Making Meaning of Difficult Experiences: A Self-Guided Program

Book Title: Making Meaning of Difficult Experiences: A Self-Guided Program

Authors: Sheila A.M. Rauch, PhD, and Barbara Olasov Rothbaum, PhD

Publication Details: Oxford University Press, 2023, 206 pp., $19.95, paperback

“We live in a dangerous and stressful world, but without adversity, there is no resilience” is the opening line in Drs Sheila Rauch and Barbara Rothbaum’s new book, Making Meaning of Difficult Experiences: A Self-Guided Program (p. 1). This workbook uses principles from prolonged exposure (PE) to help survivors of trauma successfully process their difficult memories. PE is an exposure-based psychotherapy that is considered one of the most efficacious and recommended first-line treatments for posttraumatic stress disorder (PTSD). ¹ Rauch and Rothbaum are experts on PTSD and exposure-based treatments, and helped create a therapist PE treatment manual. ² The authors have expanded their work by creating this evidence-based self-guided program, helping fill a trauma-related resource gap that health care professionals often encounter.

Unlike a boring course textbook with abstract terminology, the material is case-based and engaging. The cases are diverse and realistic. They are presented early and referenced throughout the text to illustrate how skills are applied and built on. Granting the reader autonomy and a personalized approach, the option of opting out of any area is offered, because not all areas need growth or people may not have the motivation or capacity to make certain changes at that time.

Two main elements of PE include (1) psychoeducation and (2) repeated, prolonged imaginal exposure to trauma-related memories, followed by postexposure processing. ² These elements are incorporated into the program, which is detailed in the first half of the book. The second half of the book addresses important aspects of people’s lives that often suffer because of trauma. The aspects included are (a) behavioral activation, an evidence-based treatment for depression ³; (b) increasing social connection; and (c) improving self-care in the areas of eating, sleeping, exercising, substance use, and enjoyable activities. Early in the book, readers are offered the option of starting with the second half to begin making healthy changes before processing difficult memories. The book ends similar to the way psychotherapy ends—with reflection. The last chapter summarizes what was learned at each step (ie, chapter), congratulates the reader on their effort and progress, and reviews how to continue moving forward.

This goal-oriented program expects the reader to grow and make changes with assignments. The worksheets are simple, referenced multiple times, integrated into each chapter, located separately in the appendix, and designed to help establish and solidify each skill. The authors provide a completed version of each worksheet using a case example. The book is also complemented by an app, Messy Memories (Virtually Better Inc), which is frequently referenced as a tool to assist with successful completion of the worksheet tasks. Additionally, each skill and task has a brief table of high-yield tips to make implementation most successful.

Notably, Rauch and Rothbaum frequently remind the reader that self-help has limitations and encourage seeking professional help if and when needed. The authors share how to find a high-quality clinician that provides evidence-based treatments and what specific components of therapy make treatment evidence-based. Further, the appendices provide additional information about where to find evidence-based mental health clinicians, substance use, general mental health and PTSD, crisis help, and technological supports for mental health, such as online resources and apps. This psychoeducation and range of resources can be valuable for patients when seeking professional help and unsure of how to find and use effective resources, as well as for family medicine clinicians and educators when recommending and/or teaching about behavioral health treatments and resources.

Overall, this book helps people independently process their difficult memories and improve their health habits. It empowers readers to decide what changes they want to make and when. It is easy to read and follow, limits jargon, is highly relatable to those who have survived trauma, and includes a range of tools and resources backed by research. This book can be useful no matter where people are on their journey of posttraumatic growth. Having an evidenced-based, self-guided resource can be helpful for family medicine clinicians to offer their patients, or even colleagues, as there are many barriers to seeking professional mental health help. Additionally, family medicine educators and clinicians can read this book to better understand PTSD, evidence-based trauma treatments, and the nuances of what patients are being asked to do when referred to trauma therapy. In conclusion, this book can be a useful next step, and possibly the only step needed, to release the grip of distressing memories.