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Intervention Program for Post Traumatic Stress Disorder

Abstract

Post Traumatic stress disorder (PTSD) represents a mental health condition set off by a traumatic event through witnessing or experiencing a terrifying situation. There exist a myriad of treatment options for PTSD designed to help the patient regain his or her sense of control and minimize a powerful effect of traumatic memories. The paper examines the efficacy of cognitive behavioral means of treatment, in this case, the exposure therapy, in addressing children who experience behavioral challenges stemming from a particular trauma. Cognitive behavioral therapy (CBT) should be the first step in the treatment of children with PTSD, especially in optimizing client’s adaptive functioning. If the symptoms persist or extra control is needed, the pharmacologic therapy may be implemented. CBT integrates exposure techniques, relaxation skills, stress management, and cognitive exploration techniques to facilitate the correction of erroneous cognitions and to reframe counter-productive ones. The prolonged exposure therapy is feasible and possible even for clients who have suffered from a repeated trauma and experienced high levels of comorbidity. The given paper explores how different approaches of the cognitive behavioral therapy can be used to help the client express, expose, and control his or her thoughts, situations, and feelings associated with a trauma.

Intervention Program for Posttraumatic Stress Disorder

Introduction

Posttraumatic stress disorder (PTSD) is a trauma and stressor-based disorder under the DSM-5 classification. PTSD affects close to 3.5% of the American population. It is widely experienced by soldiers owing to multiple traumatic events that they endure in the battlefield. However, PTSD can affect all individuals who experience the impacts of other traumas, including abuse, sexual assault, disasters, terrorist attacks, child neglect, and physical assault. People with PTSD face three core types of symptoms: a heightened anxiety and emotional arousal, avoidance of reminders of a trauma, and the re-experiencing of the traumatic event (Friedman, Keane, & Resick, 2014). The symptoms of PSTD typically start three months after the event and can last for over a month. A client with PTSD exhibits at least three avoidance signs, at least two hyperarousal symptoms, and at least one re-experiencing symptom. Risk factors that heighten individuals’ vulnerability to PTSD revolve around the nature of the event itself. They include the history of substance abuse, poor coping skills, weak support, high degree of stress, and the history of anxiety, depression, or mental illness (Friedman, Keane, & Resick, 2014). Environmental factors, including a head injury, childhood trauma, or the history of a mental illness, may further heighten the risk of PTSD. In addition, cognitive and personality factors coupled with such social conditions as social support influence the way in which individuals adjust to the trauma.

PTSD Treatment Options: An Overview

The early treatment of PTSD is necessary since its symptoms may worsen in the future. Moreover, they may alter a person’s family life since the individual turns angry or violent. Treatment may encourage the patient to recall and process the emotions and sensations that he or she felt during the initial event. There exists a wide range of PTSD treatment approaches, namely, CBT, art therapy, play therapy, psychodynamic therapy, and pharmacologic therapy.

The psychodynamic therapy seeks to help the client release unconscious thoughts and emotions, working into their sense of self and understanding their lives. This psychotherapy exploits such approaches as systematic desensitization, which is aimed at ensuring an enhanced reduction of avoidance and intrusion symptoms (Friedman, Keane, & Resick, 2014). The objective of the psychodynamic psychotherapy centers on understanding the connections between a childhood trauma and the challenges of modifications in the adult life. One of the strengths of this approach draws from the potential to foster the remediation of interpersonal problems linked to PTSD.

The group and family therapy offers people a platform to share aspects of their trauma with others who have had similar experiences. Sharing the story may help the client gain confidence in talking about the trauma, which in turn can aid him or her in coping with the symptoms of PTSD and painful memories about the trauma (Friedman, Keane, & Resick, 2014). PTSD can influence perceptions and attitudes of the entire family as some of its members may fail to understand why the patient is angry or stressed. The group psychotherapy transforms the patient from a helpless victim into a coping survivor. Group treatment should not be administered to children who manifest poor social skills since they risk facing further rejection.

The pharmacology therapy is used to target various PSTD symptoms, including intrusion, avoidance, arousal and reactivity symptoms, and adverse alterations in patient’s mood and cognitions. The U.S. Food and Drug Administration (FDA) have developed two medications for the treatment of adults with PTSD, namely, sertraline (Zoloft) and paroxetine (Paxil). Studies indicate that the pharmacologic therapy is effective in reducing PTSD symptoms. However, many medications fail to eliminate symptoms and may be only effective if combined with the ongoing intervention program such as psychotherapy (Dorsey, Briggs, & Woods, 2011).

Eye Movement Desensitization and Reprocessing (EMDR) can aid patients in altering the way in which they react to memories about the trauma. EMDR exploits standardized procedures to access the stored memories and activate the brain information system and reprocessing. When dealing with the client, the therapist should target the previous and present events that trigger disturbance and develop the skills required for future mental functioning (Friedman, Keane, & Resick, 2014). The integration of the EMDR approach with other therapies such as the play therapy has proven efficacious, especially in the treatment of children and adolescents. A direct play therapy enables the child to link the stimuli (triggers of events) to behavioral and emotional disturbances. In narrating the traumatic event, the child should write an account detailing the facts surrounding the situation and illuminate the story with thoughts and feelings.

Discussion

The exposure to domestic violence may be traumatic to the child, and his or her reactions may mimic responses to other traumatic stressors. The child may experience domestic violence in multiple ways: he or she may witness one parent threaten or assault another, witness the parents being uncontrollable with anger or may be a victim of a violent assault. The traumatic event may make children feel frightened or distressed; as such, the therapist should establish a sense of security by availing opportunities for relaxation and positive experiences (Shemesh et al., 2005).

Cognitive behavioral therapies used for the treatment of anxiety disorders seek to help clients minimize distress by altering their cognitive and behavioral responses. The available CBT approaches use several common elements, namely, psychoeducation, exposure or gradual desensitization to memories of the event, relaxation and affective modulation of the skills essential for the management of emotional and psychological stress, and cognitive restructuring of incorrect or maladaptive cognitions (Dorsey, Briggs, & Woods, 2011). The core aim of the approaches is to highlight factors that trigger, contribute to or aggravate the symptoms.

The CBT techniques employed in the treatment of PTSD differ depending on the case; however, the whole approach essentially seeks to change irrational thoughts and eliminate any adverse emotions linked to the traumatic experience. Several approaches of CBT have been proven effective in the treatment of PTSD, namely, exposure therapy, stress inoculation training (SIT), eye movement desensitization and reprocessing, and cognitive therapy. Stress inoculation training is intended to minimize the PSTD symptoms by teaching the patient to control anxiety. Stress inoculation training, including muscle relaxation, breathing, and positive self-talk, is designed to help patients look at their memories in a healthy manner (Dorsey, Briggs, & Woods, 2011).

The exposure therapy represents a form of the cognitive-behavioral therapy that seeks to minimize or eliminate anxiety and fear. The overall aim of the exposure intervention is to separate cues, thoughts, and other reminders of the trauma event. The exposure therapy also seeks to help the patient understand reactions during and following the traumatic event, as well as discussing and rehearsing alternative responses. Theoretically, the re-exposure therapy operates as an informal desensitization process designed to extinguish the aversive stimuli and incapacitating emotional reactions.

The prolonged exposure therapy (PE) is suitable for adults who have experienced a trauma. It is a kind of the cognitive behavioral therapy (CBT) aimed to treat PTSD. PE consists in re-experiencing the traumatic event by recollecting it instead of avoiding the traumatic memories. The goal of the therapy is to help the client process traumatic events and minimize trauma-induced psychological disturbances. PE is a theoretically based intervention program, which is highly efficacious in the treatment of PTSD and related symptoms, such as anger, anxiety, and depression. Prolonged exposure comprises three elements: psychoeducation, imaginal exposure (recollecting the trauma memory via imagination), and vivo exposure. Imaginal exposure spotlights the cognitive avoidance of trauma-based emotions, memories, and thoughts, while vivo exposure targets the behavioral avoidance of places, people, and situations that serve as reminders of the trauma.

The treatment program may take 2-4 months, involving one or two treatment sessions per week lasting 60-90 minutes in length. Delivery settings of the program may be a community agency or an outpatient clinic. Prior to the start of the treatment, the therapist should take into account salient domains of the patient, including the symptoms, family context, personal strengths, and broader environmental factors (Dorsey, Briggs, & Woods, 2011). In order for setting the right diagnosis, the PTSD symptoms ought to be present for at least a month and cause clinically significant distress or impairment in functioning.

The prolonged exposure therapy fosters the client’s capacity to process his or her traumatic experiences emotionally and overcome PTSD and other trauma-based symptoms. Although, no cure exists for PTSD, its symptoms can be managed effectively to ensure that the client enjoys normal mental functioning (Cloitre et al., 2010). The exposure therapy can be employed to aid children traumatized by family violence in understanding the linkages between violent exposure and violent reactions.

The exposure treatment program may involve the family and other kinds of support, especially in the psychoeducational sessions of treatment (Shemesh et al., 2005). The reliance on parental reports presents its own set of challenges. For instance, the parent may have been an indirect participant in the same trauma or the trauma experienced by the child may be traumatic to him or her. Consequently, the latter may in turn develop his or her PSTD symptoms, which may influence his or her understanding of the child’s behavior and emotions (Cloitre et al., 2010). In cases where parental reports on the child’s PSTD vary from the child’s version of the situation, the practitioner should seek to interpret the inconsistency actively. The intervention or treatment program for children experiencing PTSD should correspond to the children’s development milestone and their desire to participate in the program, since they should feel comfortable and safe.

Studies have shown that the exposure therapy is highly efficacious, especially for single-incident and adult-onset traumatic events. Exposure-based treatment has strong empirical support for its efficacy in ameliorating PTSD and related psychopathology. Some studies have demonstrated that PE results into a significant clinical improvement in close to 80% of patients with chronic PTSD (Dorsey, Briggs, & Woods, 2011). However, despite solid empirical support and the efficacy of the exposure-based therapy in ameliorating PTSD, the enhancement of treatment may be needed owing to high dropout rates and challenges liked to the treatment of patients with high comorbidity and treatment-impeding stressors (Dorsey, Briggs, & Woods, 2011).

Conclusion

The exposure therapy exposes the patient to the trauma and exploits his or her mental imagery to aid the person in coping with his or her feelings. The cognitive behavioral therapy may also involve cognitive restructuring intended to help people make sense of their terrifying memories. One of the benefits of the exposure therapy includes low relapse rates, especially when the intervention is accompanied with the use of medications or continued sessions. In the exposure therapy, the objective is to help clients learn how to overcome situations, thoughts, or feelings that remind them of the past traumatic events. It rests on helping the patient alter his or her reactions to stressful memories. Since every individual is unique, the kind of treatment that works for one person may not necessarily be effective for another; as such, it is essential for PSTD treatment to match patients’ situation. If the patient is experiencing a trauma like an abusive relationship or manifesting other conditions such as panic disorder, depression, or feeling suicidal, both of the problems should be treated concurrently.

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