**5. Treatment**

40 Post Traumatic Stress Disorders in a Global Context

stress disorder often assume personal responsibility for the trauma by attributing it's occurrence a personal deficiency, they also overestimate the likelihood of something

Ehlers and Clark's theory adopts some of the same concepts from dual representation theory and posits that a pathological memory contains only the sensory and emotional aspects of the event. Since the individual has not integrated the memory into their autobiographical memory, they are unable to provide all of the details of the event on cue. Remembering the details of the event may buffer from having unwanted recollections by providing context for memory. The chronological details of the event are also important because those with posttraumatic stress disorder may not be consciously aware of all of the precursors of the event, but can still be triggered by a stimulus that preceded the trauma. These individuals may also show biased attention for the negative aspects of what occurred before, during, and after the trauma. Furthermore, they often engage in behaviors that cause or exacerbate their symptoms, such as avoiding reminders of the trauma. Their avoidance often causes intrusive recollections, fails to give them the opportunity to disprove their beliefs about the trauma, and inhibits them from creating an autobiographical memory of the event. This theory provides the most integrative and detailed explanation of posttraumatic stress disorder and clearly incorporates many of the theories that preceded it. The theory's multifaceted explanation of posttraumatic stress disorder provides clinicians with a complex framework for viewing their clients. Due to the complexity of the theory, clinicians can choose which aspects are the most relevant to the cognitive distortions that they are seeing

In recent years, researchers have extended the biological theories on depression to posttraumatic stress disorder due to the comorbidity of both disorders. Kilpatrick and colleagues (2007) were one of the first research teams to generalize the genetic research on the serotonin transporter gene (5-HTTLPR) from depression to posttraumatic stress disorder. Previous research established that those with two short 5-HTTLPR alleles had a higher risk of developing depression than those with two long alleles or a combination of a short and long allele (Lesch et. al., 1996). The environment also plays a huge role in whether someone develops depression despite the genetic component of the disorder. Using this framework, Kilpatrick and colleagues (2007) investigated whether having two short 5- HTTLPR alleles increased the likelihood of developing posttraumatic stress disorder in participants who were exposed to hurricane Rita, which hit Florida in 2004. They found that low social support and high hurricane exposure proved to be risk factors for developing posttraumatic stress disorder. In addition individuals who had high levels of hurricane exposure, low levels of social support, and had two short alleles had a 4.5 times greater

chance of developing posttraumatic stress disorder than the rest of the sample.

Research has also looked at monozygotic twins to examine the biological differences in a twin with posttraumatic stress disorder compared to their twin who does not have posttraumatic stress disorder. Pitman and colleagues (2006) examined twin pairs, where one twin obtained posttraumatic stress disorder through involvement in the Vietnam War and the other twin did not experience combat exposure or develop posttraumatic stress disorder. They found that the twin with posttraumatic stress disorder demonstrated higher heart rate reactivity to a startling noise than his brother. This response is thought to be in part the

dangerous happening again.

in their client.

**4.2.3 Biological theories** 

A number of treatments have been shown to be effective in treating posttraumatic stress disorder. Many of the treatments that are used for the disorder are rooted in cognitive behavioral therapy. This section will focus primarily on the treatments that have proven effective with those suffering from combat related posttraumatic stress disorder. The Veterans Administration in particular, has endorsed both cognitive processing therapy and prolonged exposure therapy (Karlin et. al., 2010). This section will also address a few of the more novel treatments for posttraumatic stress disorder such as the use of virtual reality and biofeedback. Some clinicians and researchers have recently incorporated virtual reality technology into prolonged exposure therapy. In addition, with the use of biofeedback, veterans can be taught to monitor their own physiological reactions, which are often elevated due to the hyper-arousal component of posttraumatic stress disorder.
