What treatment approach is recommended for a client with a history of trauma who is experiencing retriggering symptoms during conception and pregnancy?

From the Guidelines

For clients with a history of trauma who are experiencing retriggering symptoms during conception and pregnancy, a trauma-informed care approach is recommended, prioritizing evidence-based treatments (EBTs) such as trauma-focused cognitive behavioral therapy (TF-CBT) or Eye Movement Desensitization and Reprocessing (EMDR) 1. This approach should begin with a comprehensive assessment by a mental health professional experienced in perinatal mental health and trauma. Key components of the treatment plan include:

• Psychotherapy: TF-CBT or EMDR to address trauma symptoms during pregnancy
• Medication: Considered when symptoms are severe, with SSRIs like sertraline (50-200 mg daily) or fluoxetine (20-60 mg daily) being relatively safe options during pregnancy, though risks and benefits must be carefully weighed 1
• Complementary approaches: Mindfulness practices, breathing exercises, and grounding techniques for triggering moments
• Birth planning: Creating a plan that addresses potential triggers during labor and delivery
• Support network: Establishing a network including the partner, family members, and healthcare providers who understand the client's trauma history Regular monitoring throughout pregnancy is crucial, with appointments every 2-4 weeks to assess symptom changes, as emphasized in trauma-informed care principles 1. This comprehensive approach addresses both immediate symptom management and longer-term trauma processing while considering the unique physiological and psychological aspects of pregnancy. Given the potential for retriggering during conception and pregnancy, it is essential to prioritize the client's mental health and well-being, ensuring that any interventions are tailored to their specific needs and circumstances, as highlighted in recent studies on trauma-informed care 1.

From the Research

Treatment Approach for Trauma Retriggering during Conception and Pregnancy

The client's history of trauma and current retriggering symptoms during conception and pregnancy require a thoughtful treatment approach.

• Trauma-focused Cognitive Behavioral Therapy (TF-CBT): This therapy has been shown to be effective in treating traumatized individuals, including those with a history of trauma 2. TF-CBT is a components-based and phase-based treatment that emphasizes proportionality and incorporates gradual exposure into each component.
• Cognitive Behavioral Therapy (CBT): CBT has been found to be effective in treating anxiety and depression, which are common comorbidities with post-traumatic stress disorder (PTSD) 3, 4. CBT can help the client recognize and regulate trauma responses, express thoughts and feelings about the trauma experiences, and master avoidance of trauma memories and reminders.
• Combination Therapy: The combination of medication and CBT has been shown to be effective in treating depression and anxiety 5. This combination may be beneficial for the client, especially if they are experiencing symptoms of depression or anxiety in addition to PTSD.

Booster Therapy Sessions Agenda

Booster therapy sessions can be tailored to the client's specific needs and may include:

• Review of Coping Skills: Reviewing coping skills and strategies that the client has learned in previous therapy sessions to help manage trauma responses and regulate emotions.
• Exposure Therapy: Gradually exposing the client to stimuli that trigger trauma responses, while teaching them coping skills and strategies to manage their emotions.
• Cognitive Restructuring: Helping the client to identify and challenge negative thought patterns and replace them with more positive and realistic ones.
• Emotional Regulation: Teaching the client skills to regulate their emotions, such as deep breathing, mindfulness, and grounding techniques.

Considerations for Ongoing Threat

The client's ongoing threat of reexposure to trauma during conception and pregnancy requires special consideration.

• Establishing Relative Safety: Establishing a sense of relative safety and stability for the client, while acknowledging the ongoing threat of reexposure to trauma.
• Differentiating between Realistic Threat and Generalized Fear Responses: Helping the client to differentiate between realistic threats and generalized fear responses, and teaching them coping skills and strategies to manage their emotions in response to these threats. 6