Transdiagnostic Approaches to Post-Traumatic Stress
According to the PTSD diagnostic criteria in the DSM, an individual must have experienced an event or series of events involving threats to their physical or sexual integrity.
Applying the Numinus care model principles of trauma- and violence-informed care, justice, equity, dignity, and inclusion, and cultural safety and humility, we can understand that traumatic events that trigger post-traumatic stress extend far beyond the definition in the DSM. The DSM diagnostic criteria for PTSD do not consider one’s social integrity, such as bullying or emotional abuse. As a result, the psychopathological consequences of trauma involving threats to one’s social integrity go beyond PTSD and other classifications and a transdiagnostic perspective is needed (Neuner, 2023).
A Transdiagnostic Approach to Treatment
As previously mentioned, a significant problem with diagnosis-specific evidence-based protocols for PTSD (such as prolonged exposure therapy and cognitive processing therapy) is early dropout from treatment.
Less than 10% of veterans in the Veterans Affairs Healthcare System diagnosed with PTSD complete treatment, despite strategies for implementation and dissemination (Gutner & Presseau, 2019).
Avoidance of trauma-related content, which is inherent to the diagnosis, may interfere with treatment engagement and retention. It is also possible that focusing on trauma–rather than adopting a transdiagnostic approach that addresses all current mental health concerns concurrently–contributes to low utilization and completion of these treatments among traumatized persons (Gutner & Presseau, 2019).
Acceptance and Commitment Therapy
Acceptance and commitment therapy is a non-pathologizing, strengths-based treatment approach which offers attention to a broader continuum of emotional experiences (shame, guilt, grief, anger), unlike the previously mentioned treatments which focus on fear-based symptom reduction (Orsillo & Batten, 2005). Acceptance and commitment therapy focuses on improving a client’s overall quality of life, and it has shown an improved response to exposure therapy (Thompson et al., 2013).
This model allows health professionals to apply trauma- and violence-informed skills to the treatment as it offers choice to clients, such as flexibility in approaches to mindfulness. The committed actions aspect of acceptance and commitment therapy focuses on adding valued behaviours rather than focusing on reducing unwanted ones. Furthermore, this model increases self-acceptance, the capacity for cognitive defusion, and psychological flexibility while decreasing thought suppression, anxiety symptoms, PTSD symptoms, and experiential avoidance (Twohig, 2009; Orsillo & Batten, 2005; Thompson et al., 2013).
Acceptance and commitment therapy addresses co-morbidities simultaneously via a consistent theoretical framework, such as depression and SUD. There is also an emphasis on defusion and acceptance with trauma-specific skills.
Learn More
To learn more about acceptance and commitment therapy, please watch Acceptance and Commitment Therapy Skills.
References
Gutner, C. A., & Presseau, C. (2019). Dealing with complexity and comorbidity: Opportunity for transdiagnostic treatment for PTSD. Current treatment options in psychiatry, 6(2), 119–131. https://doi.org/10.1007/s40501-019-00170-2
Neuner, F. (2023). Physical and social trauma: Towards an integrative transdiagnostic perspective on psychological trauma that involves threats to status and belonging. Clinical Psychology Review, 99(102219). https://doi.org/10.1016/j.cpr.2022.102219
Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.
Post, L. M., Youngstrom, E., Connell, A. M., Zoellner, L. A., Feeny, N. C. (2021). Transdiagnostic emotion regulation processes explain how emotion-related factors affect co-occurring PTSD and MDD in relation to trauma. Journal of Anxiety Disorders, 78(102367). https://doi.org/10.1016/j.janxdis.2021.102367
Rosellini, A. J., Boettcher, H., Brown, T. A., & Barlow, D. H. (2015). A Transdiagnostic Temperament-Phenotype Profile Approach to Emotional Disorder Classification: An Update. Journal of experimental psychopathology, a2(1), 110–128. https://doi.org/10.5127/pr.036014
Thompson, B. L., Luoma, J. B., & LeJeune, J. T. (2013). Using acceptance and commitment therapy to guide exposure-based interventions for posttraumatic stress disorder. Journal of Contemporary Psychotherapy, 43(3), 133–140.
Twohig, M. P. (2009). Acceptance and commitment therapy for treatment-resistant posttraumatic stress disorder: A case study. Cognitive and Behavioral Practice, 16(3), 243–252.