therapy has been found to be efficacious in cognitive-behavioral therapy (CBT) of posttraumatic stress disorder. In CBT, the patient gets exposed to trauma cues repeatedly up to a point where anxiety thereof is mastered. CBT is a choice treatment for PSTD and it attains better outcomes when conducted in group sessions in addition to paying attention to individual therapy.

Group CBT has been shown to have high promise in treatment of PSTD in victims of motor vehicle accidents. According to Beck and Coffey (2005) motor accident survivors who have gone through group CBT largely express satisfaction with the form of treatment. According to this author’s study on motor vehicle accident survivors, most of the participants were satisfied with the treatment to level that they would encourage others suffering from PSTD to seek the group approach. The main benefits that motor vehicle accident PSTD patients expressed include getting natural support from the group as well as cost effectiveness of the approach.

Beck and Coffey (2005) is however careful to state that group CBT still requires more research to fully establish its effectiveness in treatment of PSTD in motor vehicle accident victims. Group therapy in posttraumatic stress disorder has also been shown to be beneficial in non-war veteran victims. Since PSTD can result from other sources of trauma, exploring its effectiveness in a variety of traumas is noteworthy. In a study of the effectiveness of structured group therapy among PSTD male juveniles, Ovaert, Cashel and Sewell (2003) identified positive outcomes after undergoing the therapy.

After a 12-session group therapy, imprisoned male juveniles suffering from PSTD were found to benefit greatly. Lynda and colleagues report a remarkable reduction in PSTD symptoms especially among youths who had suffered trauma as a result of being involved in gang violence. This finding is indicative of the potential benefits of group therapy in PSTD in non-war veteran victims. Elsewhere, Lubin et al (1998) had identified group therapy as effective in treatment of PSTD using a trauma-focused cognitive-behavioral approach in women who suffered multiple traumas.

Due to multiple traumas, the women were suffering from chronic posttraumatic stress disorder. According to this study, there was appreciable reduction in PSTD symptoms at the end of a 16-week therapy. Not only were the symptoms reduced by the end of the program but the benefits persisted even after 6 months post-treatment. This is a positive finding that group therapy has sustainable benefits in PSTD treatment. Treatment of PSTD symptoms in young people has been shown to be effective since exposure to peer environment normalizes experiences better.

According to Jones and Stewart (2007, p 255), young people suffering from PSTD benefit from group settings as “it allows for exposure to similar peers who have also experienced a trauma and, most likely, similar psychological and physiological reactions to it. ” Combining pharmacotherapy with group CBT for young people therefore presents a better means of dealing with symptoms of posttraumatic stress disorder. In a group setting, young people are able to not only compare their situations with others but they are also able to monitor themselves in the process of gaining new skills necessary for handling trauma.

The group environment is also favorable for the young person to be empowered in showing their competency in handling trauma as they help their peers heal. This is especially important for children who may be feeling powerless due to victimization. From this viewpoint, group therapy is not a reserve treatment for PSTD adults only but children and adolescents stand even greater chances of benefiting. Conclusion Posttraumatic stress disorder is an anxiety disorder which can be managed through several approaches. Whereas individual therapy has been widely applied and succeeded in most cases, a consideration of group therapy is worthy.

Carrying out group therapy in posttraumatic stress disorder presents a myriad of benefits as demonstrated by various studies. It is evident that in addition to achieving cost benefits through taking up many participants in a group, group therapy has shown promising therapeutic benefits. Through group therapy, symptoms such as irritability, numbed feelings, feelings of hopelessness and other mood disorders are significantly reduced not only among adults but also in young people. The promise of group therapy has been shown in psychoeducational skill, trauma-based as well as present-centered group therapy approaches.

Despite these potential benefits, group therapy in PSTD still requires further research to ascertain wide applicability of this therapeutic approach. References Armstrong, M. A. and Rose, P. (1997). Group therapy for partners of combat veterans with post-traumatic stress disorder. Perspectives in Psychiatric Care, 13(4): 14+. Web. 21 May 2010. Questia. com. Beck, J. G. and Coffey, S. F. (2005). Group cognitive behavioral treatment for PTSD: Treatment of motor vehicle accident survivors. Cogn Behav Pract. , 12(3): 267–277. Berman, D. S. and Davis-Berman, J.

(2005). Reconsidering Post-traumatic Stress. The Journal of Experiential Education, 28(2): 97+. Web. 21 May 2010. Questia. com. Britvic, D. , Radelic, N. and Urlic, I. (2006). Long-term dynamic-oriented group psychotherapy of Posttraumatic Stress Disorder in war Veterans: prospective study of five-year treatment. Croat Med J. , 47(1): 76–84. Jones, A. B. and Stewart, J. L. (2007). “Group-cognitive behavioral therapy to address posttraumatic stress disorder in children and adolescents. ” In Christner, R. W. , Stewart, J. L. and Freeman, A.

Handbook of cognitive-behavior group therapy with children and adolescents: specific settings and presenting problems. ISBN0415952549, 9780415952545: CRC Press. Lubin, H. , Loris, M. , Burt, J. and Johnson, D. R. (1998). Efficacy of psychoeducational group therapy in reducing symptoms of Posttraumatic Stress Disorder among multiply traumatized women. Am J Psychiatry 155:1172-1177. Ovaert, L. B. , Cashel, M. L. and Sewell, K. W. (2003). Structured group therapy for posttraumatic stress disorder in incarcerated male juveniles. American Journal of Orthopsychiatry, 73(3): 294-301.

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