Cognitive-Behavioral Therapy: A Case Report -- Animal-Assisted Therapy

Janet Eggiman, BSN, MSN

Disclosures

October 12, 2006

In This Article

The Treatment of Posttraumatic Stress Disorder

Treatment of posttraumatic stress disorder (PTSD) in children includes behavioral interventions, cognitive-behavioral interventions, psychoeducation, medication, and play therapy.[18] The National Institute of Mental Health supports the use of CBT in the treatment of PTSD and other anxiety disorders.[19]

Behavioral interventions include techniques to increase the child's sense of safety and security. Parents and caregivers are encouraged to set family rules, provide structure with a consistent schedule, and set clearly defined roles and responsibilities. Children who have been traumatized by sexual or physical abuse should be provided with privacy and boundaries.[19]

Cognitive-behavioral interventions include teaching the child coping techniques and strategies for dealing with nightmares, intrusive thoughts, and panic. This involves relaxation techniques, distraction, and social support. For many children, there is a numbing of feelings and a resulting hypoarousal or hyperarousal, resulting in increased reactivity. It is important to teach children about feelings and thoughts and provide them with skills to express them.[20] Children can be taught "helpful thoughts" in order to improve behavior and self-esteem.[21]

Exposure to traumatic stimuli is another cognitive-behavioral treatment for PTSD. It is recommended that some form of exposure be included in the treatment for PTSD. The benefits of this include a reduction of anxiety, the blocking of negative reinforcement that results in fear reduction when avoiding trauma-related thoughts and feelings, the incorporation of safety information when trauma memory is recounted in a safe environment, and differentiation of the traumatic event from daily life. This changes the meaning of PTSD from a sign of failure to one of mastery and courage, and challenges the negative evaluations of the patients.[22]

Play therapy is often used and is either nondirective or minimally directive to help children reveal details of the trauma or help them identify feelings and thoughts that are related to the trauma.[23]

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