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The student must then post replies of 125-150 words. Each reply must incorporate at least 1 scholarly citation in the current APA format FOR EACH OF THE THREE RESPONSES. Any sources cited must have been published within the last five years. A Christian worldview or biblical integration should be included, with a question
Absolutely, Donna! We use CISM when working crisis situations. It is a very useful tool. I haven’t seen it applied to trauma treatment before. Can you explain more about the steps and process to use it as treatment?
Prolonged Exposure is a trauma treatment intervention that is strongly recommended by the American Psychological Association (APA) for individuals suffering from Post-Traumatic Stress Disorder (Courtois et al., 2017). Prolonged Exposure falls under the Cognitive Behavioral Therapy umbrella and includes confronting trauma-related memories, emotions and situations to reduce fear associated with traumatic events (Courtois et al., 2017). Typically, Prolonged Exposure is utilized in live individual counseling sessions over the course of 3 months for approximately 60-120 minutes per session and is integrated with psychoeducation and deep breathing techniques as the treatment can evoke intense anxiety (Courtois et al., 2017). Imaginal and In Vivo exposure are integral to the success of Prolonged Exposure and include confronting traumatic stimuli (thoughts, people, and places) in the counseling session by processing emotions related to recalling traumatic experiences (imaginal), and outside of the session (In Vivo) in a graduated manner to increase coping abilities (Courtois et al., 2017). According to Umhau (2018), Dr. Edna Foa developed Prolonged Exposure in 1991.
Neurologically, Prolonged Exposure decreases activation of the amygdala and increases activity in the hippocampus (Stojek et al., 2018). Over time a classical conditioning effect takes place as a result of Prolonged Exposure and when the hippocampus and prefrontal cortex determine a fear response is exaggerated, they work together to reduce activity in the amygdala and overpower the automated fear response (Stojek et al., 2018). It is estimated that approximately 68% of Prolonged Exposure participants who complete treatment no longer qualify for a Post-Traumatic Stress Disorder diagnosis (Stojek et al., 2018).
Biblically, Prolonged Exposure and the neurological effects as a treatment intervention seem to promote Timothy’s words in 2 Timothy 1:7 (KJV), which describe God as giving believers a spirit of power and self-control instead of fear (King James Version, 1769/2017). This verse is also a good reminder that believers do not have to live in fear because we are safe in the Lord!
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Courtois, C., Sonnis, J., Brown, L., Cook, J., Fairbank, J., Friedman, M., Gone, J., Jones, R., Gueca, A., Mellman, T., Roberts, J., & Schulz, P. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. American Psychological Association. Retrieved from https://www.apa.org/ptsd-guideline/Links to an external site.
King James Version. (2017). King James Bible Online. http://www.kingjamesbibleonline.org/ Links to an external site.(Original work published 1769)
Stojek, M. M., McSweeney, L. B., & Rauch, S. A. M. (2018, November 2). Neuroscience informed prolonged exposure practice: Increasing efficiency and efficacy through mechanisms. Frontiers. Retrieved from https://www.frontiersin.org/articles/10.3389/fnbeh.2018.00281/full
Umhau, J. (2018). Prolonged Exposure Therapy. University of Pennsylvania. Retrieved from https://www.med.upenn.edu/ctsa/workshops_pet.html#:~:text=PE%20was%20developed%20by%20Edna,and%20anxiety%20in%20trauma%20survivors
The interventions mentioned are eye movement desensitization and reprocessing (EMDR), assessing traumatic memories to reprocess, and yoga with awareness of the body’s response and controlling or guiding that energy (Van der Kolk, 2015). These intervention techniques show how the brain can develop new pathways to healthier thinking and response to triggers or relapse. Critical incident stress management (CISM) intervention applies venting, relaxation, cognitive processing, and debriefing techniques paired with the specific crisis. This (CISM) model utilizes the critical incident stress debriefing (CISD) tool. The (CISD) tool consists of seven phases which the first is the introduction to identify the details of the incident, assessment, and group members experiencing the same crisis. Next is the fact phase, where members share the emotional impact the trauma has on them and create a safe place to share with those who have experienced the same crisis, which goes into the next phase of sharing similar thoughts and emotional patterns that may have developed. The reaction phase explores their understanding of how they reacted to the crisis and the worst part of the experience, and the possibility of moving forward while considering their response. Next is the symptom phase; this allows the group to identify symptoms of what they are feeling in current or triggering moments and develop various coping skills. The teaching phase is where the counselor provides techniques such as relaxation, breathing, and self-regulation to reduce the impact of stress. The final phase is reentry, in which the facilitator summarizes the group discussion, practices techniques, provide resources, helps get back to normal, and the availability to answer any questions (Jackson-Cherry & Erford, 2018). This (CISD) model and its phases can neurologically help each member normalize the experience and develop healthier perspectives, producing better cognitive processing. Also, the social aspect provides this relatability and possibly develops a rapport with one another. A healthy support system to challenge and surround oneself with others who encourage and support can help (Brooks, 2017). The coping techniques used within (CISD) can help provide stabilization of heart rate variability (HRV). Biblically, it is taught that God did not give His children the spirit of fear. However, God understands that there are many challenges that every human will face at different levels of severity determined by the individual experiencing the trauma. The process in which I was taught when facing a crisis or traumatic experience is to call on God with similar practices within many intervention techniques. For instance, identifying the struggle and acknowledging what it means to me, refocusing my attention on God and Jesus Christ, developing spiritual coping skills, and continually building on His word and our relationship to help move forward with my life.
Brooks, J. (2017). Crisis intervention, The neurobiology of crisis.
Jackson-Cherry, L. R., & Erford, B. T. (2018). Crisis assessment, intervention, and prevention. Pearson.
Van der Kolk, B. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. NY. NY: Penguin Books.
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