By Sudie E. Back, Edna B. Foa, Therese K. Killeen, Katherine L. Mills, Maree Teesson, Bonnie Dansky Cotton, Kathleen M. Carroll, Kathleen T. Brady
Concurrent therapy of PTSD and Substance Use issues utilizing lengthy Exposure (COPE) is a cognitive-behavioral psychotherapy application designed for sufferers who've posttraumatic rigidity ailment (PTSD) and a co-occurring alcohol or drug use disease. COPE represents an integration of 2 evidence-based remedies: lengthy publicity (PE) remedy for PTSD and Relapse Prevention for substance use disorders.
COPE is an built-in therapy, which means that either the PTSD and substance use ailment are addressed simultaneously in treatment by way of a similar clinician, and sufferers can event great discounts in either PTSD indicators and substance use severity. sufferers use the COPE sufferer Workbook whereas their clinician makes use of the Therapist Guide to bring remedy. this system is constituted of 12 person, 60 to ninety minute remedy classes. this system comprises a number of parts: information regarding how PTSD indicators and substance use have interaction with each other; information regarding the commonest reactions to trauma; recommendations to assist the sufferer deal with cravings and strategies approximately utilizing alcohol or medicinal drugs; coping abilities to assist the sufferer hinder relapse to elements; a respiring retraining rest workout; and in vivo (real lifestyles) and imaginal exposures to focus on the patient's PTSD indicators.
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Extra resources for Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE): Therapist Guide
Development of treatment goals 4. Introduce Treatment Contract 5. Teach and model breathing retraining 6. Assign homework 1. Treatment Overview Give the patient an overview of the structure of the treatment, cover confidentiality issues, and review the PTSD and SUD treatment components. 43 Therapist Note Turn off your cell phone and ask the patient to do the same before you begin each session, especially the sessions in which imaginal exposure is conducted (sessions 4–11). I am really glad that you have chosen to come to treatment.
However, if patients are unwilling to participate in the therapy with the goal of abstinence in mind, they may instead strive toward a substantial reduction in substance use. In this case, it is important to revisit goals throughout treatment, as patients may start to realize that the use of substances is more of a problem than they initially thought, and that abstinence would be a healthier goal. 38 Ask patients to talk about any drug use that occurs and about any cravings or fears of relapse that they experience.
In the long run, however, avoidance maintains trauma-related fear by impeding emotional processing. By approaching trauma memories and reminders, PE reduces the habit of diminishing distress via cognitive and behavioral avoidance, thereby reducing one of the primary factors that maintains PTSD. Another mechanism involved in emotional processing is habituation of anxiety, which disconfirms erroneous beliefs that anxiety will last forever or will diminish only upon escape. Patients also learn that they can tolerate their symptoms and that having them does not result in “going crazy” or “losing control,” -fears commonly held by individuals with PTSD.