Many theories have been proposed to explain the causes of Post Traumatic Stress Disorder and the efficacy of therapies used in its treatment. Although the literature covers a wide array of the causes and therapies, this review will focus on domestic violence as a cause of PTSD and Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) as methods of its treatment. Furthermore, the literature presents domestic violence and the therapies in a variety of contexts, but this paper will primarily focus on the causes of domestic violence and the ensuing effects it has on its victims and the effectiveness of CBT and DBT therapies in the treatment of PTSD.
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Domestic Violence (DV)
According to the available literature, domestic violence is the behavioral pattern characterized by one person mistreating another in an intimate relationship such as marriage or in a family setting. The major cause of domestic violence is the misuse of power, mostly in the context of male privilege (Dennise, 2010). The need for control may be due to low self-esteem, extreme jealousy or due to one's inability to control anger and strong emotions. Substance abuse is another possible cause of domestic violence. The issue of domestic violence is described as a significant social problem with significant psychological and medical consequences for its victims and their children (Fruzetti & Levensky, 2000).
The main victims of domestic violence are women. Literature indicates that each year, intimate partners’ assault between two to four million women of all ages, races and classes in the United States. Among women of different racial and ethnic backgrounds, the difference in the prevalence of reported rape and physical assault is statistically significant (Hughes & Jones, 2000). Additionally, a national survey report indicates that 1 out of 8 husbands engaged in at least one violent act toward his wife during the year of study, and 1.8 million wives are assaulted by their spouses or partners each year (Fruzetti & Levensky, 2000).
Literature indicates that the symptoms exhibited by battered women are consistent with the major indicators of Post Stress Trauma Disorder (PTSD). A consistent finding across varied samples (clinical samples, shelters, hospitals, and community agencies) indicate that a substantial proportion of victimized women (31% to 84%) exhibit PTSD symptoms (Hughes & Jones, 2000). In addition, the published research indicates that battered women show a significantly higher percentage of mental health difficulties than non-victimized women do. Other effects of the abuse include permanent injury, hyper-arousal, psychosis, paranoid ideation and psychosexual dysfunction. All of which are consistent with PTSD as described by Foa et al (Foa, Keane, Friedman, & Cohen, 2010).
Post- Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) is a complex, often chronic and a debilitating mental disorder that develops in response to catastrophic life events such as combat, sexual assault, natural disasters and other extreme stressors (Foa, Keane, Friedman, & Cohen, 2010). According to the literature, PTSD has numerous symptoms. These symptoms include intrusive recollections and flashbacks, irritability and mood swings, lack of concentration and numbing (Anke & Clark, 1999). Foa et al. states that PTSD syndrome involves 17 symptoms in three clusters, which include avoidance and numbing, hyper-arousal and re-experiencing the trauma. The main symptoms of complex PTSD are dysregulation, dissociation, alterations in perceptions of self and perpetrator, markedly impaired interpersonal relationships and alterations of meaning (Foa, Keane, Friedman, & Cohen, 2010)
PTSD can be triggered by any event that threatens the physical integrity of a person or of a close associate. These events include death, injury, or a threat to one's life (Mendes, Mello, Ventura, & Passarela, 2008). Hughes & Jones state that available research indicates that the symptoms exhibited by battered women are consistent with the major indicators of PTSD, implying that domestic violence is a major cause of PTSD. Furthermore, a study by Courtois indicate that in families, PTSD is exemplified by domestic violence and child abuse (Courtois, 2008).PTSD can be as a result of a reactive emotion, a term used to refer to uncontrollable reaction to a stimulus.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) refers to a psychotherapy that is used in the treatment of dysfunctional emotions and behaviors by identifying and directly changing the cognitive processes that bring about PTSD. Hughes & Jones define CBT as the association between cognitive restructuring and exposure techniques (Hughes & Jones, 2000). CBT is the most common psychotherapy approach for the treatment of PTSD. A study published in The Journal of Psychiatry in Medicine indicates CBT to be more effective than supportive and other therapies for study completers as remission rates were higher (Mendes, Mello, Ventura, & Passarela, 2008). This method seems to be effective as either cognitive or exposure therapy. Further, the study shows that CBT appears to be more effective than Eye Movement Desensitization and Reprocessing (EMDR) in promoting diagnostic remission. Foa et al. also discusses some of the advantages of CBT over other methods. A weakly behavior report of a study done on children indicate that children who received CBT experienced significantly greater improvement scores than those who received Non- Stress Tests (NST) during a one year follow up. Furthermore, CBT led to significantly greater improvement in internalized and externalized behavioral symptoms (Foa, Keane, Friedman, & Cohen, 2010).
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy (DBT) is a treatment that teaches emotion regulation in the context of a validating environment (Follette & Ruzek, 2006). Dimeff & Koerner simply define DBT as a treatment for chronic suicidal individuals (Dimeff & Koerner, 2007). Other definitions in the literature describe DBT as a form of treatment used on individuals with emotional problems. This method is appropriate to the treatment of individuals with traumatic histories.
The available literature outlines the focus of DBT to be on the role of thoughts, beliefs and behaviors in the treatment and development of Borderline Personality Disorder (BPD). This behavior cognitive therapy works on Linehan’s theory that the core problem in BPD is emotion dysregulation resulting from mixing genetics and other biological factors and an emotionally unstable childhood environment together (Linehan & Wagner, 2006). In addition to treating BPD, DBT can be used in treating PTSD (Fruzetti & Levensky, 2000).
There are a number of techniques applied in the treatment of PTSD. The major psychotherapy approach used is CBT, which is divided into cognitive techniques and behavioral techniques. Other methods indicated in the literature are Eye Movement Desensitization and Reprocessing (EMDR), psychodynamic psychotherapy and group CBT, relaxation techniques and social skills training (Mendes, Mello, Ventura, Passarela, & Mari, 2008). Mendes et al. indicate success of CBT, exposure therapy and cognitive therapy in the treatment of PTSD (Mendes, Mello, Ventura, Passarela, & Mari, 2008). Additionally, Courtois state that CBT has been effective in the recent years in the treatment of PTSD (Courtois, 2008). Finally, Hughes & Jones that Cognitive-behavioral therapy treatment strategies are the most commonly recommended in the literature.
Domestic violence is a prevalent social problem with significant psychological and medical effects to its victims. Misuse of control by either partner in an intimate relationship and substance abuse are the main causes of domestic violence. It is a major cause of posttraumatic stress disorder to its victims. In addition to domestic violence, PTSD can be caused by any event that threatens the physical integrity of a person or of a close associate. PTSD has a number of symptoms, which include intrusive recollections and flashbacks, irritability and mood swings, lack of concentration and numbing. CBT and DBT are the main therapies used in the treatment of this disorder. The literature has indicated how domestic violence leads to PTSD and discussed the advantages that CBT and DBT have over other therapies used in the treatment of this disorder. However, the literature has not been able to detect the differences between CBT and DBT and other psychotherapies, which are also effective in PTSD treatment. The literature needs to clearly set out the differences and come up with the most suitable combination of therapies that can be used in PTSD treatment.