LPC Trauma-Informed Care and PTSD Treatment 2 — Questions and Answers
Question 1: Cognitive Processing Therapy (CPT) for PTSD focuses on changing which type of maladaptive cognition associated with trauma?
- Core beliefs about self developed in early childhood
- Stuck points — distorted beliefs about the trauma and its meaning related to safety, trust, power, esteem, and intimacy (Correct answer)
- Hallucinations and delusions triggered by trauma reminders
- Automatic thoughts maintaining generalized anxiety
Correct answer: Stuck points — distorted beliefs about the trauma and its meaning related to safety, trust, power, esteem, and intimacy
CPT targets 'stuck points' — maladaptive beliefs about the trauma's meaning related to five domains: safety, trust, power/control, esteem, and intimacy.
Developed by Patricia Resick, CPT is a structured, manual-based treatment consisting of 12 sessions. The core of CPT is identifying and challenging 'stuck points' — specific maladaptive beliefs that prevent natural emotional processing of the trauma. These are organized around five PTSD-maintaining themes: safety, trust, power/control, esteem, and intimacy. CPT includes a trauma account (A Account) and structured worksheets for challenging stuck points.
Question 2: Secondary traumatic stress (STS) in mental health professionals is best described as:
- Job burnout caused by administrative burdens and bureaucratic demands
- Trauma symptoms that develop as a result of indirect exposure to others' trauma through therapeutic work (Correct answer)
- The counselor's conscious decision to take on too many traumatized clients
- A diagnosable condition included in DSM-5
Correct answer: Trauma symptoms that develop as a result of indirect exposure to others' trauma through therapeutic work
STS involves the development of PTSD-like symptoms — intrusion, avoidance, and hyperarousal — in professionals as a result of indirect exposure to clients' traumatic material.
Secondary traumatic stress (also called compassion fatigue or vicarious traumatization) refers to the indirect trauma that mental health professionals can experience through empathic engagement with traumatized clients. Symptoms parallel PTSD: intrusive imagery, nightmares, hypervigilance, avoidance of trauma-related content, and emotional numbing. Self-care, supervision, peer support, and organizational support are critical protective factors for trauma therapists.
Question 3: Somatic therapies for trauma, such as Somatic Experiencing (SE), address PTSD by:
- Exclusively using cognitive interventions to reframe trauma memories
- Working with body sensations and the discharge of trauma-related physiological activation (Correct answer)
- Prescribing psychotropic medications to stabilize the nervous system
- Conducting exposure therapy through imaginal rehearsal only
Correct answer: Working with body sensations and the discharge of trauma-related physiological activation
Somatic Experiencing, developed by Peter Levine, helps clients track and discharge the trapped physiological activation (survival energy) associated with traumatic experiences.
Peter Levine's Somatic Experiencing is based on the observation that animals in the wild naturally discharge trauma energy through shaking and trembling, preventing PTSD. Humans often inhibit these discharges. SE uses titrated tracking of body sensations (interoception), pendulation between distress and resources, and facilitated discharge of trapped survival energy to renegotiate and resolve trauma at a physiological level. Pat Ogden's Sensorimotor Psychotherapy is a related body-based approach.
Question 4: The polyvagal theory, developed by Porges, is relevant to trauma treatment because it explains how the autonomic nervous system:
- Regulates sleep and appetite through the hypothalamic-pituitary-adrenal axis
- Creates hierarchical defensive responses (social engagement, fight/flight, freeze) that shape trauma responses (Correct answer)
- Controls the release of cortisol and adrenaline during acute stress
- Produces dissociative symptoms through hemispheric disconnection
Correct answer: Creates hierarchical defensive responses (social engagement, fight/flight, freeze) that shape trauma responses
Porges' polyvagal theory describes three hierarchical ANS states — ventral vagal (social engagement), sympathetic (fight/flight), and dorsal vagal (freeze) — that underlie trauma responses.
Stephen Porges' Polyvagal Theory proposes that the autonomic nervous system responds to perceived threat in a hierarchical sequence: the ventral vagal system supports social engagement and connection; when threatened, the sympathetic system mobilizes fight or flight; when overwhelmed, the dorsal vagal system produces immobilization (freeze, collapse). Trauma can cause chronic dysregulation of these systems. Polyvagal theory informs trauma treatment by providing a neurophysiological framework for understanding and working with body-based trauma responses.
Question 5: Trauma-focused Cognitive Behavioral Therapy (TF-CBT) is specifically designed for use with which population?
- Adults with chronic PTSD following combat exposure
- Children and adolescents who have experienced trauma, and their caregivers (Correct answer)
- Older adults with trauma histories and comorbid dementia
- Emergency responders following critical incident exposure
Correct answer: Children and adolescents who have experienced trauma, and their caregivers
TF-CBT was developed by Cohen, Mannarino, and Deblinger specifically for trauma-exposed children and adolescents and their non-offending caregivers.
TF-CBT is a structured, components-based treatment using the PRACTICE acronym: Psychoeducation, Relaxation, Affective modulation, Cognitive coping, Trauma narrative development, In vivo mastery, Conjoint child-parent sessions, and Enhancing safety and future development. The parallel caregiver component is essential — caregivers learn the same skills as their children and are prepared to support the trauma narrative. TF-CBT has robust evidence across multiple trauma types.
Question 6: Dissociation in trauma survivors involves which of the following primary processes?
- Deliberate suppression of traumatic memories to avoid distress
- A disruption or discontinuity in consciousness, identity, memory, emotion, or behavior as a protective response to overwhelm (Correct answer)
- The complete elimination of traumatic memories from long-term storage
- Neurological damage to the hippocampus that permanently impairs encoding
Correct answer: A disruption or discontinuity in consciousness, identity, memory, emotion, or behavior as a protective response to overwhelm
Dissociation is an automatic, protective disconnection of normal integrative functions of consciousness, identity, memory, or perception in response to overwhelming experience.
Dissociation exists on a continuum from mild everyday experiences (highway hypnosis) to severe dissociative disorders (DID). In trauma contexts, dissociation is understood as an automatic protective response when an experience is too overwhelming to be fully integrated. Structural dissociation theory (van der Hart, Nijenhuis, Steele) proposes that trauma disrupts the integration of personality into apparently normal parts (ANP) and emotional parts (EP). Trauma treatment often involves gradual integration of dissociated material within the Window of Tolerance.
LPC Trauma-Informed Care and PTSD Treatment 2
Cognitive Processing Therapy (CPT) for PTSD focuses on changing which type of maladaptive cognition associated with trauma?