Treatments+of+PTSD

People suffering from the trauma constantly avoid situations that can remind them of trauma. Based on the idea that talking about the event again and again will make them understand that talking about the trauma isn't the same as experiencing it. People suffering from the trauma constantly avoid situations that can remind them of trauma. Create a safe environment that shows the trauma cannot hurt them Show that remembering the trauma is not equivalent to experiencing it again Show that anxiety is alleviated over time Acknowledge that experiencing PTSD symptoms does not lead to a loss of control
 * **TREATMENT FOR PTSD ** ||
 * Examine treatment options for those living with the disorder (**individual approach**) ||
 * **//Cognitive-behavioural therapy: //**
 * Gradual exposure to thoughts, feelings and sensations that reminds one of the experienced trauma.
 * Identifying distorted, irrational and disturbing thoughts and replacing them with a balanced picture.
 *  Aims to change the person's behaviour
 * Exposure therapy: **exposes trauma to them in a safe way in order for them to face and conquer their fears. Uses mental images, writing or takes patients to the place where the trauma occurred
 * Cognitive restructuring: **helps people make sense of the bad memories. Sometimes people remember the event differently than what actually happened. They may think something was their fault and feel guilty about it when in reality they did nothing wrong.
 * Stress inoculation training: **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">reduces PTSD symptoms by teaching a person how to reduce anxiety. Helps people look at their memories in a healthy way ||
 * **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Cognitive Behavioural Therapy – Foa (1986) **
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Aim **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;"> (of CBT)**:**

<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Based on theories that collective traumatization as significant as individual traumatization --> Bosnians approach trauma as matter of collective as well as individual. Creation of oral history archive is essential component as it gives meaning and purpose to the experience of the survivor, allowing them to consider how experience has affected how they feel about present-day life. <span style="font-family: 'Century Gothic',sans-serif;">Combines cognitive therapy with to left-right stimulations or rhythms such as hand tap or sounds to "unfreeze" brain's information processing system interrupted in time of extreme stress.
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;"> Procedure: **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Includes exposure therapy and psycho-education, given information about PTSD and expose sufferers to traumatic events by searching memory and describe event again and again.
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Findings: **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">CBT yielded positive results ||
 * **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Testimonial psychotherapy – Weine (1998) **
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Aim: **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">To investigate the effectiveness of testimony psychotherapy
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Procedure: **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">All patients diagnosed using PTSD symptom scale, translated into Bosnian. All testimonies conducted in Bosnian and translated to English, then back to Bosnian so interpreter and survivor could correct mistakes and add possible new recollections and details --> back translation. Final document given back to survivor to sign and verify accuracy.
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Findings: **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Rate of PTSD decreased from 100% at pre-testimony to 85% post-testimony, 70% at two month follow up, 53% at 6 month follow up. ||
 * **<span style="font-family: 'Century Gothic',sans-serif;">EMDR (Eye Movement Desensitizing and Reprocessing) **


 * <span style="font-family: 'Century Gothic',sans-serif;">Rothbaum (1997) **


 * <span style="font-family: 'Century Gothic',sans-serif;">Aim: **<span style="font-family: 'Century Gothic',sans-serif;"> To test the effectiveness of EMDR as a treatment option for PTSD.


 * <span style="font-family: 'Century Gothic',sans-serif;">Procedure: **<span style="font-family: 'Century Gothic',sans-serif;"> Randomly assigned 18 adult female rape victims with PTSD to three sessions of EMDR or a wait-list control group. Results were evaluated by a blind independent assessor using structured interviews and self-report measures.


 * <span style="font-family: 'Century Gothic',sans-serif;">Findings: **<span style="font-family: 'Century Gothic',sans-serif;"> The self-report scores of the EMDR participants on PTSD and depression scales showed a mean decrease of more than two standard deviations at post-treatment, which was a significant improvement compared to wait-list controls. At post-treatment, 90% of the subjects in the EMDR group no longer met full criteria for PTSD compared to 12% of the wait-list group.


 * <span style="font-family: 'Century Gothic',sans-serif;">Conclusion: **<span style="font-family: 'Century Gothic',sans-serif;"> EMDR is a valuable treatment option for patients experiencing PTSD. ||
 * **<span style="font-family: 'Century Gothic',sans-serif;">Wilson, Becker, and Tinker (1995) **


 * <span style="font-family: 'Century Gothic',sans-serif;">Aim: **<span style="font-family: 'Century Gothic',sans-serif;"> To test the effectiveness of EMDR as a treatment option for PTSD.


 * <span style="font-family: 'Century Gothic',sans-serif;">Procedure: **<span style="font-family: 'Century Gothic',sans-serif;"> Randomly assigned a sample of 80 traumatized individuals, 46% of whom were diagnosed with PTSD, to EMDR treatment or Wait List conditions. Each subject received three 90-min sessions of EMDR. A blind independent assessor administered all self-report measures at pre and post treatment and at three month follow-up.


 * <span style="font-family: 'Century Gothic',sans-serif;">Results: **<span style="font-family: 'Century Gothic',sans-serif;"> Significant differences were found between EMDR and Wait List groups on standardized measures of PTSD symptoms, depression, and anxiety at post-treatment and 3 month follow-up. This improvement was also clinically significant, with the means for all measures moving into a normal range. Treatment gains were strongest for those measures specifically related to trauma. When treatment was provided to the Wait List group, treatment effects were replicated, with significant effects for all measures. In a 15 month follow-up study (Wilson, Becker & Tinker, 1997), 32 of the original 37 subjects with PTSD were interviewed by an independent assessor. There was an 84% reduction in PTSD diagnosis compared to pre-treatment.

<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">They're both antidepressants and taking these medications help control the PTSD symptoms <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">However they have side effects which include: headache, nausea, drowsiness, agitation, reduced sex drive <span style="font-family: 'Century Gothic',sans-serif;">Tranquilizers and antidepressants prescribed --> Valium and Xanx, drugs from benzodiazepine group which modulate the neurotransmitter GABA involved in regulating anxiety levels, antidepressants prescribed to alleviate symptoms of depression. è <span style="font-family: 'Century Gothic',sans-serif;">Improvements in depression contribute to improvement in PTSD, regardless of how PTSD itself is treated. || <span style="font-family: 'Century Gothic',sans-serif;">Public (e.g World War One, 9/11): <span style="font-family: 'Century Gothic',sans-serif;">Personal (physical/verbal abuse):
 * <span style="font-family: 'Century Gothic',sans-serif;">Conclusion: **<span style="font-family: 'Century Gothic',sans-serif;"> EMDR is a valuable treatment option for patients experiencing PTSD. ||
 * <span style="color: #0070c0; font-family: 'Century Gothic',sans-serif;">Discuss the use of **eclectic approaches to individual treatment** ||
 * * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Incorporates principles of techniques from various systems or theories
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Eclectic approaches combining more than one treatment are very effective for phobia sufferers
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Combines medication with therapy
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Difficult problem that people with phobias have is that they suffer from both anxiety and a desire to avoid therapy
 * o <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Medication can reduce the effects making exposure therapies more successful ||
 * <span style="color: #0070c0; font-family: 'Century Gothic',sans-serif;">Evaluate the use of **individual approaches** to the treatment of Post-Traumatic Stress Disorder ||
 * //<span style="font-family: 'Century Gothic',sans-serif;">Strengths: //
 * <span style="font-family: 'Century Gothic',sans-serif;">Short term and insurance company friendly
 * <span style="font-family: 'Century Gothic',sans-serif;">Highly effective when used with drug therapy
 * <span style="font-family: 'Century Gothic',sans-serif;">No side-effects
 * <span style="font-family: 'Century Gothic',sans-serif;">Treats rather than simply removing symptoms.
 * <span style="font-family: 'Century Gothic',sans-serif;">Individualized to meet need of client
 * <span style="font-family: 'Century Gothic',sans-serif;">Many survivors aren't willing to seek psychiatric treatment from clinician but will participate in testimony psychotherapy in the community || //<span style="font-family: 'Century Gothic',sans-serif;">Weaknesses: //
 * <span style="font-family: 'Century Gothic',sans-serif;">Overlooks broad clinical issues
 * <span style="font-family: 'Century Gothic',sans-serif;">Research on emotions suggests that while young people experience intense emotions, older people experience both happy and sad emotions in response to same environmental and cognitive stimuli. Instead of replacing a negative thought, it may be strategic for older patients to focus on both negative and positive experiences.
 * <span style="font-family: 'Century Gothic',sans-serif;">Reduce anxiety levels but do not reduce avoidance behaviour
 * <span style="font-family: 'Century Gothic',sans-serif;">Patients can become initially worse in initial stages of CBT, therapists may become upset when hearing about experiences. (Keane 1992)
 * <span style="font-family: 'Century Gothic',sans-serif;">Back translation may be necessary to study data in testimony psychotherapy but can raise problems of reliability due to translation errors. ||
 * <span style="color: #0070c0; font-family: 'Century Gothic',sans-serif;">Examine treatment options for those living with the disorder (**biomedical approach**) ||
 * <span style="font-family: 'Century Gothic',sans-serif;">Anti-depressants such as Prozac and Zoloft
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Sertraline (Zoloft)
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Paroxetine (Paxil)
 * <span style="color: #0070c0; font-family: 'Century Gothic',sans-serif;">Evaluate the use of the **biomedical approach** to the treatment of Post-Traumatic Stress Disorder ||
 * //<span style="font-family: 'Century Gothic',sans-serif;">Strengths: //
 * <span style="font-family: 'Century Gothic',sans-serif;">Drug can be compared with placebo to see effects
 * <span style="font-family: 'Century Gothic',sans-serif;">Provide long term control over thoughts, feelings and mood.
 * <span style="font-family: 'Century Gothic',sans-serif;">Significantly reduce number of hospital inpatients but that might be due to changes policies towards hospitalization. || //<span style="font-family: 'Century Gothic',sans-serif;">Weaknesses: //
 * <span style="font-family: 'Century Gothic',sans-serif;">Alleviate symptoms of PTSD eg. worry and sadness but do not treat causes of the disorder.
 * <span style="font-family: 'Century Gothic',sans-serif;">Patients can develop physical tolerance to the drugs, rendering them ineffective.
 * <span style="font-family: 'Century Gothic',sans-serif;">Based on assumption that biological factors are involved in psychological disorder-does not mean that biological factors cause disorder but are associated with changes in brain chemistry,
 * <span style="font-family: 'Century Gothic',sans-serif;">Not all individuals respond to drugs in the same manner. ||
 * <span style="color: #0070c0; font-family: 'Century Gothic',sans-serif;">Examine treatment options for those living with the disorder (**group approach**) ||
 * <span style="font-family: 'Century Gothic',sans-serif;">i.e. Family therapy
 * <span style="font-family: 'Century Gothic',sans-serif;">Enable better communication and working through problems created in relationships due to the disorder.
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Friedman and Schnurr (1998) **
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Aim **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">: To investigate the role of group therapy on Vietnam War veterans.
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Procedure: **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Had a sample of 325 Vietnam veterans undergo psychoeducational group therapy followed by trauma-focused therapy (3 components: exposure to traumatic memory, cognitive restructuring, coping skills development). Compared the group to a control group that only discussed current life issues without addressing trauma.
 * <span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">Findings **<span style="font-family: 'Century Gothic',sans-serif; font-size: 11pt;">: Psychoeducational groups worked on psychosocial deficits (i.e. Anger management, social anxiety, conflict resolution) and helped veterans in later intensive group therapy --> trauma-focused therapy. There was a higher attrition rate among those in the trauma-focused therapy group (27% vs 17%), those that worked through trauma had higher rate of improvement. ||
 * <span style="color: #0070c0; font-family: 'Century Gothic',sans-serif;">Evaluate the use of **group approaches** to the treatment of Post Traumatic-Stress Disorder ||
 * //<span style="font-family: 'Century Gothic',sans-serif;">Strengths: //
 * <span style="font-family: 'Century Gothic',sans-serif;">Cheaper
 * <span style="font-family: 'Century Gothic',sans-serif;">Advantages of seeing peers develop new skills in dealing with their anxiety.
 * <span style="font-family: 'Century Gothic',sans-serif;">Time efficient: Opportunity to counsel several clients at the same time.
 * <span style="font-family: 'Century Gothic',sans-serif;">Provides group support so that the client is less dependent on the therapist.
 * <span style="font-family: 'Century Gothic',sans-serif;">Patients don't feel outside of the norms or that their problems are unique and insurmountable
 * <span style="font-family: 'Century Gothic',sans-serif;">Allow clients to develop confidence and social skills in a safe, supportive environment. || //<span style="font-family: 'Century Gothic',sans-serif;">Weaknesses: //
 * <span style="font-family: 'Century Gothic',sans-serif;">Difficult to predict how long it is going to take if individual outcomes are set
 * <span style="font-family: 'Century Gothic',sans-serif;">Compound problems by reducing self-efficiency
 * <span style="font-family: 'Century Gothic',sans-serif;">Client may not want to disclose problems to group.
 * <span style="font-family: 'Century Gothic',sans-serif;">Confidentiality an issue.
 * <span style="font-family: 'Century Gothic',sans-serif;">Certain clients may feel excluded e.g. people with certain health problems, married men, one female in a group of 10 males, etc.
 * <span style="font-family: 'Century Gothic',sans-serif;">Group dynamics: one client may feel he/she is unheard while the other getting priority.
 * <span style="font-family: 'Century Gothic',sans-serif;">Cultural problem: Mutlaq and Chaleby (1995) identified that in Arab cultures, strict gender roles, deference to members based on age or tribal status, and misperception that therapy session is simply another social activity can disrupt treatment. Indigenous healing practices where traditional, spiritual and religious beliefs are part of the treatment can be incorporated to deal with clients from non-western countries. For example, Chinese Taoist cognitive therapy and ecological model by Miller (2000) that focuses on community-based treatment. ||
 * <span style="color: #0070c0; font-family: 'Century Gothic',sans-serif;">Discuss the relationship between **etiology and therapeutic approach** in relation to Post-Traumatic Stress Disorder ||
 * <span style="font-family: 'Century Gothic',sans-serif;">Post-Traumatic Stress Disorder is caused by a traumatic event, whether it is public or personal
 * **<span style="font-family: 'Century Gothic',sans-serif;">Biomedical approach **<span style="font-family: 'Century Gothic',sans-serif;"> is used, therefore medication is prescribed (primary approach)
 * **<span style="font-family: 'Century Gothic',sans-serif;">Group approach **<span style="font-family: 'Century Gothic',sans-serif;"> is used, as the event involved a large amount of people
 * <span style="font-family: 'Century Gothic',sans-serif;">Individual approach is used, specifically CBT and psychotherapy
 * <span style="font-family: 'Century Gothic',sans-serif;">Systematic desensitization – classical conditional (what has been learned can be unlearned)
 * o <span style="font-family: 'Century Gothic',sans-serif;">Used to overcome anxiety ||