Psychology of Trauma – A8

 

Assignment

      

              8 

      

Vignette Analysis II

:
This  assignment focuses on vignette analysis and direct application of  course concepts to the persons and situations presented in the  vignette.   All discussions must take into account the legal and ethical  considerations, as well as cross-cultural issues that pertain to the  situations presented below.

Use  the reading assignments thoroughly in an integrative discussion. All  assignments MUST be typed, double-spaced, in APA style, and written at  graduate level English. Be sure to cite your work according to APA  format. Please keep your responses focused on what is presented in the  vignette. Do not add information but use your creativity to support what  you see in the vignette as written. Avoid elaborations and assumptions.

The  course text is the primary resource for this assignment. You should be  citing the text often to support your discussion (along with the DSM-5).  Outside references should be minimal, except for culture.

Note:  Cultural  information can be found in the DSM-5. You are also encouraged to use  outside Cross Cultural sources as needed, but please reference if doing  so.  

Discussion must be 6-7 pages plus a title and reference page. 

Vignette Analysis II

Vignette Analysis II will be covering Chapters 4 through 6 in the course text and the relevant DSM-5 disorders. 

Your  discussion must include the relevance of the following areas covered in  the text, directly and specifically to the persons and situations  presented in the vignette: 

· Assessment issues and approaches to further explore PTSD

· Treatment goals

· Treatment phases 1, 2 and 3

Vignette Two

Anthony  is a 32-year-old American war veteran from a strong Latino family. He  came to see you because his wife told him that if he doesn’t get help,  she and the children are leaving. Anthony’s wife, Rosa, is  present for the initial interview. She tells you, “Anthony is not the  same man I married. Since he came back from serving our country, he is a  stranger. He drinks vodka and beer daily and has been  getting violent in the home. He has punched holes in the walls has  broken furniture.” She tells you that, “Anthony has always had a bit of  an anger problem because his father was a mean drunk and would beat his  wife and kids. Anthony has been nothing like his father until now. He scares me.” 

Anthony  has been accusing Rosa and their 2 children of stealing his money and  believes they are in a conspiracy to make him “go crazy”. Rosa also  tells you that Anthony has not been going to work. He believes there is  evil lurking out in the world and that he rarely leaves the house,  except to buy his alcohol. Anthony admits that he lives in terror, since  he returned from the war 5 years ago. He saw several of his buddies  killed in an explosion, suffers from debilitating migraines, has  recurring nightmares and horrific thoughts of his war experience. You  find Anthony to have good reality testing but occasionally during your  interview, he has odd and eccentric ways of explaining things. You  suspect a diagnosis of PTSD. 

References: 

Courtois, C.A. & Ford, J.D.    (2015).   Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach.   The Guilford Press.      ISBN 978-1462524600

Running head: VIGNETTE ANALYSIS 2 1

VIGNETTE ANALYSIS 2 8

Vignette Analysis 2

Laura Kay Utgard

PSY:87519 –Psychology of Trauma

Dr. Barbara Lackey

Cal Southern University

August, 2018

Vignette Analysis 2

Assessment and diagnosis

Anthony was exposed to traumatic events which has developed to Posttraumatic Stress Disorder (PTSD). The condition can be diagnosed after one month from the time a person is exposed to traumatic event. The condition starts as ASD and it progresses to PTSD. Based on Diagnostic and Statistical Manual of Mental Disorder, (DSM-IV), the symptoms include what is expressed by Anthony. It is evident that he has intrusive recollections of traumatic occurrences through flashbacks, avoidance of moving outside, increased efforts to avoid any association to trauma and irritability. Part of your assessment?

Study show PTSD can differ in frequency and severity and can make patients have disabilities from distress to severe incapacitation (Swartz, 2014). Moreover, although onset happens shortly after experience, the lag period linking exposure and indication is dependent and in many cases it is long. The condition of Anthony is a case of delayed onset because it has been expressed six months after the war. The PTSD can be recurrent and chronic; however, in many patients, it occurs with major depressive disorder which comes after the manifestation of PTSD. This paper focus of diagnosis and assessment of PTSD from the point when Anthony accepted diagnostic criteria for the condition as explained in DSM-IV.

Diagnostic criteria

The modern criteria of diagnosing the condition started with the DSM-III. The criteria has not changed even with the introduction of DSM-IV. The evidence-based diagnosis for the patients based on DSM-IV factors in

Exposure to traumatic event (post war)

Intrusive re-experiencing of the event

Avoidance (He did not want move out of the house)

Hyperarousal

Distress which can lead to trauma

The person under study has shown signs of traumatic disorder in which the ensuing happened

Anthony experienced and witnessed American war that involved actual death and serious injury. Moreover, the war threated him Survivor guilt?

The victim is in a state of constant avoidance of stimuli which is associated with trauma. This is indicated by (Abdul-Hamid & Hughes, 2014)

Efforts to avoid thought by taking alcohol frequently

Efforts to avoid places and people and this is expressed through being indoor

He has marked diminished interest in important activities

Anthony detached from other

Persistent symptoms of increase arousal of Anthony are indicated by exaggerated startle response and hypervigilance. Excellent relevance of reported behavior to the case of Anthony

Clinical diagnosis

The story of Anthony present hint to a psychological health profession who is familiar with analysis of PTSD. Despite this, the symptoms and diagnostic process is variable and as assessment based on the patient symptoms, mental health and willingness to work with health professional. Normally, Anthony should be evaluated in a confidential setting with one-on-one consultation by health specialist. The consultation should consider patient signs, account of the traumatic happenings and find out if somebody meets DSM-IV standards for PTSD (Courtois & Ford, 2015). The health professional ought to determine severity of symptom, associated disability and medical conditions. Specifics re Anthony

In the case of Anthony, he accepts that he has avoidance on anything which relates to trauma. For clinical assessment there is need to allocate enough time. Based on his case, the ex-military readiness and ability to relate well with health expert, the process of diagnosis takes about one hour. A simple factor of PTSD is determination if a person faced disturbing event. A war environment give an opportunities for exposure to trauma events. It is clear that Anthony experiences stressors which include injuries and death, see military personnel being killed or injured or torture. Self-report questionnaires are used to veterans to enhance professional to examine exposure to traumatic events.Which ones would you suggest for Anthony?

Assessment

Besides official diagnostic procedure, there is more inclusive review of patient by determining comorbidity, functional status, symptom severity, malingering and neuropsychologic impairments (Courtois & Ford, 2015).Relate to Anthony The process of determining comorbidity is important in assessing patient with PTSD. ?PTSD and depression, alcoholism, etdThe condition of PTSD is manifested by high rate of comorbidity. Reports show that people with PTSD have depressive disorder. It is also argued that 22% of war veterans who suffer from PTSD have alcohol abuse or dependence (Rytwinski & Scur, 2013). Anthony who has high inclination to alcohol abuse has high PTSD. Found it

There is need to do comprehensive evaluation to determine severity of the symptom. Severity is measured using a self-report questionnaire and these questionnaires are used to adjunct diagnostic interview. Yes, which ones?As noted with case of Anthony, he has impair ability to engage in social role such as being a husband and this could be the main reason his wife wants to live him. Functional ability is assessed independently. Once it is ascertained that Anthony has PTSD, test should be done to characterize neurocognitive and neurobehavioral impairments (Courtois & Ford, 2015). However, the neuropsychologic analysis should be sourced to validate report of some patients because they might confuse, as delay recall, working memory and other impairments are not only related to PTSD. Some test which can be done to Anthony include “Rey Auditory Verbal Test, continuous Visual Memory Test and the Verbal and Non Verbal Tests.”I don’t think these are relevant. See text re standardized assessment instuments

Some people like Anthony may present signs of PTSD but might be suspected of faking the condition or even exaggerating the condition. According to DSM, people can malinger the PTSD and it is recommended that health professionals should assess a patient in medicolegal context. This involve checking important shortcoming in patient report of clinical finding and Anthony symptoms. Based on presentation of symptoms, this is definitely inaccurate and not applicable, InaOther instances of malingering involves lack of cooperation in diagnostic process and presence of antisocial personality disorder (Richardson, Frueh, & Acierno, 2010). Malingering in PTSD might be shown by MMPI-2. Indicators to check malingering include incapacitating injuries, repetitive dreams, and antisocial character, poor work record and unvarying. To assessment if Anthony is truly facing PTSD, clinician should check if he demonstrates falsification of documentation, a tendency to focus blame of the situation and overemphasis on flashback moments. ????What info did you get from observation,interview, standardized assessment? Specifics needed How do you evaluate his paranoia, his vocationalissues, etd, etc.

Treatment

As noted in the case of Anthony, the main clinical feature and diagnostic approach of PTSD are defined and they are used to assess and diagnosis the patients. The maximum assessment of patient involve face-to-face interview observation standardized assessment . It is important to have sufficient time to do assessment. After assessment of Anthony the next phase is therapy. It is helpful to remember that the condition is reversible through psychotherapy and medications. The PTSD therapy has three important goals and these include restore the patient self-esteem, improve Anthony symptoms and teach him skills on how to cope with the condition (Courtois & Ford, 2015). Many of these PTSD therapies are cognitive behavioral therapy and the main idea is to transform the thought pattern (Hamblen & Kivlahan, 2016). This involve talking about the trauma and source of fear.

Goals?Missing

Eg to improve vocational functioning, decrease agoraphobic behavior, etc

Cognitive Processing Therapy

The CPT take 12 weeks for a complete treatment. This process involves talking about the trauma to therapist and expressing how the thoughts relate to the trauma affect personal life. The process assists in assessing thought pattern in relation to trauma and devising new ways to live with it. The therapist helps patients to handle events which happened and they were beyond the victim control (Curran, Bauer, & Mittman, 2012).

Prolonged Exposure Therapy

For the case of Anthony, he has been avoiding events in life which remind him of traumatic happens and this means that PE can assist him fight them. This therapy involves 8-15 sessions and each session takes 90 minutes. At the start of the process, therapist educate patient on breathing techniques which make him lose anxiety when he imagines what transpired.

Eye movement desensitization

This therapy is a manual treatment which assist patients in processing and assessing traumatic occurrences while making the adaptive. The patient should access disturbing events linked with trauma, identify paining self-referring habits and replace it with positive image. PTSD patient hold the painful image and negative thoughts in mind while tracking the movement of clinician finger for about 20 seconds. The process is repeated until the patient loss association with the traumatic event. Study show (Curran, Bauer, & Mittman, 2012) that Eye movement desensitization is efficacious treatment for post trauma disorder. Some researcher argue the result realized through EMDR as similar to those noticed in CBT. In comparison, PE is more useful than Eye movement desensitization and relaxation approach.

Group therapy

There are numerous group-based therapies for PTSD which use individual therapy to improve symptoms. Group treatment helps in increasing efficiency of treatment and give patient social support needed to improve the condition. In group therapy, patients are educated about coping mechanism, cognitive restructuring and relapse prevention. During which phase would these therapies happen Specifics to Anthony

Treatment phase I

This phase is referred to safety and stabilization. People with PTSD are unsafe and have affected relationship with others (Foa, Hembree, & Rothbaum, 2007). To regain safety, they take few weeks. The act of knowing which part of life need to stabilize is important in achieving recovery. People with trauma have issues in soothing challenging emotions. In case Anthony is diagnosed with PTSD he need to learn how to manage overwhelming emotions. Lack of safety, poor comnication , etc Specifics to Anthonyy

Phase II

This is remembrance and mourning phase. The therapy move from processing trauma and giving it some meaning. The process is undertaken with help of therapist in individual or in a group therapy. During this process, it is important to continue with safety and stability phase because it allows person affected to move in a manner which integrates trauma instead of reacting in a fight response. Timing and pace are important in this phase. The phase further involves exploring the losses linked to trauma and providing space to grieve.Specific to Anthony, eg process “survivor guilt,” family of origin issues, etc.

Phase III

This is integration and reconnection stage of the therapy. The phase involve creation of new sense of future and self. This final task redefine oneself in a way which is meaningful to relationships (Foa, Hembree, & Rothbaum, 2007). Through the process, trauma is lose in patient life and it is integrated in person life story but not the narrative which defines them. Moreover, in this stage, person affected by trauma appreciate effect of victimization but are willing to make efforts towards empowering themselves. A person with PTSD finds a way to continue healing and growing like peer mentoring and talking to youth.Specifics. return to work, feel competent, reduce alcohol consumption

The main experience of a person suffering from PTSD is isolation, helplessness and failure of power to control. The pointing concept of disturbance recovery is rebuilding of personal safety and enablement. Therapy given to victims of traumatic events does not mean full freedom from Post Traumatic effect; however, it is capacity to deal with the state in default of being overpowered by feelings of the past.Specifics

Many, most symptoms were not addressed; goals missing; assessment unclear

Treatment phases need to be specifically related to Anthony

You can redo and resubmit if you would like, Laura. Again, reeview my welcome letter to you and the syllabus directions. -35

Very well referenced and formatted Some relevant theory +105

References

Abdul-Hamid, W., & Hughes, J. (2014). Nothing new under the sun: post-traumatic stress disorders in the ancient world. Early Science Medicine, 19, 549–557.

Courtois, C., & Ford, J. (2015). Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach. The Guilford Press.

Curran, G., Bauer, M., & Mittman, B. (2012). Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care, 50(3), 217–226.

Foa, E., Hembree, E., & Rothbaum, B. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide. New York: Oxford University Press.

Hamblen, J., & Kivlahan, D. (2016). PTSD and substance use disorders in veterans. U.S. Department of Veterans Affairs. Retrieved August 07, 2018, from www.ptsd.va.gov/professional/co-occurring/ptsd_sud_veterans.asp.

Richardson, L., Frueh, B., & Acierno, R. (2010). Prevalence estimates of combat-related post-traumatic stress disorder: critical review. jounal of Psychiatry, 44, 4–19.

Rytwinski, N., & Scur, M. (2013). The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. Journal of Trauma Stress, 26, 299–309.

Swartz, M. (2014). Textbook of Physical Diagnosis: History and Examination. Philadelphia, Pennsylvania: Elsevier;.