Can you do ISTDP with patients suffering from PTSD? Thanks to Marianne for this question.
ISTDP has a treatment format for fragile patients who suffered from anxiety discharged into cognitive/perceptual disruption and whose primary mode of dealing with mixed feelings is through splitting and projection. Most of these patients have been traumatized, and many suffer from PTSD.
PTSD as a diagnosis comprises a collection of symptoms. To treat it, we must understand those symptoms and their causes. Most of the symptoms are signs of unregulated anxiety: fear, hallucinations, flashbacks, difficulty falling asleep, difficulty concentrating, hypervigilance, exaggerated startle response. Thus, anxiety regulation is essential for this group.
Due to the traumas they suffered which overwhelmed them, they often use projection to deal with complex mixed feelings. Signs of projection include hypervigilance (I project onto others and fear their actions.), avoiding people or situations (because I project onto those people and fear them), intense reactivity to events today (upon which I project feelings and danger), sense of a foreshortened future (upon which I project horrible things), and outbursts of anger (toward people upon whom I have projected).
All the effective treatments for PTSD help patients regulate anxiety (SE and body therapies), deactivate projections (CBT and dynamic therapies), and help patients face their underlying feelings (behavioral exposure therapy and dynamic therapies). ISTDP tries to do all three through the graded format.
In my book, Co-Creating Change, you see the entire middle section of the book is devoted to the graded format. In Allan Abbass’ recent book, Reaching through the Resistance, you will find two beautiful chapters showing how to work with fragile and severely fragile patients. If you read those sections of those two books, you will have an excellent introduction for how to work with patients suffering from PTSD.






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