To master difficulties within the cognitive behavioural therapy of PTBS: A new algorithmic model of therapy

Mervin R. Smucker, Ph.D.

The increasing number of studies about psychotraumatology enables clinicians today a better understanding of the treatment of PTSD than 10 years ago.  Research on trauma as treatment are now detached from their former focus on war traumata. To the field of work belong nowadays knowledge and offerings for victims of physical violence, sexual abuse, massive threat to life (for example armed assault, hijacking), acts of terror, industrial accidents, injury in job, road accidents or natural catastrophes.

Most studies in the field of trauma show that cognitive as well as on a Confrontation Rationale based therapies which aim at a emotional reprocessing of traumatic situations are the most effective PTSD treatments (Sherman, 1998) Meanwhile we know that some patients do not benefit from this type of therapy. (Bryant, 2002; Grunert, Weis, & Rusch, 2000).

Up to now there were hardly no efforts to understand and to explain these cognitive-behavioural therapeutic “failures” in PTSD treatments. Instead of spending one’s time on the question at what point of time or under which circumstances specific cognitive-behavioural therapeutic interventions with the highest (or smallest) probability modify certain traumata, representatives maintained that it must be the incorrect implementation of the treatment that causes the “failures”.

The possibilitity however that specific cognitive therapies or confrontation thereapies – although empirically reviewed – are not suitable for specific types of trauma is in scientific literature considered only insuffieciently. At that moment there are no CBT treatments that either analyse or try to predict which specific interventions for exactly which types of trauma and characteristics of trauma are the best suitable.

It is a fact that clinicians do not yet have constructive guidelines to master difficulties in the PTSD treatment and to react when a CBT treatment on a specific patient does not show the anticipated success.