Cognitive behavioral therapy and the treatment of posttraumatic stress disorder: Where counseling and neuroscience meet


There is increasing evidence to support the biological basis of mental disorders. Subsequently, understanding the neurobiological context from which mental distress arises can help counselors appropriately apply cognitive behavioral therapy and other well-researched cognitive interventions. The purpose of this article is to describe the neurobiological context underlying the formation and treatment of posttraumatic stress disorders, a mental disorder frequently encountered by counselors, from a cognitive therapy framework.

Recent changes to the Council for Accreditation of Counseling and Related Educational Programs (2009) accreditation standards include the need for counselors-in-training to understand the neurobiological basis of behavior, which marks a new direction for the training of professional counselors who have historically reacted ambivalently toward medical models for understanding client concerns and treatments. Yet recent findings in neuroscience actually support the verbally based interventions that counselors typically use in treatment; therefore, there is much to be gained by counselors and counselor educators in understanding the basics of human neurobiology and how commonly used counseling interventions intervene on these biological systems. The National Institute of Mental Health (2010) stated in a recent strategic plan that “Important discoveries in areas such as genetics, neuroscience, and behavioral science largely account for the substantial gains in knowledge that have helped us to understand the complexities of mental illnesses and behavioral disorders over the past 15 years” (“Introduction,” para. 4).

Given the increasingly biological focus of mental health research, the practicing counselor is faced with the task of understanding and using the emerging mental health treatments and explaining to clients, to reimbursing agencies, and to the broader public how counseling fits within the medically dominated mental health culture. Some counselors have long reacted ambivalently toward the pathologically oriented diagnostic categories of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV;American Psychiatric Association, 1994) system and the medication-dominated world of psychiatry. For example, the contrasting viewpoints on this issue were published in the Journal of Counseling & Development between Allen and Mary Ivey (1998, 1999) and Scott Hinkle (1999). Ivey and Ivey (1998) argued for a developmental interpretation to the DSM-IV, opposing what they called the “pathological view” (p. 334) of the manual. According to Ivey and Ivey, disorders could be viewed through a positive development tradition to lie not within the individual but within the contextual systems in which a person lives. Subsequently, disorders are viewed as a “logical response to a developmental history” (Ivey & Ivey, 1999, p. 484). By contrast, Hinkle (1999) argued that because anxiety and depressive disorders “are the most common clinical symptoms associated with presentation to counseling” (p. 475), the counseling profession is weakened if counselors shy away from direct participation in the DSM nomenclature and treatment parlance. As Hinkle indicated, “mental disorders according to the medical model describe disease processes, not people” (p. 475). Regardless of the reader's philosophical perspective, practicing counselors know participation in medical and psychiatric systems is necessary at times. Also, recent discoveries in the field of neuroscience are providing evidence that interventions often used by counselors have direct physiological impact on client neurobiology (Kennedy et al., 2007; Linden, 2006). For example, Felmingham et al. (2007) demonstrated significant differences in brain activity before and after 8 weeks of exposure therapy, which correlated with a reduction in posttraumatic stress disorder (PTSD) symptom severity. Similarly, Paquette et al. (2003) found that cognitive behavioral therapy (CBT) alters the activation and metabolism of specific brain regions following successful treatment of spider phobia. These findings, along with others (for a detailed review, see Beauregard, 2007; Frewen, Dozois, & Lanius, 2008), are significant because they support the techniques, interventions, and approaches used by counselors and provide a mechanism by which counseling positively affects brain physiology. Within the emerging physiologically based treatment milieu, counselors should be prepared to articulate how cognitive counseling interventions make measurable changes to the client. Although cognitive-behavioral-based approaches are effective in the treatment of a number of psychiatric illnesses, adult PTSD is arguably one of the best understood mental disorders from a neurological perspective. It thus presents a valuable model for exploring not only the basic tenets of neurobiology but also the mechanisms behind its successful treatment. Furthermore, PTSD is a disorder that counselors will likely encounter in practice.

PTSD is a mental disorder characterized by a sudden onset of symptoms due to environmental exposure to a psychologically stressful event such as war, natural disaster, or sexual victimization. Thus, it provides a clear example of how, even in adulthood, neurological adaptation (in this case maladaptive changes) can functionally “rewire” the brain in a short period of time, resulting in a sustained array of clinical symptoms. The diagnostic criteria for PTSD are a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyperarousal symptoms. A fifth criterion concerns duration of symptoms and a sixth assesses functioning (American Psychiatric Association, 2000).

The National Comorbidity Survey Replication, conducted between February 2001 and April 2003 (Kessler et al., 2005), determined that the estimated lifetime prevalence of PTSD among American adults is 6.8%, with women (9.7%) twice as likely as men (3.6%) to have the disorder at some point in their lives. These findings are very similar to those of the first National Comorbidity Survey conducted in the early 1990s (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), which was composed of interviews of a representative national sample of 8,098 Americans ages 15 to 54 years. In this earlier sample, the estimated prevalence of lifetime PTSD was 7.8% in the general population. As in the more recent survey, women (10.4%) were more than twice as likely as men (5%) to have PTSD at some point in their lives (Kessler et al., 2005; Kessler et al., 1995).






Ryan A. Makinson
J. Scott Young

Original Work Citation

Makinson, R. A., & Young, J. S. (2012, April). Cognitive behavioral therapy and the treatment of posttraumatic stress disorder: Where counseling and neuroscience meet. Journal of Counseling and Development, 90(2), 131-140. doi:10.1111/j.1556-6676.2012.00017.x



“Cognitive behavioral therapy and the treatment of posttraumatic stress disorder: Where counseling and neuroscience meet,” Francine Shapiro Library, accessed September 28, 2021,

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