Discussion – Week 5
Post-traumatic stress disorder (PTSD) is a psychiatric condition that requires exposure to a traumatic event for diagnosis. According to the American Psychiatric Association (APA), PTSD is a cluster of symptoms that include invasive and recurring traumatic memories, avoidance of trauma-related stimuli, numbing and/or negative changes in mood or cognition pertaining to trauma, and changes in the in physiological reaction and arousal (Koirala et al., 2017). When a person experiences a traumatic or painful event, the memory can be suppressed in the body and manifest differently in invasive and disturbing ways. PTSD can be mild, short-term, or a lifelong and debilitating condition (Koirala et al., 2017).
Observations of The Client
This is the case of William, a 38-year-old African American Iraq war veteran who now resides with his brother in California. The client was living with his wife in New Jersey but became homeless due to his inability to pay his mortgage. The client has a job as a lawyer, however, he could lose his job due to heavy alcohol use and PTSD (Laureate Education, 2012). The client appears surprised at his diagnosis of PTSD as evidenced by his statement in the video clip “they say I have PTSD” (Laureate Education, 2012).
Post-traumatic stress disorder is a common mental illness experienced by veterans. The prevalence of PTSD in the United States among previously deployed veterans ranges from 12-23% (Spoont et al., 2020). This prevalence is even reported to be higher among minorities and ethnicities of non-Latino white veterans (Spoont et al., 2020). As a war veteran and an African American, William fits the group of individuals that have a high prevalence of PTSD.
The diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) (2013) includes directly experiencing traumatic the event, witnessing in person the event or events as they occurred, learning that a relative or a loved one experienced trauma or indirect exposure to aversive details. For further assessment, the client in the study should be asked if he has experienced any life-threatening or violent event and if that event becomes invasive in his life from time to time. Substance use such as alcohol is not uncommon for patients with PTSD (APA, 2013).
Therapeutic approaches
Studies have found trauma-focused cognitive behavioral therapy (TF-CBT) to be effective in the management of PSTD. This treatment modality has been found efficacious not only in the treatment of core PTSD symptoms such as emotional numbing, re-experiencing symptoms, hyperarousal and reminders of the symptoms, but also in co-morbid disorders such as substance abuse, alcohol abuse, pain, anxiety, depression, and eating disorders (Stingl et al., 2020). Trauma-focused CBT is focused on identifying, understanding, and changing the behavior patterns that are associated with traumatic events. CBT may use exposure therapy or cognitive restructuring as interventions to affect symptom reductions in PTSD (Stingl et al., 2020).
Another treatment approach that has been found to be effective for the treatment od PTSD is eye movement desensitization and reprocessing (EMDR). According to Stingl et al. (2020), this treatment modality allows the client to reprocess the trauma by confronting physical trauma sensations in a structured manner while processing trauma-related beliefs. In this treatment, the rapid eye movement that occurs during dreaming is mimicked by the therapist moving their fingers back and forth and the client focuses their eyes on the therapist’s fingers while concentrating on a traumatic memory (Stingl et al., 2020).
Although psychotherapy is considered the first line of treatment for PTSD. pharmacological therapies have also been found effective in the treatment of PTSD. Selective serotonin reuptake inhibitors (SSRIs) are considered the first line of pharmacological treatment for PTSD (Koirala et al., 2017). Fluoxetine has been well studied and found to be effective in the treatment of PTSD. It is recommended that the starting dose for the treatment of PTSD be 20mg by mouth daily which if tolerated, may be titrated up to 60mgs until the desired effect is reached (Koirala et al., 2017).
Expected Outcomes
The expected outcome of integrating TF-CBT, EMDR, and pharmacotherapy for the treatment of PTSD is a significant reduction of core symptoms (Stingl et al., 2020). This reduction can be self-reported by the client and can be measured using a standardized clinician-rated scale such as the combat experiences scale. The reduction of concomitant symptoms such as substance abuse, depression, and anxiety are also expected outcomes. A study that compared EMDR and CBT for the treatment of PTSD found that EMDR was more efficacious in the management of PTSD and concomitant anxiety when compared to CBT. However, the two modalities were found to be just as effective for depression that resulted from PTSD (Stingl et al., 2020).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.) Author
Koirala, R., Soegaard, E. G. I, & Thapa, S., B. (2017). Updates on pharmacological treatment of
post-traumatic stress disorder. Journal of Nepal Medicinal Association, 56(206), 274-80.
Laureate Education (Producer). (2012). Academic year in residence: Thompson family case
study (multimedia file). Baltimore, MD: Author.
Spoont, M., Nelson, D., Kehle-Forbes, S., Meis, L., Murdoch, M., Rosen, C., & Sayer, N.
(2020). Racial and ethnic disparities in clinical outcomes six months after receiving a PTSD diagnosis in Veterans Health Administration. Psychology services. https://doi-org.ezp.waldenulibrary.org/10.1037/ser0000463
Stingl, M., Hanewald, B., Kruse, J., & Sack, M. (2020). Positive side effects in trauma-focusing
PTSD treatment: Reduction of attendant symptoms and enhancement of affective and structural regulation. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi-org.ezp.waldenulibrary.org/10.1037/tra000700
