Trauma Management Therapy

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Frueh, Turner, Beidel · 1996

What it is

Trauma Management Therapy (TMT) is a multicomponent behavioural treatment for chronic PTSD. It was developed for combat veterans by Frueh, Turner, Beidel and colleagues (first reported by Frueh, Turner, Beidel, Mirabella & Jones, 1996). It is now delivered and taught by Deborah Beidel's group at…

Format

• Completion criterion used in the trial: all individual exposure sessions plus at least 75% of group sessions.
• Moving between phases: in the trials, the phase change was fixed by protocol (the session count), not by a symptom threshold. In the 2011 trial, imaginal exposure ran for sessions 1–8, in vivo work started at session 9, and SER followed the exposure phase. The Salem protocol likewise fixes the…

Who practises it, and how they are trained or regulated

• Therapists: master's or doctoral clinicians trained by the developers. In the trials, each therapist delivered both individual and group components, received weekly supervision, and had sessions recorded for fidelity review. At Salem, Beidel and Frueh gave 20 hours of training: 10 hours of didactics and discussion and 10 hours of practice. The practice included running a mock group through each TMT component and…
• The developers' core idea is that exposure therapy reliably reduces the core PTSD symptoms (re-experiencing, fear, avoidance). It does not by itself repair the social isolation, anger, depression and interpersonal damage seen in chronic combat PTSD. TMT therefore pairs (a) individual exposure with (b) group Social and Emotional Rehabilitation (SER) skills training. In the 2011 trial, PTSD symptoms fell with exposure…

Evidence status, as the guide reports it

• Version followed: the standard (weekly) Trauma Management Therapy protocol as reported for the randomized trial by Beidel, Frueh, Uhde, Wong & Mentrikoski (2011), the only full-text outcome paper drawn on. Further sources: the content of the group modules (education, behavioural activation, sleep…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• activity logs filling up and mood ratings rising.
• ambivalence about exposure. Address it before session 1 (see 5.1).
• members using the time for war stories or venting. Gently redirect to rehearsal.
• increases in the frequency and duration of social activities recorded in self-monitoring.
• the client leaving still highly aroused. Extend the closure time rather than letting them go.

Problems the guide addresses

• Reluctance to start or continue exposure
• Stuck: distress not falling, or narration flat
• Overwhelm or dissociation during imaginal or VR exposure
• Not doing programmed practice
• Group problems in SER
• Risk: suicidality, substance use, violence
• Ruptures
• Modality-specific difficulties

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.