Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example
Trauma and stress-related disorders are associated with exposure to stressful or traumatic situations, which can be an event, series of events, or circumstance. The consequent psychological distress from exposure to a stressful or traumatic experience varies with the individual. In some cases, symptoms are understood in the context of fear or anxiety, while in other instances, individuals experience dysphoric and anhedonic symptoms and consequently present symptoms such as aggression, anger, or dissociation (American Psychiatric Association [APA], 2022). This paper explores psychotherapy for individuals presenting posttraumatic stress disorder (PSTD), the assessment and diagnostic criteria, recommend therapeutic approaches, and discusses the importance of using evidence-based psychotherapy for PSTD.(Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example)
The Neurobiological Basis for PTSD
When an individual experiences a traumatic event, the brain chemistry is altered. The symptoms of PSTD reflect the outcome of the neurological adaptations to cope with the stressors (Sakellariou & Stefanatou, 2017). Ideally, the neurobiology of PTSD is complex, and studies suggest the impact of PTSD on endocrine, neurochemical factors, and brain circuitry, whose linkage presents as the primary clinical features of PTSD. The central endocrine features associated with PTSD include the dysregulation of the thyroid and cortisol hormones which make up the hypothalamic-pituitary-adrenal axis (HPA) (Sherin & Nemeroff, 2022). When under stress, the HPA secures the Corticotrophin-releasing hormone (CRH). CH stimulates the production of Adreno Corticotrophin (ACTH) and the consequent stimulation and release of glucocorticoids. Glucocorticoids modulate the brain and immune functions associated with stress management. With sustained exposure, glucocorticoids have adverse effects on hippocampal neurons.(Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example)
The neurochemical features of PTSD include the dysregulation of serotonin, amino acid, peptides, opioid neurons, and catecholamine, which help regulate stress and fear responses. Stressors increase the release of dopamine, which modulates the HPA axis response and leads to hyperactivity, high blood pressures, startle response, and increased pulse (Sherin & Nemeroff, 2022). Decreased serotonin in PTSD patients affects amygdala and hippocampus functions, while decreased GABA affects an individual’s capability to regulate anxiety and stress. Lastly, the brain circuitry features involve changes in brain structure and function in PTSD patients. For instance, the changes in the hippocampus and Medial Prefrontal Cortex (PFC) include reduced plasticity and volume, while there is increased activity in the amygdala and Medial Prefrontal Cortex (PFC) (Sakellariou & Stefanatou, 2017). These changes impair the psychological and behavioral responses to stressors.(Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example)
Assessment and Diagnostic Reasoning
Screening and diagnosis of trauma are essential for treatment planning. The DSM5 outlines the diagnostic criteria for PTSD in children and adults. The client, in this case, is an 8-year-old male, which suggests that the presentation of PTSD symptoms will vary from that of children younger than six years old as provided by the DSM-5 guidelines (APA, 2020). For, a psychiatrist should identify whether there is an actual or threatened traumatic event as a direct experience, witnessing, learning, and repeated exposure of the traumatic experience. In this case, the client experienced a minor accident and threatened physical harm to his father and ensuing pursuit. The second criterion to assess is the presence of intrusion symptoms, be it recurrent memories, distressing dreams, dissociative reactions, intense psychological distress, or marked psychological reactions to perceived stressors.(Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example)
The third criterion to assess is the presence of persistent avoidance of traumatic cues. The fourth criterion is altered mood or cognition associated with the traumatic event. The fifth criterion assesses marked changes in reactivity and arousal to the traumatic event, including hypervigilance, irritability, sleep disturbance, lack of concentration, or recklessness. Lastly, a psychiatrist should confirm that the patient’s symptoms associated with PTSD have taken more than a month, causes significant distress or affects the critical area of functioning, and are not attributed to other medical condition or psychiatric disorder. The video provides adequate information for the diagnosis of PTSD and not other diagnoses. For instance, in Separation Anxiety Disorder (SAD), intrusive thoughts are not associated with a traumatic event, while Major Depression Disorder (MDD) should only be diagnosed if other PTSD symptoms are absent (APA, 2022). Although the patient presents Oppositional Defiant Disorder and Conduct Disorder (ODD/CD) symptoms, the conditions are well explained by the current diagnosis, i.e., PTSD.(Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example)
Therapeutic Approach
The best therapeutic approach for the case patient is trauma-focused cognitive behavioral therapy (TF-CBT). Although it was initially used for children who have experienced sexual abuse, TF-CBT has been used with children experiencing a broad range of traumatic experiences and other psychiatric disorders with significant outcomes. (Wheeler, 2020)(Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example). TF-CBT has multiple components, including psychoeducation, relaxation, coping skills, and child-parent sessions, among other significant features. TF-CBT will help the child understand the normal trauma responses and build skills for dealing with cues or stimuli associated with the traumatic events. Besides, the relaxation component of TF-CBT will help the child to develop thought-stopping techniques for involuntary and recurrent memories or dreams of the traumatic event. The parent will learn how to help his son cope with the stressors and manage him whenever he gets irritable, oppositional, or cannot sleep. Once the parent and the child understand their role in the therapy, they can master the skills and effectively achieve positive health outcomes.(Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example)
Importance of Evidence-Based Psychotherapy
CBT is evidence-based psychotherapy developed for children with PTSD (APA, 2017). Gold-standard psychotherapies are well-researched and supported by the best evidence. CBT treatment has proven safe and effective for PTSD (David et al., 2018; Goodnight et al., 2019). CBT is recommended in major clinical guidelines for PTSD treatment and is considered a first-line treatment for many other psychiatric illnesses. Therefore, TF-CBT is the most appropriate intervention for the case patient.(Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example)
Conclusion
The patient, in this case, presents symptoms that meet the DSM5 diagnostic criteria for PTSD. The patient presented nightmares, trouble sleeping, physical aggression, hyperarousal, intrusive thoughts, and a disorganized understanding of trauma. These symptoms overlap with other disorders, such as attention deficit hyperactivity disorder, ODD/CD, SAD, and MDD, as diagnosed in this case. However, the symptoms are best explained by PTSD as the primary diagnosis. Other disorders are considered comorbid disorders, whose symptoms could ease with TF-CBT. TB-CT is evidence-based psychotherapy with proven safety and efficacy in treating PTSDT in children and a broad range of psychiatric disorders in children and adolescents. (Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example)
References
Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (locomotive portfolios) (3rd ed.). Springer Publishing Company.(Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example)
Goodnight, J. R., Ragsdale, K. A., Rauch, S. A., & Rothbaum, B. O. (2019). Psychotherapy for PTSD: An evidence-based guide to a theranostic approach to treatment. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 88, 418-426. (Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example)https://doi.org/10.1016/j.pnpbp.2018.05.006
David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in psychiatry, 4. https://doi.org/10.3389%2Ffpsyt.2018.00004
American Psychiatric Association. (February 2017). Clinical practice guidelines of PTSD. Retrieved 19 September 2022, from: https://www.apa.org/ptsd-guideline/ptsd.pdf
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
Sherin, J. E., & Nemeroff, C. B. (2022). Posttraumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in Clinical Neuroscience(Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example). https://doi.org/10.31887%2FDCNS.2011.13.2%2Fjsherin
Sakellariou, M. O., & Stefanatou, A. (2017). Neurobiology of PTSD and implications for treatment: An overview. Current Research: Integrative Medicine, 2(1), 263-278. Retrieved 19 September 2022, from:(Psychotherapy with Trauma and Stressor-Related Disorders Comprehensive Nursing Essay Example) https://www.researchgate.net/profile/Athena-Stefanatou/publication/318226798_Neurobiology_of_PTSD_and_implications_for_treatment_An_overview/links/595e1d51a6fdcc6c1cef9faf/Neurobiology-of-PTSD-and-implications-for-treatment-An-overview.pdf
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