PTSD Treatments Flashcards
NICE Assessment
- initial assessment / meeting - determination of the ned for emergency medical or psychiatric assessment
- assessment - needs to be comprehensive and conducted by a competent individual
- physical, psychosocial, social needs and risk assessment
- patient preference - important determinant for the choice of treatment
- need to be given sufficient information about the nature of the treatments so that the P can make an informed choice
Potential difficulties with diagnosing PTSD?
PTSD P’s - tend to avoid a lot of situations
Under-diagnosed - need to find a way of attracting them to therapy
NICE treatment
- if symptoms are mild (less than 4 weeks) - ‘watchful waiting’ and then a follow-up meeting
- if severe - trauma focused CBT or EMDR can be used!
- if P refuses therapy - drugs can be used e.g. paroxetine (WARNING!)
- if co-morbidities exist, then treat them
- suicidal = priority
- therapy normally consists of 8 - 12 sessions of 90 minutes
- if trauma focused therapy is unsuccessful then drugs can be added
Prolonged Exposure Therapy
- psychotherapy got PTSD
- gradually approaching trauma-related memories, feelings and situations that have been avoided since the trauma
- by avoiding the feelings and situations associated with the trauma of PTSD, there is a halt in the recovery
- talking about the details of the trauma and controlling the situations, the P has been avoiding, PTSD symptoms can decrease and P can gain more control over their life
Prolonged Exposure Therapy
- therapy
- repeated exposure to trauma memory so that fear extinction can take place
- P’s have to learn that the world is not a terrible place even though they have experienced trauma
- assumption - traumatic events are represented differently in memory as they are contra to the P’s beliefs about safety
> challenge this - show them that this isn’t true
altering this negative view of the world = recovery?
behavioural training - show them that these stimuli/responses aren’t threatening etc
Acceptance and Commitment Therapy
- behaviour based therapy
- aim - to reduce avoidance and steer the P towards behavioural changes
- PTSD P - trying to avoid the disturbing memories, nightmares associated
- trying to get them to confront their behaviours, not avoid them!
- P - may think they are damaged which can lead to co-morbidities
- ACT helps P’s to face these traumatic memories, thoughts, feelings etc by using mindfulness, acceptance and by targeting experiential avoidance
Trauma Focused CBT
- with support from a therapist, confronting traumatic memories
- attempts to change negative thoughts and fears about self-blame and the event recurring
- also encouragement for client to resume parts of life they have given up
> pretty much basics of CPT - changing your cognitions and behaviours
confront negative attitudes and behaviours (particularly avoidance?) and realise that the world is not a scary place so that symptoms can decrease
What is EMDR?
Eye Movement Desensitisation and Reprocessing
- Shapiro (1995)
- a form of psychotherapy aimed at reducing distress that has been caused by traumatic events
> multi-saccadic eye movements whilst focusing on disturbing thoughts
authors found that these thoughts were suddenly disappearing and not returning after realising that involuntarily, their eyes were moving whilst thinking of those thoughts
EMDR - Process
- P is faced with emotionally disturbing material in small amounts (concentrating on a traumatic picture and words of a belief statement)
- visually track the therapists finger or follow something on the end of a stick
- moved rapidly back and forth across the line of vision from the extreme R to the extreme L
- information processing is enhanced and associations are built between existing memories or information and the traumatic memory
- emotional distress is eliminated and information processing is complete
How does EMDR work?
> somehow affects your working memory
kind of distracts you from the emotions associated with the traumatic event?
focusing on one thing whilst thinking about something else
Narrative Therapy
- P’s need to be able to make sense of the trauma the experience
- ‘telling the story’ of it is therapeutic
- narratives are formed with a therapist’s guidance
- can have structured exercises, homework as well as creative techniques
- very long process
- reduces stress and symptoms are managed, allowing the P to move on
What is IPT?
Interpersonal Psychotherapy
- focus on feelings and relationships / social and interpersonal functions
- alternative to exposure based therapies
IPT - Rafaeli and Markowitz (2011)
- background
- has shown efficacy in treating MDD and other psychiatric conditions
- focus on P’s current life events, social and interpersonal functioning for understanding and treating symptoms
- case report - demonstrating the novel use of IPT as treatment for PTSD
- preliminary evidence - IPT may relieve PTSD symptoms without focusing on exposure to trauma reminders
IPT - an alternative for P’s who refuse or don’t respond to exposure based therapies
- focuses on 2 problem areas specifically affecting PTSD P’s —> interpersonal difficulties and affect dysregulation
IPT - Rafaeli and Markowitz (2011)
- P and method
This specific case - demonstrates a viable alternative to exposure-based therapy for this disorder
- Mr A - grappled for more than 20 years with the after effects of a personal trauma
- numerous attempts at therapies and self-help - exposure or LT psychodynamic therapies didn’t help
IPT - gave him a chance to understand himself through his feelings and relationships subsequent to the trauma
- focus on current feelings in current interpersonal relationships through decision and communication analyses
IPT - Rafaeli and Markowitz (2011)
- results
Symptoms appeared to diminish through the processes of understanding feelings and relationship patterns and the slow building of social support
- helps P’s explore problematic relationship patterns beyond the core PTSD symptoms
- Mr A - struggled with his sexuality - the more he talked about it, the more he connected it to his relationships and PTSD symptoms
- exclusive focus on re-exposure to trauma reminders may never have realised this issue
