Psychotherapy with Trauma and Stressor-Related Disorders

Psychotherapy with Trauma and Stressor-Related Disorders

 Week 9: Psychotherapy with Trauma and Stressor-Related Disorders

Introduction

Post-traumatic stress disorder (PTSD) develops after being exposed directly or indirectly to a real or potentially traumatic event. High mortality and suicide rates, considerable comorbidity, and functional impairments are all linked to PTSD. The onset of PTSD is predisposed by biological and psychological variables, childhood trauma, present mental disease, poverty, a lack of education, and proper social support. At some point in their lives, 5% to 10% of people in the US will experience PTSD (Mann & Marwaha, 2022). In the case study, the patient developed PTSD following a minor auto accident. The paper addresses the neurological underpinnings of PTSD, DMS-5 TR criteria for post-traumatic stress disorder, symptoms described in the case study, and an alternate PTSD treatment approach to the one used in the case study.

PTSD’s Neurobiological Basis

Witnessing or suffering a severe or life-threatening incident can result in psychological trauma. Victims are likely to experience increased terror, helplessness, and fear, which can result in temporary or long-term psychological suffering accompanied by modifications in their physical, mental, emotional, and behavioral functioning. Neuroendocrine, neurochemical, and neuroanatomical changes in neural networks are all part of the neurology of PTSD (Abdallah et al., 2019). Atypical catecholamine, serotonin, amino acid, peptide, and opioid neurotransmitter dysregulation are some of the main neurochemical indicators of PTSD. These compounds are present in brain circuits that control or integrate stress and terror reactions. Patients with PTSD have dysregulated glucocorticoid signaling, which makes the HPA more sensitive to negative input. Low cortisol levels following trauma exposure may be the cause of PTSD (Miao et al., 2018). Reduced serotonin transfer in the dorsal and median raphe is associated with hypervigilance, impulsivity, and greater aggressiveness. Patients with PTSD exhibit elevated noradrenaline transmission, which increases fear and the encoding of emotional memories, raising alertness and vigilance. Hypodomainergia, which impedes the development of fear and anxiety management and raises the likelihood of substance use disorders, is experienced by PTSD patients (Abdallah et al., 2019). Additionally, those with PTSD have changed neuro-atomic characteristics that aid in stress and terror adaptation. Additionally, persons with PTSD have smaller hippocampi.

PTSD’s DSM-5-TR Diagnostic Criteria

According to the DSM-5 criteria, a patient must have experienced a traumatic event directly or indirectly and show symptoms from one of the four categories; intrusion, avoidance, negative changes in thought and mood patterns, and arousal and reactivity changes, in order to be identified as having PTSD. The DSM-5 criteria additionally stipulate that there must be a psychological, social, or functional deficit and that symptoms must have affected a person’s life and persisted for at least a month (Miao et al., 2018). Additionally, the symptoms must not be brought on by any other medical condition, alcohol usage, or drug abuse. The case study’s symptomology matches the DSM-5 criteria for confirming PTSD. The individual featured in the case study experienced a traumatic event firsthand: a small vehicle accident in which the father was physically assaulted and pursued by the person who hit them. The patient exhibits distressing accident-related recollections. He experienced worry when anything connected to the occurrence came up, such as news articles about car crashes, seeing the kind of vehicle that struck their car, or hearing people discuss it. The patient struggled to fall asleep, taking several hours, sleeping in his dad’s room, and having flashbacks. At home and school, he started acting physically hostile. He once hurled trash everywhere in the classroom and overturned tables. The patient frequently got into arguments with his older siblings. He was hyperaroused, had intrusive thoughts, had a disjointed knowledge of what had happened, and could not talk about what had occurred.

PTSD is the established diagnosis, implying the details and manifestations presented in the scenario are sufficient to make the diagnosis. Trauma-focused cognitive therapy, which focuses on memories, meanings, and management, was employed as the primary treatment method. Memory characteristics are essential for the onset of PTSD. Patients with PTSD have trouble remembering details, and their memories are frequently disjointed and fractured. Maladaptive assessments are experienced by patients; PTSD sufferers are unable to appropriately assess the event’s timing. Patients exhibit a perception of a present threat but are unable to comprehend the occurrence in the past.

Other diagnoses identified in the patient include opposition defiant disorder (ODD), conduct disorder (CD), major depressive disorder (MDD), attention-deficit hyperactivity disorder (ADHD), separation anxiety disorder (SAD), and a phobia of spiders. All other diagnoses emerged after that incident, except for ADHD and spider phobia. I support ODD and SAD diagnoses considering Joe’s symptomology, which includes violence at home and school, fighting, and sleeping in his dad’s room. Joe was previously diagnosed with ODD, making conduct disorder unlikely because the symptoms presented are not severe enough to indicate CD. The co-occurrence or diagnosis of the two illnesses is uncommon. Usually, one or the other applies. Joe is acting largely defiantly in this situation. The progression of major depressive illness necessitates monitoring. It is uncommon for MDD to be connected to a particular traumatic experience, making the diagnosis in this presentation dubious.

Alternative Treatment

The primary non-pharmacological method of treating PTSD is cognitive behavioral therapy (CBT). CBT is common in individual settings but can also be administered in group settings (Miao et al., 2018). CBT focuses on an individual’s functionality and quality of life by informing people how to recognize their problematic skewed thought patterns, improve their comprehension of behavior, adopt coping strategies and problem-solving techniques, and boost self-assurance. CBT is the gold standard for treating PTSD, as it has been proven to be successful (Mann & Marwaha, 2022). Approximately 12 sessions of cognitive behavioral therapy (CBT) are required to reduce most PTSD symptoms significantly (Miao et al., 2018). CBT can be administered as repeated exposure, cognitive processing therapy, teaching coping skills, and eye movement desensitization and reprocessing (EMDR). Reliability, precision, and efficacy are guaranteed in mental health care when using gold standards or generally acknowledged, evidence-based therapies. Gold-standard therapies boost confidence among patients and virtually guarantee success in treating mental disorders.

(Psychotherapy with Trauma and Stressor-Related Disorders)

Why the Sources are Scholarly

Scholarly articles are written by experts and researchers with foundational knowledge in the field. The selected articles, Miao et al. (2018), Abdallah et al. (2019), and Mann and Marwaha’s (2022), were written by researchers and experts with knowledge in the psychology field and affiliated to institutions, including Department of Anesthesiology and Intensive Care, Third Affiliated Hospital of Second Military Medical University, Shanghai, China, Clinical Neuroscience Division, Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. And Case Western Reserve Un/MetroHealth MC. The affiliation to academic and healthcare institutions adds to their authority to research and write about the topic.

Conclusion

PTSD patients repeatedly relive the traumatic incident, exhibit obtrusive thoughts, experience nightmares, flashbacks, detachment from realities and themselves, unpleasant feelings, heightened vigilance, reactivity, irritation, and difficulty falling asleep and focusing. Joe exhibits the symptoms above, consistent with the DSM-5 criteria, confirming PTSD. The initial therapy for PTSD is psychotherapy. However, results are better with combining medication and psychotherapy. According to research, CBT is an effective treatment for PTSD because it enhances cognitive functioning, promotes behavioral changes, and encourages the use of effective coping skills.

References

Abdallah, C. G., Averill, L. A., Akiki, T. J., Raza, M., Averill, C. L., Gomaa, H., Adikey, A., & Krystal, J. H. (2019). The Neurobiology and Pharmacotherapy of Posttraumatic Stress Disorder. Annual review of pharmacology and toxicology, 59, 171–189. https://doi.org/10.1146/annurev-pharmtox-010818-021701

Mann, S.K. & Marwaha, R. (2022). Posttraumatic Stress Disorder. StatPearls [Internet]. StatPearls Publishing.

Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 32. https://doi.org/10.1186/s40779-018-0179-0

 

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