It is estimated that more almost 7% of the U.S. population will experience posttraumatic stress disorder (PTSD) in their lifetime (National Institute of Mental Health, 201

Week 9: Psychotherapy With Trauma and Stressor-Related Disorders

Assignment: Posttraumatic Stress Disorder

Explain the neurobiological basis for PTSD

Apply assessment and diagnostic reasoning skills to clients presenting with posttraumatic stress disorder

Recommend therapeutic approaches for treating clients presenting with posttraumatic stress disorder

Analyze the importance of using evidence-based psychotherapy treatments for clients with posttraumatic stress disorder

It is estimated that more almost 7% of the U.S. population will experience posttraumatic stress disorder (PTSD) in their lifetime (National Institute of Mental Health, 2017). This debilitating disorder often interferes with an individual’s ability to function in daily life. Common symptoms of anxiousness and depression frequently lead to behavioral issues, adolescent substance abuse issues, and even physical ailments. For this Assignment, you examine a PTSD video case study and consider how you might assess and treat clients presenting with PTSD.

Review this week’s Learning Resources and reflect on the insights they provide about diagnosing and treating PTSD.

View the media Presentation Example: Posttraumatic Stress Disorder (PTSD) and assess the client in the case study.

For guidance on assessing the client, refer to Chapter 3 of the Wheeler text.

Note: To complete this Assignment, you must assess the client, but you are not required to submit a formal comprehensive client assessment.

The Assignment

Succinctly, in 3 pages, address the following:

Briefly explain the neurobiological basis for PTSD illness.

Discuss the DSM-5-TR diagnostic criteria for PTSD and relate these criteria to the symptomology presented in the case study. Does the video case presentation provide sufficient information to derive a PTSD diagnosis? Justify your reasoning. Do you agree with the other diagnoses in the case presentation? Why or why not?

Discuss one other psychotherapy treatment option for the client in this case study. Explain whether your treatment option is considered a “gold standard treatment” from a clinical practice guideline perspective, and why using gold standard, evidence-based treatments from clinical practice guidelines is important for psychiatric-mental health nurse practitioners.

Support your Assignment with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

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0:33 Video trnascript

the reference to this article in the

description for this video this is an

interesting presentation example it's of

an eight-year-old boy I'll call him Joe

this takes place in the United Kingdom

this is a good example of how a

traumatic event might not seem severe

but how it's the interpretation that can

lead to post-traumatic stress disorder

it's also a good example of how trauma

focused cognitive therapy can be used to

treat post-traumatic stress disorder one

of the mysteries of post-traumatic

stress disorder is why does it tend to

form in some people who have relatively

minor of

massacre when it might not form and

other people have really serious events

occur right so for example a severe

motor vehicle accident compared to a

minor motor vehicle accident and that's

what we're talking about here in this

case a minor motor vehicle accident well

we learn here of course is it's not just

the severity of the traumatic event that

matters there are a number of other

factors that have to be weighed in

genetic factors environmental factors

prior experiences cognitive processing

and what was perceived during the event

so first I'll review Joe's history then

take a look at trauma focused cognitive

therapy and then look at the course of

treatment in this case so again Joe is 8

years old he lives with his father and

two older siblings Joe's father takes

care of the three children alone as his

wife left him many years ago Joe's

father has a physical disability but no

history of mental health conditions now

taking a look specifically at the

traumatic event I mentioned it was a

minor motor vehicle accident we see that

Joe was riding home as a passenger in

the front seat of his father's car his

father was driving they were coming back

from soccer practice and his father

entered into a traffic circle in this

case it was a five-way intersection the

father slows down as he sees another

vehicle in the circle so he has to yield

to that vehicle because either the

vehicle has the right of way

and as the father slows down the vehicle

behind him runs into the rear of his

vehicle the guy behind him was driving

too fast not paying attention whatever

was going on there but again he drove

into Joe's father's car so Joe was not

hurt at all Joe's father sustained a

minor injury to his knee because it hit

the steering column there was no airbag

deployment the vehicle is only

cosmetically damaged and it was drivable

immediately after the collision

evidently when Joe's father exited the

vehicle to talk to the driver that hit

them an argument ensued and the other

driver threatened Joe's father with

physical harm so Joe's father got back

into the vehicle and drove away from the

scene but the other driver pursued them

before eventually breaking off the

pursuit by pulling over on

the road Joe's father waited till they

arrived home before he called the police

shortly after this event Joe was taken

in to receive mental health care he

presented with intrusive memories of the

accident and the subsequent pursuit he

did not seem to understand the incent

but he did understand that was an

accident

and the car was slightly damaged and he

also understood that the other driver

chased him and his father Joe we become

very anxious when presented with

anything that reminded him of the

accident the stretcher Road word

occurred stories on television related

to car accidents the type of vehicle

that hit them and talking about the

insect Joe had trouble sleeping it took

him a few hours to get to sleep and had

to go to sleep in the same room as his

dad to fall asleep he also had a lot of

nightmares

he became physically aggressive in

school and at home at school he was

engaging in outburst in the middle of

class it was one incident where he

turned over tables and threw trash all

around the classroom and apparently this

was pretty frightening to the school

staff and to his fellow students at home

he was fighting with older siblings and

was set off by the slightest

provocations in addition to meeting the

criteria for post-traumatic stress

disorder Joe had significant comorbidity

including oppositional defiant disorder

conduct disorder that's really uncommon

that both of those diagnoses would be

givens he also had major depressive

disorder attention deficit hyperactivity

disorder ADHD separation anxiety

disorder and one specific phobia spiders

the only diagnoses that were of concern

before the incident would be the ADHD

and the fear of spiders all the other

diagnoses were given after the event

that's a lot of mental disorders to be

diagnosed with that quickly I'll talk

about this a little later specifically

at the post traumatic stress disorder we

see Joe had symptoms of hyper or

avoidance and intrusive thoughts he also

had a disorganized understanding of the

event and didn't really seem to be able

to discuss the incident so now take a

look at the trauma focused cognitive

therapy a key concept of this therapy

when talking about PTSD

is the nature of the traumatic memory

not so much what happened but again the

properties of the actual memory it's

considered to be critical to the

development of PTSD individuals with

PTSD often struggle to retrieve

information about the event when they do

recall information it's often fragmented

and disorganized as I mentioned this is

something of course we see specifically

in this case with Joe another important

concept is the idea of maladaptive

appraisals so an individual PTSD is

unable to accurately assess the event

and the idea that the event was time

limited so they don't really understand

that the event is in the past but it's

over this leads to the sense that

there's some sort of current threat

right again so the traumatic event is

not just in the past but it's happening

right now in some way or it may happen

right now in some way to address these

concepts and the other factors we see

around PTSD trauma focused cognitive

therapy focuses on the 3ms of PTSD

memories

distorted memory representations

meanings the maladaptive cognitive

appraisals and management this is

working on the difficulty we see with

coping with feelings and thoughts and

perceptions so now moving to the course

of treatment we see in this case of Joe

the treatment team explained to Joe how

the treatment was supposed to work so

they explained the three M's and all the

other information about trauma focused

cognitive therapy we see that Joe's

father joined him for the early sessions

this kind of makes the client more

comfortable in the case of Joe it

certainly did these initial sessions had

a lot of normalizing of the response to

the event so anybody would be distressed

if they are in a car accident and

pursued by the person that hit them

there was a lot of rapport building they

made it clear to Joe that he had

permission to talk about the event which

I think seems particularly bored in this

case because again he had difficulty

really expressing thoughts or feelings

around the incident they also gave him

permission to talk about the symptoms

and they discussed the incident in a

calm and safe way kind of setting at

for joe tafolla trying to really make

This a little bit less emotional for Joe

Joe was encouraged to recognize his

emotions to express his emotions and to

manage the more extreme emotional

reactions some relaxation techniques

were used including progressive muscle

relaxation Joe was also instructed to

practice this at home so we see some

homework assigned which is actually

fairly common for all different types of

cognitive therapy we see the specific

cognitive distortion was identified

early on this is that Joe believed that

the world was a different place since

the accent in relation to him right so

he didn't fit in with the world in the

same way because of that accent

Joe was assigned a number of new

activities this is called behavioral

activation essentially we see a series

of tasks that Joe and his father would

complete together for example they would

play soccer in the garden then in the

street and then play soccer in the park

the idea here was they're trying to move

Joe into other geographic areas and

increased the probability of contact

with his friends from these behavioral

activation exercises it became clear

that one of Joe's fears was that when he

was away from his father something bad

would happen to his father to alleviate

this fear they discussed with Joe how

his father – actually been a number of

altercations before this incident they

tried to sell this like Joe's father had

a lot of skill at surviving fights so it

always worked out okay for him because

he knew how to take care of himself I'm

not sure I would have gone with this

route right like telling Joe that his

father had been in a lot of fights and

kind of was a survivor it seems a little

unusual to me it's kind of introducing

new information that may have backfired

but we see in the case report that this

appears to have been effective again

maybe not something I would have done

but a kind of maneuver that seemed to

work in this case Joe also incorrectly

believed that his father was still

suffering from the injuries that

occurred in the accent what we see is

that Joe became more alert about

behavior as his father already engaged

in for example taking medication the

father already did this right

early but now Joan noticed it and

attributed this behavior to the accent

so Joe had a lot of blanks in terms of

understanding what happened and he

tended to fill in those blanks with the

worst case scenario the treatment team

kind of created a game for Joe to

address this making him the detective

who is responsible to find evidence and

fill in those blanks so unlike that

other technique of talking about all

these flights that the father had been

in I think this technique makes a lot of

sense

this one really I think kind of empowers

Joe and allows him to use his creativity

and critical thinking skills to solve

problems that could help him move past

these symptoms so I really like this

technique in particular we see an

example of some of the blanks that Joe

had in terms of the narrative Joe

believed that immediately after the

accent that him and his father were both

severely injured so severely in fact he

believed they required immediate medical

treatment because they did not receive

treatment Joe felt that there must be

unresolved physical issues so he

believed that both him and his father

had physical problems as a result of

that accent but really it was a

cognitive distortion they did not have

any problems at the time that Joe was

receiving treatment so to address this

they talked with Joe about his

understanding what happened and in the

narrative we see that behind the vehicle

that hit Joe and his father there was an

ambulance the ambulance crew saw the

accident of course they were right

behind the vehicle to hit him as I

mentioned but then they drove past the

accent drove around the circle and came

back to make sure that no one was

injured to the degree where they would

need transportation to the hospital Joe

remembers seeing the ambulance twice

which is in fact what happened the

ambulance passed their position again

two times going past them and then

coming back the presence of that

ambulance led to this assumption by Joe

that he would need to be hospitalized

therefore his injuries must have been

serious so again we kind of see how

these cognitive sources play out there

was information that was accurately

collected at the time by Joe but

incorrectly interpreted

the treatment team was able to spin this

around and paint another narrative I

thought this was also a good technique

they said clearly it was unlikely that

Joe and his father were severely injured

as evidenced by the ambulance crew

seeing them and continuing on so they

really took the same information but

interpreted more accurately and in a way

tat was more helpful to treating Joe's

symptoms Joe made fairly good progress

as a result of therapy

there was this distress scale that they

used in therapy and went from 0 to 10

with 10 being the most distressed Joe

initially reported a score of 10 when

discussing the incident but by the time

he got to the end of therapy he was

reporting scores of 0 during all parts

of his narrative not just the parts

associated low distress but even the

parts that have been associated with a

high l

presentation example this is an

interesting case we get to see as I

mentioned before how severity may be

important sometimes but it may not be

the most important thing for everybody

and it would also appear here that the

altercation was as traumatic as the

accent so I think that's what's really

interesting about this as well we see

this accent that was fairly minor right

Joe was uninjured but then we see this

pursuit and that as a separate incident

could be quite frightening and it's

really again how somebody perceives that

pursuit I think most people would have

been fairly alarmed when being chased by

another car but by the accident itself I

think most people would not have viewed

that as traumatic when these things

combined for Joe it did result again in

the development of post-traumatic stress

disorder

we're also left with the sense that if

Joe didn't realize that they were being

chased he would not have been

traumatized right so maybe the motor

vehicle accident really wasn't enough to

lead to PTSD but it was his

interpretation of that pursuit which of

course as I mentioned would have been

scary to anybody but if he was sitting

there and didn't know about it he may

not have had any reaction to it now

there's not a strategy that comes from

this of course there's no way to really

say hey let's ignore what's going on

right Joe's father couldn't have just

said hey nothing's really happening here

not worry about it he had to acknowledge

what was going on and he was probably

scared himself but again it just points

back to how important perception is I

mentioned before that it seemed like Jo

was given a large number of diagnosis I

have to in some sense of course defer to

the people that treated him because they

actually saw him and they put together

this case report but I can't help

thinking that it may have been more

useful to diagnose him just with

post-traumatic stress disorder and treat

that for a while

rather than stacking on a lot of

diagnoses the one that concerns me the

most of course is that conduct disorder

diagnosis conduct disorder carries a

stigma because about a third of

individuals diagnosed with it will go on

to develop antisocial personality so I

think I would have tried to avoid the

conduct disorder diagnosis especially

because the oppositional defiant

disorder was already diagnosed as I

mentioned before it's unusual to have

both of those diagnoses together usually

it's just one or the other of course

somebody can technically be diagnosed

with both but again this is somewhat

unusual and if you have the o DD

diagnosis there I don't really see the

urgency to go ahead and move forward

with conduct disorder but again that's

just my opinion for me in the case

report there's a lot of information of

course that would not be included there

of less concern but still somewhat

troubling is the diagnosis of major

depressive disorder this is an episodic

disorder that has a distinct course to

it somebody has a major depressive

episode then they usually recover some

degree and sometime later they have

another major depressive episode usually

sometimes there's one episode but

usually there's more than one so this

isn't something that we really think of

as being associated with a traumatic

event like a traumatic event occurs and

then immediately after that we see major

depressive disorder this is a disorder

where you would typically take a lot of

time before making the diagnosis watch

somebody for a while see if there's some

sort of change in their mood look at the

level of depression and the level of

some of the other symptoms associate the

disorder so a little bit unusual I think

to jump right to major depressive

disorder as well so we see kind of I

think some unusual diagnostic behave

on the part of the clinicians not

necessarily technically incorrect but

just unusual I thought this presentation

example overall though was excellent and

demonstrating how trauma focused

cognitive therapy could be applied to a

real-life situation and how cognitive

distortions were highly problematic for

Joe and addressing those distortions

seemed to lead to a market improvement

PTSD and part is driven by individual

perceptions it's what people think of

those events that really matters at

least in some cases so I know whenever I

talk about topics like this like

post-traumatic stress disorder and I

look at these different presentation

examples there gonna be a variety of

opinions please put any opinions and

thoughts in the comment section

they always generate a really

interesting dialogue as always I hope

you found this presentation example on

post-traumatic stress disorder and

trauma focused cognitive therapy to be

interesting thanks for watching

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