Customization and Future Directions in TIMBER
When it comes to the experience of trauma or mindfulness practice, no two people are exactly alike. In any psychotherapy, especially in trauma-focused therapy or mindfulness therapy, it is important not to follow the “one-size-fits-all” approach. It is important to customize the therapeutic interventions based on the client’s biopsychosocial profile as well as the experiential data that the client provides to the therapist. Assessment scales in addition to qualitative information are important to help individualize the interventions and evaluate the progress in therapy. However, an assessment scale for trauma that includes only the verbal accounts of client is incomplete and inaccurate and excludes the key processes such as dissociation. Therefore, assessment of trauma should take into account the non-verbal behavior as well.
This chapter describes two rating scales and a practice log of meditation that we currently use for customizing the TIMBER psychotherapy for the clients. The two scales are ASMI© (for measuring the level of mindfulness) and ART-MR© (for measuring the level of arousal due to activation of the trauma memories). With respect to these aspects, we describe the clinical utility of these instruments and also mention our plan for the future toward improvising them as well as improve further the delivery of TIMBER, especially for the clients located in remote areas.
KeywordsTIMBER therapy Mindfulness scale Trauma scale Meditation home practice log Trauma care
- 1.Van der Kolk B. The body keeps the score. New York: Viking Penguin; 2014.Google Scholar
- 2.Pradhan BK. Yoga and mindfulness based cognitive therapy: a clinical guide. Switzerland: Springer Publishers; 2014.Google Scholar
- 3.Pradhan BK, Wainer IW, Moaddel R, Torjman MC, Goldberg M, Sabia M, Parikh T, Pumariega AJ. Trauma Interventions using Mindfulness Based Extinction and Reconsolidation (TIMBER) psychotherapy prolong the therapeutic effects of single ketamine infusion on post-traumatic stress disorder and comorbid depression: a pilot randomized, placebo-controlled, cross-over clinical trial. Asia Pac J Clin Trials Nerv Syst Dis. 2017;2(3):80–90.Google Scholar
- 4.Pradhan BK, Mitrev L, Moaddel R, Wainer I. D-Serine is a biomarker for clinical response in (R, S)-ketamine treatment of post-traumatic stress disorder and co-morbid depression. Biochim Biophys Acta. 2018;S1570-9639(18):30035–9.Google Scholar
- 5.Pradhan BK. Depression specific Yoga and mindfulness based cognitive therapy model: description, data on efficacy and differences from contemporary models (Chapter 24). In: Greenblatt J, Brogan K, editors. Integrative psychiatry for depression: redefining models for assessment, treatment, and prevention of mood disorders. FL: Taylor & Francis; 2015. p. 373–81.Google Scholar
- 6.Pradhan BK, Sharma A. The time has come for integrating complementary medicine into psychiatry. Adolesc Psychiatry (Editorial). 2015;5(2):71–2.Google Scholar
- 7.Pradhan BK, et al. Ketamine, trans-cranial magnetic stimulation (TMS) and mindfulness based cognitive therapy in management of treatment resistant depression: review and some data on efficacy Dep Res Treat. 2015;1–14. Epub 2015 Oct 5.Google Scholar
- 8.Analayo B. Satipatthana: the direct path to realization. Birmingham, UK: Windhorse publications; 2003.Google Scholar
- 9.Thera U. The path of freedom (Vimuttimagga). Kandy, Sri Lanka: Budhist Publication Society; 1961.Google Scholar
- 10.Lama D. The middle way: faith grounded in reason (trans: Jinpa T). Boston: Wisdom Publications; 2009.Google Scholar
- 12.Pradhan, B.K. (2016): TIMBER (Trauma Interventions Using Mindfulness Based Extinction/Re-consolidation of trauma memories) therapy for chronic and refractory PTSD was included in the program registry website of the California Evidence-Based Clearinghouse for Child Welfare (CEBC, www.cebc4cw.org).
- 15.Kunaparaju, S., Pradhan, B.K., Parikh, S. (2017): Using video-conferencing to deliver TIMBER psychotherapy for PTSD: A Case Report on an Indian Client. Proceedings of the Annual Meeting of the American Psychiatric Association, San Diego.Google Scholar