The Non-pharmacologic Approach to the Treatment of Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a multifactorial condition with significant negative impacts on health, quality of life, and healthcare utilization. Martin et al. (2021) define PTSD as a “debilitating mental condition that can significantly impact the sufferer’s quality of life” (p. 1).

The Non-pharmacologic Approach to the Treatment of Post-Traumatic Stress Disorder (PTSD)

In this sense, the condition manifests through various symptoms, including avoidance of reminders, intrusive symptoms, flashbacks, nightmares, and increased incidences of self-directed harm and suicidal ideation. The potential causes of PTSD are primarily past and present exposures to life-threatening and horrific incidences such as accidents, physical and sexual assaults, work-related traumatic events, childhood abuse, and serious health problems such as the presence of a critical health condition.

Although PTSD results in multiple health ramifications, healthcare professionals rely massively upon pharmacologic interventions such as antidepressants and antiadrenergic drugs to address different symptoms. However, these interventions prove ineffective in improving the patients’ quality of life due to medication adherence and side effects issues.

Therefore, this DNP project aims to explore and expound on the contribution of non-pharmacological interventions in treating and managing post-traumatic stress disorders among older adults in a psychiatric primary care setting (Please insert the site of the project here).

The Type and Focus of the DNP Project

Post-traumatic stress disorder (PTSD) is a prevalent challenge in psychiatric primary care settings. As stated earlier, older adults are susceptible to PTSD due to their occupational interactions, experience, and encounters with traumatic events such as the presence of chronic health conditions like cancer, dementia, and cardiovascular diseases.

Pless Kaiser et al. (2019) argue that 50% to 90% of older adults in the United States have encountered at least one type of potentially traumatic event. For example, older veterans are at an increased risk of traumatic events throughout their lives. As a result, PTSD remains a profound mental health issue for older adults that requires health professionals to embrace evidence-based practices, especially non-pharmacological interventions, to improve patients’ quality of life.

Eventually, the primary focus of the DNP project is to provide insights into non-drug approaches that have literature backings as ideal strategies for treating and managing post-traumatic stress disorder among older adults.

Analyzing a Patient Practice Problem

As stated earlier, older adults are more susceptible to multiple causative and contributing factors for post-traumatic stress disorder (PTSD) due to their past encounters with traumatic events such as combats, accidents, and life-threatening conditions like chronic diseases.

According to Pless Kaiser et al. (2019), the estimated prevalence of PTSD among ethnic minority and non-minority groups ranges from 4% to 4.5%. Since PTSD is a multifactorial condition, 50% to 90% of older adults encounter trigger events such as accidents. However, veterans are susceptible to elevated risk for combat-related stress (Pless Kaiser et al., 2019).

It is essential to note that PTSD results in adverse health effects on the patients. According to Martin et al. (2021), about 59% of patients suffering from post-traumatic stress disorder have severely impaired quality of life due to its association with other comorbidities such as depression and substance abuse disorders.

Also, the condition leads to impaired judgments, declining cognitive functions, and a high risk of self-directed harm such as suicide. Therefore, it is essential to implement evidence-based and proven interventions that improve patients’ safety and well-being.

Evidence-Interventions Proposed to Address the Clinical Problem

The conventional approach for treating PTSD entails applying various pharmacologic interventions, including administering antiadrenergic and antidepressant drugs such as Benzodiazepines and cannabinoids. Other common medications for addressing PTSD symptoms include psychostimulants, sedatives, and steroids.

However, administering these drugs may result in adverse health effects to older adults considering their susceptibility to side effects. Also, drug tolerance and adherence are profound challenges that compromise the effectiveness of pharmacologic approaches. As a result, non-pharmacologic strategies provide opportunities for improving the quality of life for patients as well as treating PTSD.

Many primary quantitative studies recommend non-drug treatment interventions such as prolonged exposure therapy, acupuncture, exercise, yoga, and mindfulness-based stress reduction interventions as ideal in addressing PTSD effects and symptoms.

Carlsson et al. (2018) conducted a pragmatic randomized study to compare the effectiveness of cognitive-behavioral therapy (CBT) and cognitive restructuring (CR) in stress management among trauma-affected refugees in the Competence Center for Transcultural Psychiatry (CTP) in Denmark. The study revealed a positive correlation between CBT and CR in managing stress by causing body relaxation, breathing, and behavioral activation (p. 121).

In a multisite randomized controlled trial, Davis et al. (2018) investigated the plausibility of applying mindfulness-based stress reduction (MBSR) and the present-centered group therapy (PCGT) in treating PTSD. The researchers exposed the positive contribution of the two interventions in reducing PTSD symptoms.

Another primary quantitative study by Knaevelsrud et al. (2017) supports the application of virtual non-pharmacologic interventions such as moderated exposure and cognitive reconstruction in treating PTSD. According to Knaevelsrud et al. (2017), internet-based intervention for older people with childhood traumatization promote access to quality, convenient, and affordable care services.

Also, these approaches improve patients’ health by enhancing their coping and recovery capacity. These quantitative studies validate the plausibility of applying non-pharmacologic interventions in treating PTSD.

The Implementation Team for the DNP Project

Undoubtedly, implementing this DNP project prompts relevant stakeholders to embrace interdisciplinary collaboration to guarantee the project’s feasibility. In this sense, the interdisciplinary team will comprise nurse leaders, advanced practice nurses, registered nurses, psychiatrists, physical therapists, psychologists, physicians, patients, and social workers.

Nurses, social workers, psychologists, physical therapists, and patients will collaborate in implementing non-pharmacologic approaches for treating and managing PTSD. On the other hand, nurse leaders, physicians, and advanced practice nurses will provide much-sought-after expertise and knowledge regarding PTSD diagnostics, improvement thresholds, and process monitoring. Also, they will communicate project objectives to prepare staff members to embrace change initiatives.

Measurable Patient Outcome and DPI Project’s Timeframe

This DPI project aims to improve patient outcomes by implementing evidence-based non-pharmacologic interventions and enhancing patients’ quality of life by preventing adverse effects of PTSD. The interdisciplinary team will assess patients’ outcomes by conducting pre-treatment, post-treatment, and follow-up activities.

Also, they will utilize the post-traumatic stress diagnostic scale (PDS-15) to evaluate the severity of PTSD symptoms. Further, the team will apply the General Self-Efficacy Scale (GSE) to assess the levels of perceived self-efficacy before and after applying non-pharmacologic interventions.

While the DPI project’s feasibility relies massively upon implementing evidence-based interventions within eight months, the implementation team will emphasize proper delegation of responsibilities, pre-implementation evaluation, and effective collaboration to ensure effective implementation.

Nurse leaders, physicians, and advanced practice nurses will communicate and educate other employees on thresholds for applying non-pharmacologic interventions for treating PTSD. On the other hand, nurses, psychologists, physical therapists, and social workers will collaborate with patients to develop patient-centered care and assess the levels of patient satisfaction towards care approaches.

Finally, the team will conduct a progress-oriented evaluation to identify areas of improvement and investigate whether the project aligns with strategic goals.

Conclusion

Post-traumatic stress disorder (PTSD) results in compromised quality of life for patients, among other adverse ramifications. Older adults are more susceptible to PTSD due to their encounters with traumatic events such as accidents, occupational stress, and life-threatening health conditions.

Despite their vulnerability, only a section of the population benefits from pharmacologic interventions. As a result, non-pharmacologic approaches such as prolonged exposure, cognitive processing therapy, acupuncture, exercise, yoga, and mindfulness-based stress reduction are evidence-based and proven interventions for preventing and reducing PTSD effects.

Since the existing literature supports non-drug treatment options, this DPI project aims at exploring and expounding on the contribution of non-pharmacological interventions in treating and managing post-traumatic stress disorders among older adults in a psychiatric primary care setting.

References

  • Carlsson, J., Sonne, C., Vindbjerg, E., & Mortensen, E. L. (2018). Stress management versus cognitive restructuring in trauma-affected refugees—a pragmatic randomized study. Psychiatry Research, 266, 116–123. https://doi.org/10.1016/j.psychres.2018.05.015
  • Davis, L. L., Whetsell, C., Hamner, M. B., Carmody, J., Rothbaum, B. O., Allen, R. S., Bartolucci, A., Southwick, S. M., & Bremner, J. D. (2018). A multisite randomized controlled trial of mindfulness‐based stress reduction in the treatment of posttraumatic stress disorder. Psychiatric Research and Clinical Practice, 1(2), 39–48. https://doi.org/10.1176/appi.prcp.20180002
  • Knaevelsrud, C., Böttche, M., Pietrzak, R. H., Freyberger, H. J., & Kuwert, P. (2017). Efficacy and feasibility of a therapist-guided internet-based intervention for older persons with childhood traumatization: A randomized controlled trial. The American Journal of Geriatric Psychiatry, 25(8), 878–888. https://doi.org/10.1016/j.jagp.2017.02.024
  • Martin, A., Naunton, M., Kosari, S., Peterson, G., Thomas, J., & Christenson, J. K. (2021). Treatment guidelines for PTSD: A systematic review. Journal of Clinical Medicine, 10(18), 1-14. https://doi.org/10.3390/jcm10184175
  • Pless Kaiser, A., Cook, J. M., Glick, D. M., & Moye, J. (2018). Posttraumatic stress disorder in older adults: A conceptual review. Clinical Gerontologist, 42(4), 359–376. https://doi.org/10.1080/07317115.2018.1539801

The Non-pharmacologic Approach to the Treatment of Post-Traumatic Stress Disorder (PTSD) Instructions

My Direct Project Improvement topic is: For older adults admitted to the psychiatric primary care setting, does the translation of Bremner, J. D et al on mindfulness-based stress reduction (Meditation) decrease the prevalence of Post-Traumatic Stress Disorder (PTSD) symptoms compared to current practice in twelve weeks? For this assignment, learners explain how personal knowledge and skills gained in this course assist in solving their Direct Practice Improvement Project practice problem, and how the Christian worldview is supported within your project\'s purpose and the project site’s organizational mission and vision. General Requirements: Use the following information to ensure successful completion of the assignment: •	This assignment uses a template, located in the DNP-815A folder in the DC Network, titled \"Case Report: DPI Project Application of Theory to Organizational Mission and Vision, and Christian Worldviews.\" •	This assignment requires that at least four scholarly, peer-reviewed, sources related to this topic with at least one in-text citation for each source. Directions: Construct a case report (2,000-2,250 words) using your Direct Practice Improvement (DPI) Project\'s purpose, problem, and clinical questions. Apply your chosen nursing theory and evidence-based change model from the Topic 3 assignment to support your DPI Project. Your case report must include the headings provided below. Refer to the \"Case Report: DPI Project Application of Theory to Organizational Mission and Vision, and Christian Worldviews\" template, located in the DNP-815A folder in the DC Network, to complete your assignment. The specific criteria for this assignment are located on this template. •	Case Report Background •	Christian Worldviews •	Organization\'s Mission and Vision to Theory and Model •	Pulling It Together  Topic 3 Assignment nursing theory was centered at improving the quality of care by understanding the determinants of Healthcare-Associated Infections (HAIs) and proposing the best evidence-based strategies. Refer to order number (Order # 115004)