Session 12: Review and Termination

This chapter describes the last session (session 12) of the COPE therapy for post-traumatic stress disorder (PTSD) and substance use disorders. In this chapter, the therapist is instructed to assess the patient’s progress since the beginning of treatment and review areas in need of continued work. Finally, this chapter instructs the therapist on how to elicit and provide the patient feedback, and treatment is terminated.

Session 10: Imaginal Exposure Continued and Anger Awareness

This chapter describes session 10 of the COPE therapy. This chapter instructs the therapist to conduct and process the imaginal exposure. Then, this chapter shows the therapist how to help patients increase their awareness and understanding of anger. The chapter instructs the therapist to review constructive and destructive anger, and triggers for anger (both PTSD- and substance use—related). Finally, this chapter instructs the therapist to teach the patient about daily wellness strategies to help keep anger levels at a minimum.

Session 5: Imaginal Exposure Continued and Planning for Emergencies

This chapter describes session 5 of the COPE therapy. The therapist’s instructions for how to provide and process imaginal exposure are reviewed in this chapter. Then, the therapist will be guided on how to help the patient generate a personal emergency coping plan for high-risk situations that may increase risk for using alcohol or drugs. The difference between a lapse (e.g. a slip) and a relapse is reviewed for the therapist.

Outline of This Treatment Program

This chapter provides the therapist with an outline of the COPE treatment and components of each session (e.g. check-in, review homework, post-traumatic stress disorder [PTSD] focus, substance use disorder focus). Questions regarding who can deliver the therapy are addressed, as well as questions regarding the role of medications. Finally, special considerations for delivering treatment to patients with PTSD and comorbid substance use disorders are reviewed for the therapist.

Introductory Information for Therapists

This chapter provides the therapist with introductory information on the program, reviews the COPE treatment and how it works, and discusses what type of patients are most appropriate for the COPE therapy. In addition, it provides the therapist with the diagnostic criteria for post-traumatic stress disorder (PTSD) and substance use disorders.

Session 7: Imaginal Exposure Continued and Managing High-Risk Thoughts

This chapter describes session 7 of the COPE therapy. This chapter instructs the therapist to conduct and process the imaginal exposure. This chapter shows the therapist how to teach patients about the ABC model (Activating event, Beliefs, Consequences), as well as the basics of cognitive restructuring.

Session 4: Initial Imaginal Exposure

This chapter describes session 4 of the COPE therapy. This session is dedicated to conducting the first imaginal exposure. The therapist will be guided in this chapter on how to provide the rationale for imaginal exposure, as well as how to conduct and process the imaginal exposure. In addition, the therapist will be guided on how to handle problems that may arise (e.g. under-engagement, over-engagement, avoidance).

Session 3: Developing the In vivo Hierarchy and Craving Management

This chapter describes session 3 of the COPE therapy. The therapist will be guided in this chapter on how to provide the rationale for in vivo exposure exercises and will generate an in vivo hierarchy with the patient. This chapter provides the therapist with instructions for how to teach patients to use the Subjective Units of Distress Scale (SUDS). Cognitive behavioral techniques for how to manage cravings to use are reviewed for the therapist, such as decision delay, healthy distracting activities, breathing retraining exercise, play it out technique, cognitive restructuring, and urge surfing.

Session 1: Introduction to COPE

This chapter describes session 1 of the COPE therapy for post-traumatic stress disorder (PTSD) and substance use disorders. It provides the therapist with an overview of the COPE treatment program and how it works, reviews the treatment contract, addresses goals for therapy, and guides the therapist on how to teach the breathing retraining exercise.

Session 9: Imaginal Exposure Continued and Seemingly Irrelevant Decisions (SIDs)

This chapter describes session 9 of the COPE therapy. This chapter instructs the therapist to conduct and process the imaginal exposure. Then, the therapist is shown how to help patients increase their awareness and understanding of ‘seemingly irrelevant decisions.‘