Overcoming the Trauma of Your Motor Vehicle Accident: A Cognitive-Behavioral Treatment Program Edward J. Hickling Edward B. Blanchard OXFORD UNIVERSITY PRESS Overcoming the Trauma of Your Motor Vehicle Accident -- David H. Barlow, PhD    Anne Marie Albano, PhD Jack M. Gorman, MD Peter E. Nathan, PhD Bonnie Spring, PhD Paul Salkovskis, PhD G. Terence Wilson, PhD John R. Weisz, PhD Overcoming the Trauma of Your Motor Vehicle Accident A COGNITIVE-BEHAVIORAL TREATMENT PROGRAM T h e r a p i s t G u i d e Edward J. Hickling • Edward B. Blanchard 1  1 Oxford University Press, Inc., publishes works that further Oxford University’s objective ofexcellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © by Oxford University Press, Inc. Published by Oxford University Press, Inc. Madison Avenue, New York, New York  www.oup.com Oxford is a registered trademark ofOxford University Press All rights reserved. No part ofthis publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission ofOxford University Press. Library ofCongress Cataloging-in-Publication Data Hickling, Edward J. Overcoming the trauma ofyour motor vehicle accident : acognitive-behavioral treatment program, therapist guide / Edward J. Hickling, Edward B. Blanchard. p. cm.—(Treatments that work) Includes bibliographical references. ISBN-----;----(pbk.) ISBN---;---(pbk.) . Traffic accident victims—Rehabilitation—Problems, exercises, etc. . Cognitive therapy—Problems, exercises, etc. . Traffic accidents—Psychological aspects. I. Blanchard, Edward B. II. Title. III. Series. . .(cid:1)—dc           Printed in the United States ofAmerica on acid-free paper A b o u t Tr e a t m e n t s T h a t W o r k ™ Stunning developments in health care have taken place over the last sev- eral years, but many of the widely accepted interventions and strategies in mental health and behavioral medicine have been brought into ques- tion by research evidence as not only lacking benefit, but also perhaps inducing harm. Other strategies have been proven effective using the best current standards of evidence, resulting in broad-based recommen- dations to make these practices more available to the public. Several re- cent developments are behind this revolution. First, we have arrived at a much deeper understanding ofpathology, both psychological and physi- cal, and this understanding has led to the development of new, more precisely targeted interventions. Second, our research methodologies have improved substantially, such that we have reduced threats to internal and external validity, making the outcomes more directly applicable to clini- cal situations. Third, governments around the world, as well as health care systems and policymakers, have decided that the quality of care should improve, that it should be evidence-based, and that it is in the public’s interest to ensure that this happens (Barlow, ; Institute of Medi- cine,). Ofcourse, the major stumbling block for clinicians everywhere is the ac- cessibility of newly developed evidence-based psychological interven- tions. Workshops and books can go only so far in acquainting responsible and conscientious practitioners with the latest behavioral health care practices and their applicability to individual patients. This new series, Treatments That Work™, is devoted to communicating these exciting new interventions to clinicians on the frontline of practice. The manuals and workbooks in this series contain step-by-step, detailed procedures for assessing and treating patients with specific problems and diagnoses. However, this series also goes beyond the books and manuals by providing ancillary materials that approximate the supervisory process in assisting practitioners in implementing these procedures in practice. In our emerging health care system, the growing consensus is that evidence-based practice offers the most responsible course of action for the mental health professional. All behavioral health care clinicians deeply desire to provide the best possible care for their patients. In this series, our aim is to close the dissemination and information gap and make that possible. This therapist guide and the companion workbook for clients address the treatment of posttraumatic stress disorder due to severe motor ve- hicle accidents (MVAs) or related events. MVAs are surprisingly com- mon, resulting annually in personal injury in over  million victims in the United States alone. However, the physical injuries often have less impact in the long run than the severe emotional distress, flashbacks, and substantial impairment in work or family life. Yet, few people seek treatment immediately, mostly because they are not aware of the nature of their condition or do not realize that successful brief treatments are available. During the past years, we have developed increasingly effective treat- ments for PTSD, to the point where these interventions compare favorably to the best psychological treatments for other disorders (Keane & Bar- low, ). These treatments also have the advantage of proven durabil- ity after treatment ends, with the added benefit of allowing substantial reduction or elimination of any medications prescribed prior to this treatment. The approach described in this manual was developed by two of the pioneers in this area, with decades of experience in developing and testing new treatments, and their substantial experience will come through in the case examples and solutions to the many individual issues that arise during the course oftreatment. This program is a welcome ad- dition to our growing list of psychological treatments with empirical support, when administered by skilled clinicians. David H. Barlow, Editor-in-Chief, Treatments That Work™ Boston, MA vi C o n t e n t s Chapter Introductory Information for Therapists  Chapter Patient Self-Assessment  Chapter Session   Chapter Session   Chapter Session   Chapter Session   Chapter Session   Chapter Session   Chapter Session   Chapter Sessions and  Chapter Session   Chapter Special Considerations  References  About the Authors  This page intentionally left blank