Treating Complex Traumatic Stress Disorders Case Study

While there is agreement that trauma informed care generally refers to a philosophical stance integrating awareness and understanding of trauma and its ongoing impact on patients’ health and lives, there is not yet consensus on a definition or clarity on how the model can be applied in a variety of settings. The philosophical underpinnings of trauma informed care trace to the feminist movements of the 1970s (Burgess & Holstrom, 1974), and the emergence of child-advocacy centers and awareness and response to child abuse in the 1980s. In combination with the growth of research in combat-related posttraumatic stress after the Vietnam War, the focus then expanded to mental health practice, especially in the context of traumatic events. By the late 1990s and early 2000s, social work and mental health professionals began to articulate organizational frameworks for delivery of trauma informed care, as well as conceptual models based on scientific evidence about how traumatic stress impacts brains and behavior (Bloom, 1997; Harris & Fallot, 2001; Covington, 2002; Rivard, Bloom, & Abramovitz, 2003; Ko, Ford, Kassam-Adams, et al. 2008; Bloom, 2010). In 1998, SAMHSA launched the Women, Co-Occurring Disorders and Violence study, a seminal study in 27 sites over five years that examined trauma-integrated services counseling. Following that, the National Child Traumatic Stress Network (NCTSN) began identification and distribution of empirically supported trauma-specific mental health

Long Term Treatment goals: Lower the negative effect that the traumatic event has had, and return to pre-trauma level of functioning.Recall the traumatic event without becoming overtaken with negative emotions.Stop destructive behaviors that serve to maintain escape and denial, and implement behaviors that promote healing, acceptance of the past events, and responsible

Using the diagnostic algorithm discussed in class as a guide, explain how you would arrive at a diagnosis of PTSD based on the clinical data in the case example. Be sure to justify the ways in which the client meets all of the diagnostic criteria for PTSD and provide information about how you would go about elaborating on your diagnosis according to this model.

The fast paced, often demanding world of life in the military, and the experiences of combat and death, create situations in which many veterans experience psychological stress. These stressful situations are typically complicated further by the self-medication of substance use, and other psychological disorders that may be present. There is a large number of military personnel that are facing stressful issues such as homelessness, suicide, and substance abuse, which could lead to them getting involved with the criminal justice system. There is approximately 18.5% of service members returning from Iraq or Afghanistan that suffer from post-traumatic stress disorder or depression, and about 19.5% of military personnel report experiencing a traumatic brain injury during their deployment in the middle east (Veterans and Military Families, 2014).

Goodman, R. D. (2015). Trauma counseling and interventions: Introduction to the special issue. Journal Of Mental Health Counseling, 37(4), 283-294.

This literature review briefly examines the scholarly journal articles and research cited above. The aim of these articles were to identify the effective intervention methods used for the treatment of co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Although there is much evidence to support the high rate of individuals who experience symptoms of or are diagnosed with both PTSD and a SUD, there is little known about the comorbidity of these two disorders. There is also little research focused on specific populations, such as veterans, who experience a high rate of SUD diagnoses generally associated with combat PTSD. The literature also describes possible rationale for the high rate of

Kar, Nilamadhab. “Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review.” Cibi.nlm.gov. National Center for Biotechnical Information, 2011. Web. 21 July, 2016.

been deemed breakthrough therapy by the Food and Drug Administration. The introduction of promising research from ecstasy to treat PTSD has allowed doors for researchers to begin working with LSD which is commonly called magic mushrooms that have shown a lot of promise in producing affective medications for combating PTSD. Along with these promising medications we also need to look at the home life of the veterans, a lot of veterans are either very old and have little family or do not have that family support system that are crucial in the healing process. Receiving treatment and therapy is crucial but if you do not have a strong support system it would be easy for veterans to slip down through the cracks which would allow PTSD to win the

The Diagnostic and Statistical Manual of Mental Disorders describes posttraumatic stress disorder (PTSD) as an acute stress disorder (2013). Individuals that experience this disorder are exposed to or have had an experience of near death or bodily harm (American Psychiatric Association. 2013). Evidence based therapy that has shown positive outcomes in cognitive behavioral therapy (CBT) which is based on changing behavior. The use of client-centered therapy can also be beneficial with this type of client if applied in addition to CBT. Joseph stated that a client-centered approach to PTSD could result in Post-traumatic growth (2004). Post-traumatic growth does not try to bring the client back to the original state before the trauma but bring the client beyond their previous level of functioning (Joseph, 2004). When a person experiences a trauma, they can have a myriad of emotions, it is the therapist responsibility to help the client make better sense of the issue and continue functioning in a normal manner. Not all traumas are alike and not all clients can be treated equally. The most significant aspect of treatment in helping this type of client is the approach the therapist takes which should include the temperament of the client and the goals the client seeks. Included here is an examination of a fictitious client that has experienced a trauma and the therapist care plan. The therapist

“The most basic definition of Post-traumatic stress disorder (PTSD) is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic in nature.” (Kassam-Adams, & Winston, 2004, p.409). In the event that a client suffers from PTSD an evidenced based therapeutic concept should be used, this concept is generally called Trauma-Focused Cognitive behavioral therapy (TF-CBT). TF-CBT has been used in the management of PTSD in both children and adolescents for many years as it has been proven over and over again to be the most effective in treating clients with PTSD with an emphasis on children. (Cohen, Mannarino, & Deblinger, 2012, p.3). Post-traumatic stress disorder (PTSD) can and usually is an extremely

Many children are exposed to traumatic events before they even become adults. All around the world they are exposed to child abuse, rape, natural disasters, terrorism, car accidents, and school violence among many others. Studies have shown that these traumatic events, if left untreated, can result in significant psychological problems, such as post traumatic stress disorder (PTSD) or other anxiety disorders, depression, or a number of other behavioral difficulties (Cohen, Mannarino, Berliner & Deblinger, 2000). These difficulties can become chronic and produce negative effects which could last into adulthood. It is therefore imperative that effective treatment strategies be

The model begins with the traumatic event which leads to the broken part of the individual who then experiences behavioral symptoms which are measured at time one and time two. Time one represents the stress reactions and time two is the manifestation of the disorder. The medical model is a single factor, main effect cause. A stressful event involves one experiencing or witnessing a serious injury, threatened death or threat to physical integrity. Another cause is changes in parts of the brain such as the amygdala and hippocampus. These causes lead to various emotional and behavioral symptoms such as disturbing thoughts, marital issues, unemployment, depressive symptomatology, diet & sleep problems, numbing, and distancing. The criteria for outcomes are direct effects, stress reactions and the dose-response relationship. A direct effect is a direct read-out of the traumatic stressor into the person’s ethological behavior between time one and two. The dose-response relationship is the dose of the trauma its relationship to the individual. The risks of the symptoms involve a robust immediate reaction and long term outcome. [Mechanism of the medical model is a continuing cause, which is the sufficiency claim.] Measuring PTSD involves three clusters of trauma which are re-experience, avoidance or hyperarousal of the traumatic condition. Victims would provide a self-report of the event. To help intervene with PTSD, there are secondary and tertiary treatments. A form of secondary treatment is a debrief of the person’s stress and exposure therapy and pharmaceutical drugs are tertiary.

Seeking Safety is an integrated treatment model that was designed in order to help treat both posttraumatic stress disorder (PTSD) and substance use disorder (SUD) (Najavits, 2006, 240). According to Najavits (2006), PTSD, which is the psychiatric disorder most directly related to trauma, is highly associated with SUD (228). For those who will use this method of treatment in a clinical setting the format and structure is not an overly complicated design and it give the clinician room for flexibility. This treatment also has a number of strengths that will help someone towards working to overcomes their PTSD and SUD, namely that it works towards treating two very dangerous disorders at one time while also being both flexible and structured for those who are seeking treatment. As with any sort of clinical treatment there are weaknesses that have to be assessed as well, two that can be associated with this treatment are a lack of research to see what the long term outcome of this treatment is and also that speaking about past traumas is not allowed. When working with a client towards any sort of treatment it is important to evaluate the treatment using the NASW Code of Ethics and NASW Standards for Clinical Work, three that are very important with this type of treatment are service, dignity and worth of a person, and also accessibility to the clients.

Group interventions for trauma-related psychoeducation and social support may also provide a benefit (Defense Centers of Excellence, 2015). The first line of treatment for PTSD should include an evidence-based psychotherapy (i.e., talk therapy) and/or psychopharmacology (the study of drug-induced changes in mood, thinking, and behavior). The psychotherapies with the most evidence typically include one or more of several productive therapeutic approaches including exposure to traumatic memories, stimuli or situations; cognitive restructuring of trauma-related beliefs; and stress reduction techniques. “The table below summarizes effective PTSD psychotherapy approaches detailed in Department of Veterans Affairs and Department of Defense (VA/DoD) clinical practice guidelines. These treatments should be considered the first line of treatment for patients with PTSD” (Defense Centers of Excellence, 2015)

The family has good intentions by taking care of the veteran who is experiencing difficulty, but the caretaking becomes compulsive and defeating. Co-dependents often take on a martyr’s role. The problem is that these repeated rescue attempts allow the needy individual to continue on a destructive course and to become even more dependent on the unhealthy caretaking of the family. As this reliance increases, the co-dependent develops a sense of reward and satisfaction from “being needed” (Mental Health America). The family will begin to feel helpless in the relationship, but are unable to break away from the cycle of behavior that causes it: viewing themselves as victims.