PTSD Clinicians Guide

Cognitive-Behavioral Therapy for

PTSD

A Program for Addiction Professionals

Clinicians Guide

Mark P. McGovern, Ph.D.Kim T. Mueser, Ph.D.

Jessica L. Hamblen, Ph.D.Kay Jankowski, Ph.D.

HazeldenCenter City, Minnesota 55012

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Cover design by David SpohnInterior design by Madeline BerglundTypesetting by Madeline BerglundIllustrations by Patrice Barton

Illustrations for handout 17, Feelings from A to Z, by David Swanson

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ABOUT THE AUTHORS

Mark P. McGovern, Ph.D.Mark P. McGovern, Ph.D., is an Associate Professor of Psychiatry and of Community andFamily Medicine at the Dartmouth Medical School in Hanover, New Hampshire. He joinedDartmouth in 2001 after fifteen years on the faculty of the Department of Psychiatry andBehavioral Sciences at Northwestern University Medical School in Chicago. He began hisprofessional career as an alcohol counselor in an inner-city detoxification program inNorth Philadelphia in 1978. Dr. McGovern specializes in the treatment of co-occurring sub-stance use and psychiatric disorders and practices through the Department of Psychiatry atDartmouth Hitchcock Medical Center. He has studied and published widely in the area ofaddiction treatment services research. He has conducted treatment research in a variety ofsettings including addiction treatment programs, community mental health centers, statepsychiatric hospitals, academic medical centers, office-based practices, private specialtytreatment programs, and state addiction and mental health treatment delivery systems.Dr. McGovern has worked extensively with special populations including impaired healthcare professionals and the National Football Leagues Program for Substance Abuse. Hehas also conducted training and research in the assessment and treatment of the dual-diagnosis patient in both psychiatric and addiction treatment systems. In July 2004, hereceived a career development award from the National Institute on Drug Abuse. Theoverarching goal of this award involved developing, testing, and transferring evidence-based treatments to community settings for persons with co-occurring substance use andpsychiatric disorders.

Kim T. Mueser, Ph.D.Kim T. Mueser, Ph.D., is a clinical psychologist and a Professor in the Departments ofPsychiatry and of Community and Family Medicine at the Dartmouth Medical School inHanover, New Hampshire. From 1985 to 1994, he was on the faculty in the Department ofPsychiatry at Drexel University College of Medicine, where he was an Assistant Professorand then Associate Professor. Dr. Muesers clinical and research interests include the treat-ment of co-occurring psychiatric and substance use disorders, post-traumatic stress disorder,and psychiatric rehabilitation for severe mental illnesses. He has published extensively, is theco-author of more than ten books, and has given numerous lectures and workshops. Hisresearch has been supported by the National Institute of Mental Health, the NationalInstitute on Drug Abuse, the Substance Abuse and Mental Health Services Administration,and the National Alliance for Research on Schizophrenia and Depression. In 2007, hereceived the Emily Mumford Medal for Distinguished Contributions to Social Science inMedicine from the Department of Psychiatry, College of Physicians and Surgeons ofColumbia University.

ABOUT THE AUTHORS

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Jessica L. Hamblen, Ph.D.

Jessica Hamblen, Ph.D., is the Deputy Director for Education at the National Center forPosttraumatic Stress Disorder and Assistant Professor of Psychiatry at the DartmouthMedical School in Hanover, New Hampshire. After working as a substance abusecounselor at an adolescent inpatient chemical dependency program, she attendedthe State University of New York at Buffalo where she obtained her Ph.D. in clinicalpsychology in 2000. She completed her internship and postdoctoral fellowship atDartmouth. Dr. Hamblens interests are in developing, disseminating, and evaluatingcognitive-behavioral treatments for PTSD and related conditions. Dr. Hamblen haswritten more than twenty-five publications, presents regularly at national conferences,and provides training across the country on PTSD and post-disaster interventions.She was principal author of a twelve-session cognitive-behavioral intervention forpost-disaster distress that was used in New York City after the September 11, 2001,terrorist attacks, in Florida following the hurricanes of 2004, and in Baton Rouge,Louisiana, after Hurricane Katrina. Dr. Hamblen is currently evaluating the inter-vention in a randomized controlled trial with survivors of Hurricane Ike.

Kay Jankowski, Ph.D.

Kay Jankowski, Ph.D., is an Assistant Professor of Psychiatry at the Dartmouth MedicalSchool in Hanover, New Hampshire. She is a clinical psychologist who specializes inthe treatment of children, adolescents, and adults who have been traumatized andsuffer post-traumatic symptoms. Dr. Jankowski provides training and consultation toproviders in New Hampshire and elsewhere in best practices for treatment of trauma-related disorders in children and adolescents. She has given numerous presentationsto community and professional organizations on trauma and PTSD and publishedarticles on trauma and its effects.

List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

How to Build a Patient Workbook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Part 1: Background

Chapter 1: PTSD and Addiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Chapter 2: Core Principles of Cognitive-Behavioral Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Chapter 3: Background and Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Chapter 4: Evidence for CBT for PTSD among People with Severe Mental Illnesses

and Other Vulnerable Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Chapter 5: Evidence and Experience of CBT for PTSD in Addiction Treatment Programs . . . . . . 31

Part 2: Practical Considerations Before You Begin

Chapter 6: CBT and Traditional Addiction Counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Chapter 7: Therapeutic Alliance and Therapeutic Frame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Chapter 8: Logistical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Chapter 9: How to Use This Guide . . . . . . . . . . . . . . . . . . . . .