Week 5 Discussion
Posttraumatic Stress Disorder
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The experience of trauma has potentially long-lasting negative impact on physical and mental health and trauma is the almost universal experience of people with mental and substance use disorders (Wheeler, 2014). Trauma is globally harmful and a costly public health concern (APA,2020). People experience trauma in different ways when exposed to a myriad of emotionally distressing situations like loss of a loved one, violence, abuse, neglect, war, disaster, or other emotionally harmful experiences (APA, 2020). While some people may have no lasting negative effects from the event, others may carry the burden of trauma for years. When trauma is left unaddressed, it increases the risk of mental and substance use disorder significantly and can also lead to chronic physical diseases. Post-traumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced these emotionally harmful experiences listed above and the list is inconclusive (APA, 2020).
In the case study of reference, William Thompson, a 38-year-old male veteran who served as Captain in the Iraq war, appears to be suffering from PTSD. While not much information is provided about his history, we learn from the clip that William Thompson is newly married, a finance lawyer in the civilian world but presently homeless and staying with his married brother (Laureate Education, 2012a). It was also said that William is in jeopardy of losing his job because of alcohol and PTSD-related concerns. While William projects that his brother Henry and his wife Rosita, believe he may be suffering from PTSD, William did not acknowledge it (Laureate Education, 2012a). William appears to be in denial, or he is hiding the fact that he has some unaddressed or unresolved trauma that has led to substance use disorder which has eaten his finances.
According to a national study from the Veteran’s Health Administration (VHA) Substance use disorders are common comorbidities among veterans with PTSD and are associated with more severe symptoms and impaired functioning (Bhalla, Stefanovics & Rosenheck, 2019). Multiple substance use is associated cheap essay writing help with additional medical and psychiatric comorbidities as well as a greater risk of homelessness, legal problems, and other manifestations of social dysfunction (Bhalla, Stefanovics & Rosenheck, 2019). The effects of trauma events place a huge burden on families and communities and create challenges for public institutions and service systems (Morgan, 2020).
People diagnosed with PTSD commonly have intense, disturbing thoughts and feelings related to their experience that can last for a long time after the traumatic event has ended (Bruce & Jongsma, 2010b). They tend to avoid trauma-related thoughts and emotions and discussion of the traumatic event; however, the event is often relived through intrusive, recurrent recollections, dissociative episodes or flashbacks and nightmares (Bhalla, Stefanovics & Rosenheck, 2019). According to the Dsm-5 criteria, following the exposure to a traumatic event, PTSD includes four symptom clusters: re-experiencing, avoidance, negative alterations in cognition/ mood and alterations in arousal and reactivity (APA, 2013). The case study did not specify how long the ago the war was but It is noteworthy to understand “the process of transitioning and reintegrating back to civilian life is often stressful and can generate lasting psychological difficulties” (Mobbs & Bonanno, 2018).
Treatment
PTSD is treatable and the chance of recovery is greater when people seek treatment early. The challenges that the people suffering from PTSD face are sometimes complex, impacting their everyday lives (Wheeler, 2014). Clinicians are often faced with multi-faceted complex issues including symptoms of psychiatric and mental health disorders which can prove challenging. Psychiatrists and other mental health professionals use various effective evidenced-based methods to help people recover from PTSD. The combination of Psychotherapy and medication provide effective evidence-based treatments for PTSD. One category of psychotherapy, cognitive behavior therapies (CBT), ‘Talk therapy, is highly effective’. Cognitive processing therapy, prolonged exposure therapy, stress inoculation therapy, Movement Desensitization and Reprocessing Therapy (EMDR) are effective first-line treatment modalities for PTSD (Wheeler 2014).
There are no PTSD-specific drug treatments. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment (Freeman, 2009). While these medications can alleviate certain symptoms associated with a PTSD diagnosis, the effects are very minimal and do not target any PTSD pathways specifically, because these biological pathways are not currently well understood (Freeman 2009).
Psychotherapy is not a ‘quick fix’ and it can often require a long-term commitment to attend regular therapy sessions over many years (Morgan, 2020). Other people like William Thompson, may find it difficult to confront or relive the deeply buried trauma in the presence of a therapist and even harder to form trusting relationship that is required for effective psychotherapy. William Thompson has not acknowledged the fact that he has PTSD even after losing his home and is being threatened with a job loss. He would benefit from fear conditioning along with psychotherapy because the cycle of avoidance and reexperiencing a traumatic event is thought to persist due to a deficit in the extinction of fear conditioning (Morgan 2020). People that have PTSD need to have their fears reduced which can only be achieved when information incompatible with the fear structure is incorporated (Morgan, 2020). In William Thompson case it might be necessary to incorporate different treatments which may prove beneficial for the veteran.
I would recommend a combination treatment of MDMA to be used on William Thompson which will act as a catalyst to facilitate trauma processing during psychotherapy. Attending to threat and relieving the fear factor is essential for the successful treatment of people diagnosed with PTSD which is inherently problematic for this group of people (Morgan 2020).
MDMA-Helped psychotherapy is a monoamine releaser and promotes the release of neurotransmitters namely, serotonin, dopamine and noradrenaline and elevates serum oxytocin in the brain. The resulting effect is the client experiences a decrease in hypervigilance and anxiety, increased relaxation, and enhanced mood (Morgan, 2020) This combined treatment of MDMA and psychotherapy may be effective for treating PTSD as MDMA appears to diminish the fear response and decrease defensiveness without blocking access to memories(Morgan, 2020) This can help William Thompson stay engaged with Psychotherapy without being overwhelmed or distressed with painful memories or emotions (Morgan, 2020).
References
American Psychological Association (2020). PTSD treatment. https://www.apa.org/ptsd-
guideline/treatments/
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Bhalla, I. P., Stefanovics, E. A., & Rosenheck, R. A. (2019). Polysubstance Use Among
Veterans in Intensive PTSD Programs: Association with Symptoms and Outcomes Following Treatment. Journal of Dual Diagnosis, 15(1), 36–45. https://doi-org.ezp.waldenulibrary.org/10.1080/15504263.2018.1535150
Bruce, T., & Jongsma, A. (2010b). Evidence-based treatment planning for post-traumatic stress
disorder [Video file]. Mill Valley, CA: Psychotherapy.net.
Freeman, C. P. (2009). Psychological and drug therapies for post-traumatic stress
disorder. Psychiatry, 8(8), 301–309. https://doi-org.ezp.waldenulibrary.org
/10.1016/j.mppsy.2009.06.001
Laureate Education (Producer). (2012a). Academic year in residence: Thompson family case
study [Multimedia file]. Baltimore, MD: Author.
Morgan, L. (2020). MDMA-Helped psychotherapy for people diagnosed with treatment-
resistant PTSD: what it is and what it isn’t. Annals of General Psychiatry, 19(1), 1–7. https://doi-org.ezp.waldenulibrary.org/10.1186/s12991-020-00283-6
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to
guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing
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