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VA Palo Alto Health Care System


WTRP Curriculum

Affect Management (Cognitive Behavioral Therapy)
This group assists the development of emotional regulation and improved coping skills via increased ability to identify and effectively challenge problematic thinking patterns.

Art Therapy
Therapeutic art directives and materials are provided to group members which directly engage their goals for treatment. Group members create their own projects according to the directive and with the mediums offered and include their values, goals, thoughts, and emotions. They are offered a time to share their projects and discuss the outcome which assists to integrate learning and facilitate expression.

Acceptance & Commitment Therapy (ACT)
Participants learn to make meaningful behavioral changes in accordance with their values, despite the presence of problematic thoughts, feelings, and physical sensations. The therapy aims to decrease the experiential avoidance that contributes to the destructive secondary effects of PTSD.

Dialectical Behavior Therapy (DBT)
DBT is a present-centered therapy that teaches skills in four areas: distress tolerance, mindfulness, emotion regulation, and interpersonal effectiveness. DBT emphasizes both acceptance of one's current situation and learning new strategies for change. WTRP residents participate in three DBT skills group per week. One group session focuses exclusively on skills for interpersonal effectiveness including learning and practicing how to express your beliefs and needs, set limits, and negotiate solutions to problems - while maintaining (or improving) your relationships and self-respect. The other two DBT sessions focus on learning and practicing skills related to mindfulness, distress tolerance and emotion regulation. These strategies are useful for anyone who struggles to manage anger, sadness, guilt/shame, fear, or any strong emotions. Residents are encouraged to practice these strategies in group and during the week with peers and family.

Leisure Planning
Leisure Planning Group helps individuals identify leisure preferences, patterns and behaviors and how these factors relate to recovery goals. This group explores healthy and productive leisure activities and explores how participation in these specific activities may be more or less helpful with regard to individuals reaching their short and long term goals.

Learning by Doing
Learning by Doing utilizes experiential therapy, which is a psychological treatment approach through which individuals find meaning through direct experiences and actions. During this group, participants engage in hands-on cooperative, trust, and problem solving experiential exercises designed to encourage discovery, engage with others, experience successes, identify obstacles, develop improved self-esteem, and advance treatment goals.

Strength and Toning
This exercise group focuses on paced circuit training combined with metabolic conditioning adapted to an individual's current fitness level. The instructor adapts the program to help each individual feel comfortable and successful regardless of physical ability. This group provides a space to inspire, encourage, motivate and support self and peers while working as a community towards individual health and wellness goals.

This weekly mat or chair yoga class is taught by a certified trauma sensitive yoga instructor. The environment, exercises, and language are taken into consideration when creating a safe and comfortable practice. Yoga can provide relief of symptoms such as pain, fatigue, anxiety, depression and increase flexibility, balance, mindfulness, and relaxation. The instructor teaches practical yoga poses that can be done to reduce stress and re-energize one's self during the day.

Cycling to Recovery
The WTRP focuses on a holistic bio-psycho-social approach to recovery from PTSD. One of the ways the program supports this is through bicycling to increase avenues to address symptoms of PTSD such as isolation, depression, avoidance, anxiety, and building relationships with others. Residents who have participated in the cycling program have experienced a decrease in their PTSD symptoms and have discovered a path to reconnect with their community when they discharge.

Harm Reduction
This group helps to identify and consider changing ways of coping that may be unhealthy or maladaptive. Using a motivational interviewing approach, facilitators encourage group members to discuss struggles they have had and weigh the pros and cons of coping in the ways they have been, given their treatment goals. With the help of facilitators and peers, residents develop change plans for behaviors they would like to reduce or eliminate and work on implementing these throughout treatment.

Family Issues
Group members explore their roles as members of a family, the impact of personal functioning on relationships, and the challenge of change within the family. This is an excellent group in which to address communication issues. (Gender-specific issues include the fact that women are often the custodial parents of children, when the generational impact of PTSD is very acute.)

Seeking Safety
This group seeks to establish a foundation for all therapeutic work by helping patients set goals for achieving abstinence from substances, eliminating self-harm behaviors, acquiring trustworthy relationships, and gaining control over overwhelming symptoms. (The Seeking Safety Protocol is one of the only empirically-based treatments initially designed specifically for women and is geared towards those who struggle with both PTSD and substance use issues.)

Cognitive Processing Therapy
Known for advancing cutting-edge treatments for PTSD, our program was the first to implement Cognitive Processing Therapy (CPT) for women participating in residential treatment for PTSD. This empirically-validated therapy has been shown to reduce PTSD symptoms and help survivors recover from the painful aftermath of trauma. This therapy assists participants to (a) access memories of the event(s), (b) identify and experience painful emotions until they have been extinguished, and (c) identify and challenge problematic beliefs that impede recovery. Participants are provided with a great deal of emotional support from both peers and staff as they work through their trauma. The fact that the majority of the women we see have been alone with their pain is an issue that is targeted in the program, and participants are encouraged to seek the assistance of both staff and fellow patients. The philosophy of the program, reinforced by the various groups, is that one needs others to recover. Recommendations regarding participation in this group are taken on a case by case basis and will depend on an individual’s readiness as determined by the treatment team and in collaboration with the individual.

Skills Training in Affective & Interpersonal Regulation (STAIR)
The STAIR Program is a cognitive-behavioral therapy group, which focuses very directly on teaching participants skills that will increase their ability to manage negative emotions and improve their relationship functioning. STAIR has been shown to improve PTSD symptoms, emotion regulation and interpersonal functioning in multiple populations in randomized controlled trials in the community.