NRNP 6645 Week 9 Psychotherapy With Trauma and Stressor-Related Disorders

NRNP 6645 Week 9 Psychotherapy With Trauma and Stressor-Related Disorders

NRNP 6645 Week 9 Psychotherapy With Trauma and Stressor-Related Disorders Sample Paper

Trauma is always associated with physical and psychological sequelae. In mental health, trauma has been associated with mood disorders in both children and adults. Post-Traumatic Stress Disorder is one of the mental disorders that are associated with trauma. The trauma can be physical or emotional in most cases. In this week’s tasks, Dr. Grande Todd (2019 Week 9 Psychotherapy With Trauma and Stressor-Related Disorders) talks about a junior patient who was diagnosed with PTSD. This paper describes the neurobiological basis of PTSD, provides the basis for diagnosis, and relates the patient’s case in this week’s media.

Week 9 Psychotherapy With Trauma and Stressor-Related Disorders

Neurobiological Basis for PTSD

Week 9 Psychotherapy With Trauma and Stressor-Related Disorders

The brain has neurons that communicate with each other through neurohormones and other chemicals. The brain consists of various lobes that are responsible for different functions such as mood, memory, thought processing, and movements. The most prominent manifestations are impairments in cognitive and emotional domains. This concept suggests derangement in the functioning of the hippocampal and related brain areas responsible for thought and emotions.

Various scientific studies have found that there are derangements in levels of catecholamines in the brain of people with PTSD (Dossi et al., 2020). These findings are also seen in people with traumatic brain injury (TBI). Dysregulation of neurotransmitters, serotonin, and neurohormones has been associated with the fear, anxiety, stress, and depression seen in PTSD (Hoffman & Taylor, 2019). Dysregulation in other systemic hormones and other substances has been reported (Marin et al., 2019). Cortisol level derangements have been associated with the sequelae of trauma. However, the actual cause of the dysregulation is still unclear. Week 9 Psychotherapy With Trauma and Stressor-Related Disorders

Diagnosis of PTSD

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) outlined the criteria for the diagnosis of PTSD. In their criteria, the presentation of the patient is classified into seven features. The DSM-V described that there has to be a history of exposure(s) to death, threatened death, violence, or severe injury (American Psychiatric Association, 2013 Week 9 Psychotherapy With Trauma and Stressor-Related Disorders). This feature has to be present should be coupled with one or more of the following features: persistence in avoidance of the initiators of the trauma or memory for the trauma, negative cognitive & mood changes, intrusion symptoms, arousal & reactivity alterations related to the trauma, significant clinical in social or physical domains, no physiological disease process is present and can be associated with the symptoms, and that the (Wheeler, 2020) symptoms have lasted for more than one month. Week 9 Psychotherapy With Trauma and Stressor-Related Disorders

In the case scenario, dr. Grande talked about a younger patient, Joe, who encountered a traumatic event with his father when they were driving. His current presentation included intrusive symptoms, hyper avoidance, disorganized understanding of the event leading to the trauma. In my view, this patient meets the criteria for diagnosis of post-traumatic stress disorder. There is an evident history of physical and emotional trauma from the traffic accident and the ensuing quarrel between the father and the other driver.

Joe met the aforementioned criteria because we see his school life has deteriorated with violence and accessional aggression. He presented more than one month after the occurrence of the traumatic event. Other diagnoses are also possible in this patient. Major depressive disorder and conduct disorders are possible diagnoses that are evident from his presentation but the posttraumatic sequelae predominate.

Another Psychotherapy Treatment Option for Joe

Dr. Grande recommended trauma-focused cognitive behavioral therapy for Joe. Another option available for Joe is Eye Movement Desensitization and Reprocessing (EMDR) Therapy. EMDR therapy also focuses on trauma but briefly (Shapiro, 2018 Week 9 Psychotherapy With Trauma and Stressor-Related Disorders). The target of this psychotherapy is to improve the emotions associated with the trauma as well the vividness of the scenes. The through and responses to the memory of the trauma as well the reencounter of similar trauma are improved with the EMDR. The efficacy of this method is varied with the target patient or population. EMDR is not the gold standard treatment for PTSD.

Gold standard treatment modalities are usually considered the best efficacious and effective method is in the genre of treatment for a particular condition (Brodsky & Lichtenstein, 2020). Trauma-focused CBT is usually considered the gold standard for PTSD. However, some studies have reported that trauma-focused CBT and EMDR are equally efficacious. Joe would benefit from EMDR the same way he would benefit from CBT. Using gold standard methods provides the best outcomes for nurses and therapists. However, it should be noted that gold standard methods of treatment are cast in stone but are bound to change with new evidence generated through evidence-based practice. Week 9 Psychotherapy With Trauma and Stressor-Related Disorders

My Sources

My sources have included two books and five journal articles. No websites have been used. I consider my sources scholarly because they have been peer-reviewed and structured in a scholarly manner and language. The database from which they have been retrieved are credible in providing peer-reviewed sources.

Conclusion

The neurological basis of PTSD has been described through evidence-based practice. Dysregulation of neurohormones and neurotransmitters has been reported. This week’s case was of joe a young boy who presented with PTSD symptoms following a traumatic incident on the road. He was prescribed trauma-focused CBT. However, EMDR is also an option despite not being a gold standard for this condition. Week 9 Psychotherapy With Trauma and Stressor-Related Disorders

Week 9 Psychotherapy With Trauma and Stressor-Related Disorders References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)) (5th ed.). American Psychiatric Association Publishing.
  • Brodsky, S. L., & Lichtenstein, B. (2020). The gold standard and the pyrite principle: Toward a supplemental frame of reference. Frontiers in Psychology, 11, 562. https://doi.org/10.3389/fpsyg.2020.00562
  • Dossi, G., Delvecchio, G., Prunas, C., Soares, J. C., & Brambilla, P. (2020). Neural bases of cognitive impairments in post-traumatic stress disorders: A mini-review of functional Magnetic Resonance Imaging findings. Frontiers in Psychiatry, 11, 176. https://doi.org/10.3389/fpsyt.2020.00176
  • Grande, T. (2019, August 21). Presentation example: Posttraumatic stress disorder (PTSD). https://youtu.be/RkSv_zPH-M4
  • Hoffman, A. N., & Taylor, A. N. (2019). Stress reactivity after traumatic brain injury: implications for comorbid post-traumatic stress disorder. Behavioral Pharmacology, 30(2 and 3), 115–121. https://doi.org/10.1097/fbp.0000000000000461
  • Marin, M.-F., Geoffrion, S., Juster, R.-P., Giguère, C.-E., Marchand, A., Lupien, S. J., & Guay, S. (2019). High cortisol awakening response in the aftermath of workplace violence exposure moderates the association between acute stress disorder symptoms and PTSD symptoms. Psychoneuroendocrinology, 104, 238–242. https://doi.org/10.1016/j.psyneuen.2019.03.006
  • Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy, third edition: Basic principles, protocols, and procedures (3rd ed.). Guilford Publications.
  • Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.

NRNP 6645 WEEK 9: POSTTRAUMATIC STRESS DISORDER

Neurobiological basis for PTSD

The processing of heightened stress, the consolidation of trauma-related memories, and the resulting inaptitude to extinguish these fear responses causing a lack of inhibition of trauma-avoidance reminders are linked to disorganized resting-state neural activity (Toledo & Carson, 2022). The emotional circuitry includes many areas of the brain, including the amygdala, hypothalamus, thalamus, cingulate gyrus, the hippocampus, parahippocampal region and the prefrontal cortex. This intricate network of circuits does not follow the same process for everyone, and it affects everyone differently.

PTSD Criteria per DSM-5-TR

As per the American Psychiatric Association (2022), the DSM-5-TR manual for PTSD includes 7 criteria: exposure to actual or threatened death, serious injury or sexual violence, intrusive memories, persistent avoidance of stimuli, negative alterations in cognition and mood associated with the traumatic event, alterations in arousal and reactivity.

Duration > 1 month, and cause of significant distress.

Video Presentation

In the video presentation: Posttraumatic stress disorder (Grande, 2022) the question as to whether the young boy (Joe) has PTSD can be answered by following the above criteria. If we break down the criteria individually, does he meet all the criteria? I believe he does. He was exposed to an actual threat, which in his mind was the MVA with the verbal altercation and “being chased” that followed. He experienced intrusive memories, and although he did not understand the entirety of the situation, he did understand that his father was chased after an MVA, in which the car did receive damage. 

He then persistently avoided further stimuli by avoiding stories about the accident, stories about other accidents, and the type of vehicle involved, and avoiding discussion regarding the incident. Negative alterations in cognition and mood associated with the traumatic event included trouble sleeping, difficulty falling asleep, and nightmares. Alterations in arousal and reactivity included being physically aggressive at home and school, including the destruction of property, fighting with siblings, and being “set off” quickly. These behaviors lasted more than a month and caused significant distress.

 Based on that information, Joe did have PTSD, which may not have caused distress to his father or other people put in that exact situation. However, this did cause significant distress to Joe. I believe that the therapist who analyzed this case presentation was correct in diagnosing PTSD and then waiting to determine if other diagnoses were appropriate. Like many things, things are not always as they seem. Moreover, it appeared that many of Joe’s symptoms, which earned him significantly more diagnoses, were all related to a single issue…PTSD r/t the MVA and the maladaptive ways that he processed the incident.

Psychotherapy treatment option (gold standard treatment)

Recommendations of the APA guideline strongly recommend cognitive processing therapy (CPT) as a general guide to best practices (American Psychiatric Association, 2017).  CPT is a manualized therapy typically consisting of 12 weekly sessions. The treatment focuses on identifying and modifying maladaptive thoughts about the causes or consequences of the traumatic event. Patients are taught cognitive skills to examine and change maladaptive beliefs that have kept them stuck in their recovery from trauma (Graziano et al., 2023).

This type of therapy is a learned specialty and requires skilled training and adherence to specific elements of this type of therapy to yield the expected results. As with any type of therapy, being well-educated and having supervision while learning and performing these techniques are important for the success of these treatments.

Conclusion

While there was no final conclusion as to whether Joe was “fully treated,” there is an inference that by using valid treatment skills and looking to see what triggered Joe’s responses and caused his trauma, it is easier to see what the treatment plan would be, and how to help Joe resolve these feelings that caused the PTSD, thus resolving most/all of the behaviors that were associated with the incident.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

American Psychiatric Association. (2017). Clinical practice guideline of PTSDLinks to an external site. https://www.apa.org/ptsd-guideline

Grande, T. (2019, August 21). Presentation example: Posttraumatic stress disorder (PTSD)Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=RkSv_zPH-M4

Graziano, R. C., LoSavio, S. T., White, M. A., Beckham, J. C., & Dillon, K. H. (2023). Examination of PTSD symptom networks over the course of cognitive processing therapy. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0001464

Toledo, F., & Carson, F. (2022). Neurobiological Features of Posttraumatic Stress Disorder (PTSD) and Their Role in Understanding Adaptive Behavior and Stress Resilience. International Journal of Environmental Research and Public Health, 19(16). https://doi.org/10.3390/ijerph191610258

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