Learning From Experience (LFE) demonstrates how to integrate approaches [e.g. Systems-Centered (SCT), Prolonged Exposure (PE), Cognitive Processing (CPT)] to build groups that increase emotional tolerance, build environments for processing experience, and promote real-life change. Emphasis is on making the learning process understandable and meaningful, while teaching leaders to maintain structure with attunement. Patient and therapist manuals, and gathering data to become evidence-based, will be discussed.
Open to All Levels
Primarily didactic, with lots of room for questions and answers
Based on attending this event, I know, or am able to:
Use early group introductions and leader demonstrations to ease the introduction of exploring experience and functional subgrouping into newly developing groups
Use “next step challenges,” with group support, to encourage members to make changes in their day-to-day lives
Integrate cognitive restructuring techniques into helping group members explore their experience
PTSD is widespread, with a lifetime prevalence of 6.8—7.3% among U.S. adults, and 7–23% for returning war veterans (Fulton et al, 2015; Institute of Medicine (IOM), 2014). It develops in response to a variety of stressors, most frequently rape, combat, childhood abuse/neglect, sexual molestation, physical assault, and sudden unexpected deaths (Norris & Slone, 2014). PTSD is associated with increased physical, mental health, and substance abuse problems, high healthcare costs, and job productivity loss (Resick, Monson, Gutner, & Maslej, 2014).
Since its inclusion in DSM-III in 1980, much effort has gone into understanding and treating PTSD. Veterans Affairs/Department of Defense treatment guidelines (VA/DOD, 2017) indicate the greatest success has been achieved with “manualized trauma-focused psychotherapies that have a primary component of exposure and/or cognitive restructuring,” (p. 46), with the strongest evidence for prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing (EMDR). These therapies are often referred to at the evidence-based therapies (EBTs) for PTSD. The VA/DOD guidelines also call for further research “to explore the efficacy of novel, emerging treatments,” (p. 47). Treatment guidelines from the International Society for Traumatic Stress Studies released in 2018 (see Forbes, Bisson, Monson, & Berliner, 2020) also provide a “strong” recommendation for these three approaches, while adding cognitive therapy for PTSD (CT-PTSD) and “general undifferentiated individual CBT with a trauma focus” to the list. With regard to treatment success they report similar results, “the core elements appear to be (1) addressing trauma-related cognitions; (2) engaging with, and activation of, the trauma memory; and (3) addressing experiential avoidance,” (Olff et al, 2020, p. 176). Forbes et al. (2020) also note that “The challenge for the field is to be open to new ideas and innovations, while still adhering to scientific principles and a commitment to evidence-based treatment (EBT),” p. 7.
Despite progress in treatment outcomes, up to 50% of patients in evidence-based studies, “still meet diagnostic criteria for PTSD at the end of treatment and at follow-up,” (Resick et al, 2014, p. 429); even among those who don’t, elevated residual symptoms often remain (IOM, 2014); dropout rates continue to be high, averaging around 35% (Goetter et al, 2015; VA/DOD 2017), and the condition is most often seen as chronic in primary care settings (Bray et al, 2016). Findings such as these have led to a call for developing more comprehensive treatments for PTSD (Resick et al, 2014, 2017b; IOM, 2014; VA/DOD, 2017).
Learning From Experience (LFE)
LFE is primarily derived from the theory of living human systems, and the systems-centered® therapy (SCT®) based on it, (Agazarian, 1997; Gantt, 2021), and has elements to suggest it has potential for being effective, perhaps even improving, the treatment of PTSD. It has components of both engaging/activating the trauma memory and addressing experiential avoidance (exposure) through teaching group members the technique of exploring their experience. In addition, between sessions, members help select, and then implement, next step challenges, which is a form of in vivo exposure similar to what is found in PE (Foa, Hembree, Rothbaum, & Rauch, 2019). Trauma-related cognitions (cognitive restructuring) are addressed by identifying and undoing cognitive defenses, which, as noted above, are currently believed to be the most effective components of treatment (VA/DOD, 2017; Resick, Monson, & Chard, 2017).
In addition, by integrating techniques from SCT, PE, and CPT; LFE focuses greater attention on, 1) building skills to tolerate strong emotions by using mindfulness centering techniques, 2) identifying and undoing obstacles/psychological defenses that block access to primary experience (including somatic and discharge defenses), 3) teaching patients to identify dysfunctional patterns/roles that inhibit change, and 4) enhancing empathy and interpersonal connectedness by processing individual experiences in a group format that utilizes functional subgrouping. The emphasis on building coping skills to help the individual tolerate and learn from strong emotions, and developing a group structure that further facilitates such processing, before the deeper emotional experiences connected to traumas are brought to the surface, are some of the reasons LFE is expected to result in positive outcomes for treating PTSD. The concept of building skills in an orderly manner is similar to that found in dialectical behavioral therapy (DBT, Linehan, 2015) and skill training in affective and interpersonal therapy, narrative therapy (SNT, Cloitre et al, 2020). The functional subgrouping component creates a context that is high on similarities and resonance, which is believed to further enhance the processing of emotionally charged material (Agazarian, 1997; O’Neill, 1997).
Agazarian, Y. M. (1997). Systems-centered therapy for groups. New York, NY: Guilford Press.
Bray, R.M., Engel, C.C., Williams, J., Jaycox, L.H., Lane, M.E., Morgan, J.K., & Unützer, J. (2016). Posttraumatic stress disorder in U.S. Military primary care: Trajectories and predictors of one-year prognosis. Journal of Traumatic Stress, 29(4), 340–348. doi:10.1002/jts.22119
Cloitre, M., Choen, L.R., Ortigo, K.M., Jackson, C., & Koenen, K.C. (2020). Treating survivors of childhood abuse and interpersonal trauma, (2nd ed.). New York, NY: Guilford Press.
Foa, E.B., Hembree, E.A., Rothbaum, B.O., & Rauch, S. (2019). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist Guide, (2nd ed.). Oxford, UK: Oxford University Press.
Dick Ganley, Ph.D., CGP. Dick Ganley, Ph.D., CGP, Licensed psychologist since 1983, practice specializing in PTSD (currently in Veteran's Administration setting); Certified Group Psychotherapist since 1994. Licensed SCT Practitioner since 2000; Director of Research for SCTRI since 1997. More than 50 professional publications and presentation (see CV), many of these on PTSD. Director of Research for SCTRI, and numerous previous presentations at national, state, local, and SCT conferences.
Tiffany Urquhart, Ph.D.. Dr. Urquhart currently works in a residential treatment program, and an outpatient MH clinic, at the Veterans Administration (VA) in Waco TX, and in both settings serves Veterans with PTSD, as well as other conditions. She has also trained in four other VAs as part of her education to become a clinical psychologist. Dr. Urquhart is actively involved in the research being conducted with the Learning From Experience (LFE) approach, which, as described above, integrates elements of SCT (esp., functional subgrouping and exploring experience), with Prolonged Exposure (PE) and other interventions strategies. She is a young career professional who has given over 25 professional presentations, and has also served for a year as a teaching assistant.