10 hours ago
Individuals who have been exposed to aversive events can have heterogenous presentations. When individuals have psychological distress related to such an event their condition falls into trauma and stress related disorders in the “Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5)” (American Psychological Association [APA], 2013). In this group of disorders anxiety or fear-based symptoms can present but often these individuals have externalizing anger, aggression, dissociation, dysphoria, and/or anhedonia (APA, 2013). Post-traumatic stress disorder (PTSD) is one of the six disorders that falls into this category and will be examined in William, a client from this week’s learning sources, for the purpose of this discussion.
Observations, Behaviors, and PTSD
William is a 38-year-old, African American who currently works as lawyer and is an Iraq war veteran (Laureate Education, 2012). William and his wife are currently living with William’s older brother and their family after being unbale to pay their mortgage (Laureate Education, 2012). William’s job is currently in jeopardy due to alcohol use and PTSD symptoms (Laureate Education, 2012). William’s hobbies include soccer, art collecting, and jazz music (Laureate Education, 2012). Client reports he has “hit some hard times” causing him to move back in with his brother and that he has been told he has PTSD (Laureate Education, 2016). During the interview William’s affect is normal and mood appears dysphoric though William appears avoidant when discussing his diagnosis of PTSD and shameful in terms of moving back in with his brother.
According to the DSMV-5 to be diagnosed with PTSD certain criteria (A-H) need to be present (APA, 2013). In criterion A the individual must have been exposed to death either perceived or real, suffered serious injury, or sexual violence through direct contact, witnessing, learning, and/or repeated exposure (APA, 2013). For William it can be assumed criterion A is met in any of the ways listed as he is an Iraq war veteran (Laureate Education, 2012). Criterion B involves intrusive thoughts through memories, dreams, flashbacks, and/or prolonged psychological and physiological distress from internal and external cues (APA, 2013). From the clip and chart, we are unable to determine if William meets criterion B. Criterion C focuses on avoidance of memories which William appears to be doing as he looks away when he mentions he has PTSD (APA, 2013). Criterion D involves anhedonia, amnesia, and negative beliefs, emotions, and cognitions two of which need to present (APA, 2013). William appears shameful but there is nothing indicating he has lost pleasure in activities, has negative beliefs, emotions, or cognitions, or amnesia (Laureate Education, 2012). Criterion E involves changes in arousal and reactivity characterized by two or more of the following: aggression or irritability, reckless behavior, high alertness, sleep, and/or concentration issues (APA, 2013). William’s drinking is leading to his instability and can be considered self-destructive behavior (Laureate Education, 2012). At the beginning of the video William needs to be redirected and refocused lending to perhaps issues with concentration.
For criterion F symptoms of A-E must be present at least one month which can be inferred as the client most likely missed more than one mortgage payment to have been evicted. Criterion G involves impairment in areas of functioning which is evident by Williams occupational troubles and criterion H involves ruling out any other causes (APA, 2013). Though William on the service meets some of the criteria for PTSD further interviewing and screening would need to be conducted to confirm. Investigation into problems at work due to “PTSD related concerns” would need to be explored as well as client’s self-image and associated symptoms.
Wheeler (2014) states first line treatment approaches for PTSD are cognitive behavioral therapy (CBT) or eye movement desensitization and reprocessing (EMDR). First and foremost, for client’s with PTSD treatment needs to begin with safety and stabilization before they are able to safely process the traumatic event (Wheeler, 2014). One form of CBT, stress inoculation therapy (SIT), can be useful in the stabilization phase through education, skills building, and use (Wheeler, 2014). Medications are not considered first-line therapy and should only be used if client has failed CBT or EMDR if there is concomitant severe depression (Wheeler, 2014).
If the latter is the case selective serotonin reuptake inhibitors (SSRIs), Paxil and Zoloft, are the only two currently approved medications indicated for PTSD (Wheeler, 2014). Benzodiazepines should be avoided as they can interfere with processing and are highly addictive (Wheeler, 2014). For sleep disturbances non-benzodiazepines such as trazadone should be considered (Wheeler, 2014). Seeing as William has alcohol abuse issues benzodiazepines would not be a safe choice if medications were to be considered. Given William has not been in therapy (according to the chart) and is currently in the stabilization phase of Maslow’s hierarchy of needs CBT would be the recommended treatment without augmentation of medication at this time.
It estimated that almost 65% of Iraq and Afghanistan war veterans have PTSD co-occuring with a substance abuse disorder (SUD) (Capone et al., 2018). This co-occurrence results in poorer psychosocial functioning compared to each disorder alone (Capone et al., 2018). Integrated Cognitive Behavioral Therapy (ICBT) occurs over 12 sessions and is a guided treatment that concurrently addresses both SUD and PTSD symptoms that is found to be highly transferable (Capone et al., 2018).
Capone et al. (2018) conducted a randomized control trial examining ICBT vs standard treatment in war veterans suffering from PTSD and SUD. Capone et al. (2018) found ICBT to be effective in reducing re-experiencing symptoms, avoidance, and hyperarousal. Decrease in percent of alcohol days was found as well (Capone et al., 2018). Though the researchers concluded the results were not as robust as they had hoped, and further research to validate was needed (Capone et al., 2018). Goals of treatment for William early on would be stabilization to include alcohol abstinence, job security, and housing which the provider would hope to achieve over a 3-month period of ICBT or similar CBT model with the client. Once stabilization occurs the provider can then move into to processing the trauma, though this can be a life-long process (Wheeler, 2014).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorder (5th ed.). Author
Capone, C., Presseau, C., Saunders, E., Eaton, E., Hamblen, J., & McGovern, M. (2018). Is integrated CBT effective in reducing PTSD symptoms and
substance use in Iraq and Afghanistan Veterans? Results from a randomized clinical trial. Cognitive Therapy and Research, 42(6), 735–746.
Laureate Education (Producer). (2012). Academic year in residence: Thompson family case study [Multimedia file]. Baltimore, MD: Author
Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how- to guide for evidence-based practice (2nd ed.). Springer
Reply Quote Email Author
Select: All None
Message Actions (Click to see options) Expand All Collapse All
PLEASE REPLY TO POST
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.