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Post-Traumatic Stress Disorder
Treating PTSD with Expert Companionship
A posttraumatic growth-based model for addressing PTSD.
Posted August 23, 2022 Reviewed by Devon Frye
Key points
- Alternatives to traditional PTSD treatments are needed.
- Posttraumatic growth-based models provide an alternative to traditional PTSD treatments.
- Expert companionship is based on sound psychological principles shown to work in research studies.
In our previous article, we discussed the challenges and limitations of the current and most popular talk therapies for posttraumatic stress disorder. Here, we discuss an alternative approach to addressing PTSD that is based on the theory of posttraumatic growth and the related intervention model, expert companionship, as described by Tedeschi and McNally (2011), Calhoun and Tedeschi (2013), and Tedeschi and Moore (2016).
This intervention relies heavily on key individuals who assume the role of expert companion, which involves joining participants in supportive conversation as they make their way through phases of distress, growth, and transformation (Tedeschi, Shakespeare-Finch, Taku, & Calhoun, 2018). Expert companions support individuals as they attempt to understand and accept current circumstances that have unfolded in the aftermath of traumatic events, as they work to consider new or revised cognitive beliefs and identities, and as they search for meaning in their experiences (Tedeschi et al., 2018). Above all, expert companions join individuals who are actively struggling with distress in working towards the positive psychological change that can stem from psychological trauma, known as posttraumatic growth (Tedeschi et al., 2018).
Expert companions actively join participants as they journey through the five phases of the expert companionship model. First, they facilitate psychoeducation about trauma responses in a way that specifically emphasizes the PTG perspective on core belief disruption as well as the physiological aspects of trauma response.
Second, they train participants on the necessity for and application of emotional regulation practices that allow them to better tolerate internal and external reminders of trauma as well as interpersonal conflict. Third, these individuals evoke disclosure of memories or situations that trigger PTSD symptoms associated with avoidance and arousal. The exposure that occurs during this process happens naturally during the various low-threat exercises and is not as deliberate as seen in evidenced-based psychotherapies like prolonged exposure; in this way, it is not unlike exposure that occurs in the discourse between a trauma survivor and someone within his or her social support system.
Fourth, individuals are invited to create a coherent narrative in order to develop a clearer sense of their life events and how they have led to their current situation and point toward possible futures. Finally, individuals develop new missions of service that allow them to transform their trauma experiences into benefits for others. These PTG-based elements are nested within a variety of different activities such as journaling, peer-led group discussions, goal setting, meditation, and physical adventure-based therapies that have been shown to be efficacious for reducing negative mental health symptoms.
Considering the strengths of the posttraumatic growth-based expert companionship model, including its underlying PTG philosophy, we believe it is a promising alternative or supplement to existing first-line PTSD treatments available to military, veteran, and first responders. We believe that the model mitigates some limitations noted with other evidence-based treatments.
Specifically, the PTG-based philosophy underlying expert companionship is designed to help participants develop new missions and goals, while also facilitating psychological processing of the struggles that unfold in the aftermath of trauma. This important work, which is facilitated with a deep understanding of cultural norms and challenges, makes the intervention highly effective for addressing symptoms of PTSD and other mental health issues in military and first responder populations.
In light of research suggesting that current first-line psychotherapies available to military, veteran, and first responder populations do not consistently improve PTSD symptoms, we believe the posttraumatic growth (PTG)-based expert companionship model is a viable intervention available to our nation’s heroes who are in need of tremendous support as they work towards healing deep psychological wounds stemming from posttraumatic stress.
We would like to thank Taryn Greene, Ph.D. for her work on this review for the Boulder Crest Institute.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edition). American Psychiatric Publishing.
Barrington, A., & Shakespeare-Finch, J. (2013). Posttraumatic growth and posttraumatic depreciation as predictors of psychological adjustment. Journal of Loss and Trauma, 18(5), 429-443.
Blevins, C. L., Greene, T. C., & Tedeschni, R. G. (2019). Identifying and Facilitating Posttraumatic Growth in Military Personnel. In Moore, B., & Penk, W. (Eds.), Treating PTSD in Military Personnel: A Clinical Handbook, (pp. 415). New York: Guilford Press.
Calhoun, L., & Tedeschi, R. (2013). Posttraumatic growth in clinical practice. New York: Routledge.
U.S. Department of Veterans Affairs and U.S. Department of Defense. (2017). VA/DOD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder. Retrieved from https://www.healthquality.va.gov/guidelines/mh/ptsd/.
Edwards‐Stewart, A., Smolenski, D. J., Bush, N. E., Cyr, B. A., Beech, E. H., Skopp, N. A., & Belsher, B. E. (2021). Posttraumatic Stress Disorder Treatment Dropout Among Military and Veteran Populations: A Systematic Review and Meta‐Analysis. Journal of Traumatic Stress. 1-11.
Eftekhari, A., Crowley, J. J., Mackintosh, M. A., & Rosen, C. S. (2020). Predicting treatment dropout among veterans receiving prolonged exposure therapy. Psychological trauma: Theory, research, practice, and policy, 12(4), 405-412.
Ellis, A. E., Simiola, V., Brown, L., Courtois, C., & Cook, J. M. (2018). The role of evidence-based therapy relationships on treatment outcome for adults with trauma: A systematic review. Journal of Trauma & Dissociation, 19(2), 185-213.
Gil, S. (2015). Is secondary traumatization a negative therapeutic response? Journal of Loss and Trauma, 20(5), 410-416.
Hamblen, J. L., Norman, S. B., Sonis, J. H., Phelps, A. J., Bisson, J. I., Nunes, V. D., ... & Schnurr, P. P. (2019). A guide to guidelines for the treatment of posttraumatic stress disorder in adults: An update. Psychotherapy, 56(3), 359-373.
Haugen, P. T., Evces, M., & Weiss, D. S. (2012). Treating posttraumatic stress disorder in first responders: A systematic review. Clinical psychology review, 32(5), 370-380.
Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Welton, N. J., Stockton, S., ... & Pilling, S. (2020). Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychological medicine. 50, 542-555.
Miles, S. R., Hale, W. J., Mintz, J., Wachen, J. S., Litz, B. T., Dondanville, K. A., Yarvis, J. S., Hembree, E. A., Young-McCaughan, S., Peterson, A. L., & Resick, P. A. (2022). Hyperarousal symptoms linger after successful PTSD treatment in active-duty military. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0001292
Moore, B. A., Tedeschi, R. G., & Greene, T. C. (2021). A preliminary examination of a posttraumatic growth-based program for veteran mental health. Practice Innovations, 6(1), 42.
Sciarrino, N. A., Warnecke, A. J., & Teng, E. J. (2020). A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder. Journal of Traumatic Stress, 33(4), 443-454.
Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., Tendick, V., & Gray, S. H. (2008). Nonresponse and dropout rates in outcome studies on PTSD: Review and methodological considerations. Psychiatry: Interpersonal and biological processes, 71(2), 134-168.
Steenkamp, M. M., Litz, B. T., & Marmar, C. R. (2020). First-line psychotherapies for military-related PTSD. Journal of the American Medical Association, 323(7), 656-657.
Steenkamp, M. M., Litz, B. T., Hoge, C. W., & Marmar, C. R. (2015). Psychotherapy for military-related PTSD: A review of randomized clinical trials. Journal of the American Medical Association, 314(5), 489-500.
Tedeschi, R. G., & McNally, R. J. (2011). Can we facilitate posttraumatic growth in combat veterans? American Psychologist, 66(1), 19-24. doi: 10.1037/a0021896
Tedeschi R. & Moore, B. A. (2016). The posttraumatic growth workbook: Coming through trauma wiser, stronger, and more resilient. Oakland, CA: New Harbinger.
Tedeschi, R. G., Shakespeare-Finch, J., Taku, K., & Calhoun, L. G. (2018). Posttraumatic growth: Theory, research, and applications. Routledge.
Winders, W. T., Bustamante, N. D., Garbern, S. C., Bills, C., Coker, A., Trehan, I., ... & Levine, A. C. (2021). Establishing the effectiveness of interventions provided to first responders to prevent and/or treat mental health effects of response to a disaster: a systematic review. Disaster medicine and public health preparedness, 15(1), 115-126.
*The comprehensive reference list above is related to this column and the previous one.
