The Vicious Cycle of Impaired Self-Efficacy: Conceptualization and Treatment Guide lines for Severe, Chronic Posttraumatic Disorder - Abstract
Against the backdrop of the changes introduced in the definition of posttraumatic stress disorder (PTSD) in the 5th edition of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-5), this paper proposes a comprehensive perspective on the chronic posttraumatic disability that follows the long-term struggles with adult-onset PTSD, especially in the context of combat trauma. The vicious cycle created by the perceived and factual damage to self-efficacy and the disintegration of the sense of self is presented thoroughly, with a special focus on the powerful ripple effect of posttraumatic shame. The paper offers guidelines for treatment and a conceptual approach to intervention developed during years of treating combat veterans with severe and complex manifestations of chronic PTSD, including veterans from Arab minority communities.