READING REPORT: CASH AND FRIEDMAN ASSIGNMENT 1
Reading Report: Cash and Friedman Assignment
Leah Rocha
Liberty University
READING REPORT: CASH AND FRIEDMAN ASSIGNMENT 2
Reading Report: Cash and Friedman Assignment
This reading report covers the following five chapters from Wiley Concise Guides to
Mental Health: Posttraumatic Stress Disorder (Cash & Weiner, 2006): chapter two, “theories of
stress and coping;” chapter three, “the biopsychosocial effects of traumatic stress;” chapter four,
“exposure to trauma and risk for posttraumatic stress disorder;” chapter six, “biological theories
and models of posttraumatic stress disorder;” and chapter fifteen, “integrated and other treatment
approaches.” These chapters explore general stress theories and coping mechanisms in response
to stress. The authors investigate posttraumatic stress disorder (PTSD) in terms of its biological,
psychological, and social impacts, including the core symptoms, clinical course, and prognosis.
They then review patterns of recovery and the concept of resilience. Factors related to exposure
and risk for developing PTSD are addressed, including a review of biological models underlying
the disorder. Furthermore, the integration of treatment techniques for PTSD is evaluated (Cash &
Weiner, 2006).
Chapter 2: Theories of Stress and Coping
Cash and Weiner (2006) focus on how PTSD is a stress disorder in their second chapter.
They espouse that a deep understanding of stress is crucial for grasping the complexities of
PTSD. Everyone experiences common stressors in daily life, such as traffic and occupational
stress. Although experienced on an intense level, extreme stressors are rare. Examples of extreme
stressors are war, personal assaults, and human-made or natural disasters. The authors define
stress as “the physiological and psychological response and experience to a stimulus that strains
one’s ability to maintain his or her equilibrium, ability to adapt, or ability to adjust” (Cash &
Weiner, 2006, p. 20). Stress affects the person's biological, emotional, and cognitions, disrupting
their equilibrium, adaptability, or capacity to adjust (Cash & Weiner, 2006).
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The authors highlight Hans Selye’s general adaptation syndrome (GAS), which sheds
light on the human response to stress (Cash & Weiner, 2006). GAS demonstrates how biological
and physiological stressors activate the fight-or-flight response through the sympathetic nervous
system. According to GAS, the three stress Cash & Weiner, 2006, p. 31states are the alarm stage,
the resistance stage, and the exhaustion stage (Cash & Weiner, 2006).
Another issue raised is “primary appraisal” (Cash & Weiner, 2006, p. 25), which
evaluates a situation and determines if danger is present. Following is “secondary appraisal” (p.
25). This is when individuals assess the significance of a situation and evaluate their ability to
manage the stressor based on personal experiences and existing resources. Variables such as
resiliency, distress tolerance, emotional regulation, and past trauma experiences influence a
person's subjective appraisal (Cash & Weiner, 2006).
The repercussions of stress can range from marginal irritations to severe physical and
mental health issues (Cash & Weiner, 2006). Research has linked stress to various physical
health issues, including ulcers, hypertension, cardiovascular events, and immune system
suppression. There is research supporting stress playing a role in the development of irritable
bowel syndrome (IBS), back pain, and multiple sclerosis. Mental illnesses such as PTSD,
generalized anxiety disorder, depression, adjustment disorder, and substance abuse disorders find
their basis in stress (Cash & Weiner, 2006).
Chapter 3: The Biopsychosocial Effects of Traumatic Stress
In chapter three, Cash and Weiner (2006) explored PTSD and its impact on individuals in
a cyclical fashion – biologically, psychologically, and socially. Additionally, they cover the order
in which traumatic stress affects a person. First, individuals experience a traumatic event that can
cause a “psychological crisis” (Cash & Weiner, 2006, p. 36), which may generate "peritraumatic
READING REPORT: CASH AND FRIEDMAN ASSIGNMENT 4
reactions” (p. 37). However, these reactions may subside and not lead to any mental disorder.
However, acute stress disorder evolves if disabling peritraumatic reactions meet the Diagnostic
and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association [APA],
2022) criterion and occur two days to four weeks after the event. If the symptoms remain or
appear four weeks after the stressful event, PTSD is diagnosed (Cash & Weiner, 2006).
The DSM-5 categorizes the symptoms of PTSD into three large clusters: reexperiencing,
avoidance, and arousal. PTSD is known for its reexperiencing symptoms (American Psychiatric
Association [APA], 2022; Cash & Weiner, 2006). These symptoms include flashbacks, intrusive
thoughts and images, nightmares, flashbulb memories, and hallucinations. The avoidance cluster
consists of individuals trying to avoid places, people, or conversations that remind them of the
traumatic event. This can cause the person to be emotionally numbed or detached in their
relationships, thus producing isolation (Cash & Weiner, 2006). The final category, arousal, is
characterized by insomnia, exaggerated startle response, “irritability, outbursts of anger, poor
concentration, and hypervigilance” (Cash & Weiner, 2006, p. 42).
Beyond the aforementioned PTSD symptoms, an individual’s physical health can be
affected (Cash & Weiner, 2006). Research supports higher rates of unexplained somatic
symptoms, obesity, cardiovascular events, insomnia, and gastrointestinal issues among those
with PTSD. Research shows alterations in the brain chemistry and structure of those with PTSD.
Furthermore, research supports that PTSD can produce personality changes. Trauma effects can
cause poor memory recall, a fragmented sense of self, and attentional biases. Dissociation,
suicide, and self-harm are all maladaptive attempts at coping with the painful symptoms of
PTSD. While dealing with the personal torment of the traumatic event the individual
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experienced, PTSD symptoms can negatively affect an individual’s relationships and social
functioning (Cash & Weiner, 2006).
Chapter 4: Exposure to Trauma and Risk for Posttraumatic Stress Disorder
Not everyone exposed to a traumatic event will develop PTSD. Understanding the
variables interplay in developing PTSD is vital when treating individuals exposed to crises. Cash
and Weiner (2006) explore the topic of exposure and risk factors related to the onset of PTSD in
their fourth chapter. The authors refer to the "dose-response model" (Cash & Weiner, 2006, p.
56), which means “the more intense a stressor, the more likely PTSD will develop” (p. 56).
However, research has not supported this model. The potential for developing PTSD relies
heavily on the individual's subjective evaluation of the experienced event (Cash & Weiner,
2006).
Different theories of stress approach the definition of traumatic events and the
development of PTSD differently (Cash & Weiner, 2006). One espouses that a traumatic event
has three key factors: “negative valence, lack of controllability, and suddenness” (Cash &
Weiner, 2006, p. 57). Another speaks about pretrauma, peritraumatic, and posttraumatic risk
factors for developing PTSD. Most research looks at only a facet of PTSD when it is more
complex (Cash & Weiner, 2006).
In trauma work, one must consider exposure risk (Cash & Weiner, 2006). Pretrauma risk
factors encompass personality traits, history of trauma, mental health background,
psychobiology, and genetics. Certain group factors, such as gender and socioeconomic status,
can increase the likelihood of developing PTSD. Peritraumatic reactions characterized by
dissociation and intense emotions also serve as risk factors. Furthermore, posttraumatic social
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support and effective coping mechanisms play significant roles in determining the trajectory of
PTSD symptoms (Cash & Weiner, 2006).
Chapter 6: Biological Theories and Models of Posttraumatic Stress Disorder
In chapter six, Cash and Weiner (2006) delve into the essence of the biological
perspective on PTSD, which lies in the dysfunction of normal brain processes and mechanisms
involved in responding to danger and threat (Cash & Weiner, 2006). The authors write, “[a]t the
center of this dysfunction or malfunction is the process of learning. … Essentially, individuals
with PTSD have been biologically trained to respond to danger when no credible danger exists”
(Cash & Weiner, 2006, p. 83).
Danger responses are impulses to protect the body when danger is feared (Cash &
Weiner, 2006). These responses are fear, memory, arousal, fighting, fleeing, freezing,
dissociation, and returning to baseline. When danger responses are activated intensely or for an
extended period, the brain can learn a new way of acting and responding – essentially rewiring
itself. The body then becomes conditioned to this new way of being (Cash & Weiner, 2006).
When the brain has rewired to stay in a perpetuated state of alertness, changes in
neurochemical functioning within specific brain circuits manifest PTSD symptoms (Cash &
Weiner, 2006). These changes mainly occur in the amygdala, prefrontal cortex, hippocampus,
and locus coeruleus. Furthermore, “alterations in neurochemicals such as neurotransmitters,
hormones, and neuropeptides” (Cash & Weiner, 2006, p. 91) are found in people with PTSD.
Research has focused on the main neurochemicals of catecholamines, serotonin, hormones and
peptides, endogenous opiates, the benzodiazepine system, and gamma-aminobutyric acid (Cash
& Weiner, 2006).
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Chapter 15: Integrated and Other Treatment Approaches
In chapter fifteen, Cash and Weiner (2006) examine therapy options that focus on the
significance of relationships in establishing safety, the importance of rewriting trauma narratives,
and the empowerment needed to confront fear. This chapter focuses on approaching PTSD
treatment from multiple perspectives. Some treatment modalities mentioned are group therapy,
constructivist narrative therapy, eye movement desensitization and reprocessing (EMDR),
feminist therapy, and Judith Herman’s model (Cash & Weiner, 2006).
Group therapy encompasses three main approaches: supportive, psychodynamic, and
cognitive-behavioral (Cash & Weiner, 2006). Group therapy empowers an individual through
altruistic interaction with others instead of the "inherent limitation of individual therapy" (Cash
& Weiner, 2006, p. 235). A clinician must ensure that group therapy is a good fit for their client.
The individual needs to be flexible and able to accommodate others, not be suicidal or homicidal,
with no severe paranoia or psychopathic tendencies. They must be able to adhere to group rules
and share their story (Cash & Weiner, 2006).
Constructivist narrative therapy explores helping traumatized individuals restructure how
they tell their stories (Cash & Weiner, 2006). Considering the role of subjective cognitive
appraisal plays in the development of PTSD, supporting the client in finding the positive, the
strength, or the resiliency in their story can help mitigate the symptoms they are experiencing.
Meaning-making is an inherent human need, and constructive narrative therapy meets this need
(Cash & Weiner, 2006).
Eye movement desensitization and reprocessing (EMDR) is an integrated approach to
PTSD treatment that combines “cognitive, behavioral, neurophysiological, and information-
processing elements” (Cash & Weiner, 2006, p. 237). This treatment modality consists of eight
READING REPORT: CASH AND FRIEDMAN ASSIGNMENT 8
phases: 1) history taking, 2) resourcing, 3) setting up the targets for treatment, 4) desensitization
and reprocessing of the targets, 5) installation of the positive belief, 6) somatization treatment is
utilized, 7) relaxation techniques are coached for in-between session maintenance, and 8)
assessment of treatment goals. According to current theories, researchers believe that EMDR
induces synaptic modifications in networks responsible for mood and memory. This enables
more comprehensive processing and reduces the bioelectrical charges within those networks
(Cash & Weiner, 2006).
Feminist therapy for trauma takes a philosophical and political standpoint, aiming to
empower individuals while challenging oppressive societal dynamics (Cash & Weiner, 2006).
Like constructivist narrative therapy, feminist therapy aims to help the victim recontextualize
"internalized oppression" (Cash & Weiner, 2006, p. 240). The therapist supports the client by
believing their perspective through validation and unconditional positive regard. The clinician
assists the client in understanding how the larger culture significantly influences how they
narrate their story and supports the client in constructing an adaptive narrative (Cash & Weiner,
2006).
Similarly, the model of Judith Herman is reviewed (Cash & Weiner, 2006). This model
utilizes cognitive-behavioral and psychodynamic approaches. The focus is empowering the
individual through connection with others. An essential aspect of treatment is a locus of internal
control versus external control. Since trauma destroys the sense of an individual’s control, the
therapeutic relationship must be one of collaboration and support. This theory is a bottom-up
approach that focuses on treating the most pressing needs of the body first and then working
towards gaining control of destructive behaviors. Herman’s model also supports the client in
rewriting their trauma story to one of autonomy and resiliency (Cash & Weiner, 2006).
READING REPORT: CASH AND FRIEDMAN ASSIGNMENT 9
Application
Cash and Weiner's (2006) book offers a comprehensive understanding of the intricacies
of PTSD and the disorder’s profound impact on individuals at biological, psychological, and
social levels. They emphasize trauma therapy's dynamic and evolving nature, highlighting the
need for clinicians to continually update their knowledge and engage in ongoing skill
development to provide effective treatment. Recognizing that PTSD is a complex and
multifaceted cyclical disorder that affects various aspects of an individual's life, gaining training
and experience in therapeutic modalities that address the diverse variables involved is crucial.
Modalities such as Eye Movement Desensitization and Reprocessing (EMDR), narrative therapy,
and biofeedback offer valuable tools for addressing the multidimensional nature of PTSD.
Therefore, a flexible and adaptable approach to case conceptualization and treatment
selection is essential when working with individuals with PTSD. Cash and Weiner (2006)
underscore the need to move away from a simplistic, black-and-white understanding of the
disorder, instead approaching it with respect and sensitivity toward each individual's unique
experiences and needs. By embracing a holistic perspective, clinicians can provide
comprehensive and individualized care considering the biological, psychological, and social
factors contributing to the client's distress.
The author of this paper seeks to acquire knowledge and skills in biofeedback techniques
and narrative therapy to enhance her therapeutic repertoire, complementing her proficiency in
basic and advanced EMDR training. Additionally, further deepening her understanding of the
neuroscience of PTSD would enable the author to support clients in achieving adaptive nervous
system regulation and restoring adaptive homeostasis. The commitment to holistic client care
drives this author's passion for continuous professional development.
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Above all, the author values therapeutic relationships and aims to provide a humble,
supportive, and client-centered approach. Every client's story deserves respect and empathy, and
the author strives to create a safe and non-judgmental space for clients to share their experiences.
The author aims to foster a therapeutic alliance built on trust and collaboration by being an
unbiased listener and honoring her clients’ unique narratives.
Critical Thinking Questions
Question #1
In chapter 2, Cash and Weiner (2006) discuss the underlying issue of stress and how it is
a stress disorder. Furthermore, they explore the wear and tear of stress on the physical body.
What is the best treatment for individuals suffering from many physical ailments of long-term
stress but do not recall any specific trauma events? For example, what would be the first line of
treatment for a workaholic and perfectionist suffering from chronic illnesses?
Question #2
In chapter 3, Cash and Weiner (2006) refer a lot to sleep issues with those who have
PTSD. A large part of the issue is nightmares which cause trouble sleeping. However, addressing
sleep issues is crucial in symptom stabilization. Many people living with PTSD avoid sleep due
to not wanting to experience a nightmare, but psychiatrists often prescribe sleep meds to induce
sleep to help stabilize the client. How should this cyclical issue be approached if the client resists
medication for fear of experiencing a nightmare?
Question #3
On page 56, Cash and Weiner (2006) report research findings that “only 9 percent of
those exposed to traumatic stressors develop PTSD.” What are the adverse childhood
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experiences (ACE) scores of those 9 percent? What is the susceptibility of developing PTSD for
those with an ACE score of 0?
Question #4
On page 95, Cash and Weiner (2006) suggest that individuals who experienced a stressful
childhood life show elevations in corticotropin-releasing factor (CRF). Over time, these high
levels of CRF damage the hippocampus and make the individual more vulnerable to future
stress. What would be the most vital skill to teach children how to cope with stress who are
living in stressful environments such as poverty to better protect them from prolonged elevations
of CRF?
Question #5
On page 238, Cash and Weiner (2006) discuss how a theory of the active components of
EMDR is that it "creates alterations in brainwave activity between cerebral hemispheres that
allow for consolidation and interhemispheric communication.” Walk-and-talk therapy is
becoming more popular as of late. When one walks, both hemispheres are in use to move the
opposite leg. Does walk-and-talk therapy engage the brain in the same way EMDR does? Could
it be considered another form of EMDR?
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References
American Psychiatric Association [APA]. (2022). Diagnostic and statistical manual of mental
disorders: DSM-5-TR (5th ed.). American Psychiatric Publishing.
Cash, A., & Weiner, I. B. (2006). Wiley concise guides to mental health: Posttraumatic stress
disorder. Wiley.
