(Safety) Behavior Therapy for PTSD (June 2024)

Course Overview

(Safety) Behavior Therapy for PTSD is a simple and effective behavior therapy that focuses on reducing and countering safety behaviors to treat PTSD. Safety behaviors are well established in the etiology and maintenance of PTSD (Dunmore et al., 1999). These behaviors both maintain the sense of threat characteristic of PTSD and prevent the processing of traumatic memories (Goodson & Haeffel, 2022). Safety behavior usage is also associated with smaller treatment gains in PTSD treatments (Goodson & Haeffel, 2018). Surprisingly, relatively little attention is given to safety behaviors in the treatment of PTSD and no treatments have been developed that solely focus on safety behaviors. This is somewhat surprising given that early conceptual models emphasized safety behaviors (Dunmore et al; 1999), several of the symptoms of PTSD are themselves safety behaviors (e.g., vigilance, avoidance, etc.), and safety behavior usage is well known to interfere with CBT treatment outcomes (Helbig-lang et al., 2017). (S)B-PTSD is divided into the following phases: 1) assessment, education, awareness building; 2) addressing safety behaviors related to intrusive memories; 3) addressing threat-related safety behaviors; and 4) moving forward. (S)B-PTSD also contains 3 optional modules specific to PTSD, which include: 1) Trust-related safety behaviors 2) Withdrawal and Avoidance-related safety behaviors, and 3) Rumination-related safety behaviors. The first phase culminates with a Master List of safety behaviors to be addressed in treatment and leads into the intrusive memory processing phase. This begins with Welcoming Intrusions, which is a mindfulness-based practice for calling up and holding intrusive memories along with the feelings that accompany them. Clients are also taught how to accept intrusions in real time. Next, purposeful trauma recall is carried out, which is a scene-by scene walk-through of the traumatic event (along with holding images and feelings for each scene). Following, trauma narrative writing is carried out in 1-2 sessions and the narrative is continued to be read until by the client feels ready to stop. Other potential interventions in this phase include addressing keeping one’s mind occupied, (e.g., do nothing for 30 minutes) countering avoidance of triggers (e.g., trigger seeking);countering avoidance of the memory (e.g.,. talking with others about the trauma when appropriate), and countering intrusions through art (e.g., drawing the trauma,, writing a poem, writing letters, etc.). These continue until the client feels the trauma has been processed. Additionally, a measure called the Intrusive Memory Questionnaire is used to help assess the extent to which the memory has been processed and this phase completed. The next phase addresses threat -related safety behaviors. This phase has a primary emphasis on countering vigilance. As an augmentation strategy, Attention Training can be used to help develop attention flexibility and the ability to refocus out of threat-based vigilance states. Two primary strategies are used to address vigilance. The first is a mindfulness intervention known as Recognize, Drop, and Refocus. The next are blocking interventions where clients are taught ways to prevent themselves from scanning for danger. While vigilance is the primary focus of this phase, other safety behaviors are addressed in this phase as well (checking, escape, evade, planning, excessive preparation, etc.). During this phase, the goal to work through all the safety behaviors on the master list. The SBAF-PTSD subscale is a useful measure for helping determine when clients are ready to end this treatment phase. The final phase of treatment is Moving Forward, which is a discussion of progress and how to maintain gains in treatment.

(S)B-PTSD also has three optional modules that can be useful, especially for relationship distress and/or depression. These include: 1) trust-related safety behaviors (identifying and countering interpersonal protective safety behaviors); 2) withdrawal and avoidance safety behaviors (identifying and incorporating valued activities and valued relationships, and countering avoided situations), and 3) rumination (monitoring and reducing/countering rumination). Early effectiveness data show large treatment effects for (S)B-PTSD. One PTSD clinical team and several trainees have undergone this training for (S)B-PTSD and approximately 25 cases have been completed. Outcomes show reductions similar to those seen in prolonged exposure therapy with significant decreases in PTSD, depression, intrusions, and safety behaviors and significant increases in quality of life. A description of the treatment and early outcomes have published in the Journal of Clinical Psychology and Special Education (Goodson & Haeffel, 2022).

Participants will be given client and therapist workbooks along with helpful treatment forms and materials. They will also be given a copy of the Safety Behavior Assessment Form and the recently validated PTSD subscale.

Learning Objectives

Course Bibliography

Approvals

Cognitive Behavior Institute, #1771, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 06/30/2022-06/30/2025. Social workers completing this course receive 7 total credits including 6 clinical continuing education credits.

Cognitive Behavior Institute, LLC is recognized by the New York State Education Department's State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0098 and the State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0646 and the State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors #MHC-0216.

Cognitive Behavior Institute has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7117. Programs that do not qualify for NBCC credit are clearly identified. Cognitive Behavior Institute is solely responsible for all aspects of the programs.

Cognitive Behavior Institute is approved by the American Psychological Association to sponsor continuing education for psychologists. Cognitive Behavior Institute maintains responsibility for content of this program. Social workers, marriage and family therapists, and professional counselors in Pennsylvania can receive continuing education from providers approved by the American Psychological Association. Since CBI is approved by the American Psychological Association to sponsor continuing education, licensed social workers, licensed marriage and family therapists, and licensed professional counselors in Pennsylvania will be able to fulfill their continuing education requirements by attending CBI continuing education programs. For professionals outside the state of Pennsylvania, you must confirm with your specific State Board that APA approved CE's are accepted towards your licensure requirements. The Association of Social Work Boards (ASWB) has a process for approving individual programs or providers for continuing education through their Approved Continuing Education (ACE) program. ACE approved providers and individual courses approved by ASWB are not accepted by every state and regulatory board for continuing education credits for social workers. Every US state other than New York accepts ACE approval for social workers in some capacity: New Jersey only accepts individually approved courses for social workers, rather than courses from approved providers. The West Virginia board requires board approval for live courses, but accepts ASWB ACE approval for other courses for social workers. For more information, please see https://www.aswb.org/ace/ace-jurisdiction-map/. Whether or not boards accept ASWB ACE approved continuing education for other professionals such as licensed professional counselors or licensed marriage and family therapists varies by jurisdiction. To determine if a course can be accepted by your licensing board, please review your board’s regulations or contact them. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit.