Selection Of Your Colleagues’ Responses.

The Assignment:

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients. In APA Format and proper citation, provide at least two references in each response post.

Colleagues’ Response Post #1

Patient with Post -Trauma Stress Disorder

Post-traumatic stress disorder (PTSD) is common among U.S military war veterans and about 20 of them are affected with estimates ranging from 8.1% to 15.2. Post-Traumatic Stress Disorder (PTSD) is a chronic psychological disorder that can develop from exposure to traumatic events in an individual’s life. It can also be caused by witnessing or perceived traumatic events (as serious injury, violence, or death), but war time veterans are more at risk.  Symptoms may include flashbacks, nightmares, severe anxiety hypervigilance, as well as recurrent thoughts about the event (American Psychiatric Association [APA], 2013 (Lancaster et al., 2016).

The Diagnostic and Statistical Manual of Mental disorders (DSM-5) criteria of the traumatic event must include an actual exposure or threatened death, serious injury, a violence in at least one criterion (American Psychiatric Association, 2013). In this case, William meet the criterion for PTSD. He is an Iraq war veteran captain which implies he would have directly experienced the traumatic event, witnessing the event occur to others, exposure to adverse details of the traumatic events, and self-destructive behavior (American Psychiatric Association, 2013).

The focus in the case study is William Thompson as a military captain and an Iraq war veteran, Lawyer, husband who is about to lose his job, has lost his home as a result of his inability to pay his mortgage due to alcohol use and PTSD. As a result, he lives with his elder brother and his family

Therapeutic Approaches

In the case of Williams, I will be utilized both the psychotherapy and psychopharmacological treatment to manage his PTSD.

The first psychotherapy treatment I will use for this patient with trauma is the Eye Movement Desensitization and Reprocessing (EMDR). This therapy was developed to resolved symptoms from disturbing and unresolved life experiences like trauma. EMDR is a unique kind of psychotherapy used to eliminate negative emotions linked with traumatic events’ memories by focusing less on the traumatic event but more on the disturbing feelings that derive from the event (Wheeler, 2014). This therapy used approach to address past and present aspect of memories. Francine Shiparo was to first to develop this approach. The Veterans Affairs/Department of Defense clinical practice guideline for PTSD recommends treating PTSD with individual trauma-focused psychotherapy over medications.

Studies have shown that trauma focused therapies can lead to greater outcomes and last longer compared to using just medications (Norman, Hemblen, Schnurr, & Eftekhari, 2018).

Secondly, Cognitive Behavioral Therapy (CBT) will be utilized both PTSD and alcohol abuse. In his case, he has already lost his home and may soon lose his job due to alcohol, CBT will benefit him. CBT focuses on learning to diminish problematic behaviors linked to substance abuse, in this case, alcohol (Wheeler, 2014)

Another therapy for PTSD or trauma survivors is Prolonged Exposure therapy.  In this therapy sessions, the client is required to relates the traumatic event or experience for an hour in the treatment session, and then listens to the audiotape of the session for an hour every day. Exposure therapy also requires in vivo exposure homework in which the client engages in an avoided activity related to the trauma. When this therapy is delivered in an intensive format, it has been shown to be highly effective in the treatment of PTSD (Hendriks, Kleine, Broekman, Hendriks, & Minnen, 2018).

Psychopharmacologic therapy can be used if psychotherapy is not effective or in combination. In this case both will be utilized since his PTSD is causing him life. Problems. The Veterans Affairs/Department of Defense clinical practice guideline recommends the use of medication therapy if the client is nonresponsive to psychotherapy or if the client refuses to engage in therapy (Norman, Hemblen, Schnurr, & Eftekhari, 2018). The recommended medications for the treatment of PTSD are sertraline, paroxetine, fluoxetine, or venlafaxine but only sertraline and paroxetine are approved by the FDA for the treatment of PTSD (Norman, Hemblen, Schnurr, & Eftekhari, 2018).

Treatment Outcomes

With the expected results from EMDR, the client will process negative feelings to the scope of traumatic memories and can recalled without producing negative emotions (Khan et al., 2018). William Thompson will recognize his health concern and the need for therapy.

In regard to CBT, the expected outcomes are that of learning communication skills to addresses avoidance related to PTSD, relationship problems and challenging trauma-related beliefs. The benefit of CBT will cause the client to be aware of his health-related concerns and the need to receive the intervention (Flanagan, Jones, Jarnecke & Back, 2018). Also, with CBT, another expected outcome is the ability to resist alcohol use as several studies have demonstrated that CBT significantly reduces alcohol use disorder.

In summary, the important thing to remember regardless of the treatment choice, is that therapy should be adjusted to the clients need. Using an individualized therapy, the therapy will be use with clients who get the greatest response. Also, the willingness to engage in therapy will depends on the patient. As PMHNP we have lots of different options to explore to help someone with a trauma in their life.  Everybody responds differently so one therapy might not work for one person but will work for the others.

 

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