1. PTSD: Treating Invisible Wounds Through Different Treatment Modalities
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Erica Denner, MSW Candidate
GRC MSW Program
Abstract
Data
Historical PTSD
Posttraumatic Stress Disorder (PTSD) is a diagnosis that is common among people that have experienced, in some fashion, a traumatic event. Reviewing the history of PTSD, it is concluded that the diagnosis is still relatively new compared to other diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013). In this article, we aim to review the professional literature that synthesizes the effectiveness of common treatment modalities for PTSD in soldiers that have been in combat. The specific treatment approaches to be reviewed include Cognitive Processing Therapy, Art Therapy, Eye Movement Desensitization and Reprocessing, and Prolonged Exposure Therapy.
The American Psychiatric Association identified within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, that “Among U.S. military personnel and combat veterans who have been deployed to recent wars in Afghanistan and Iraq, co-occurrence of PTSD and mild TBI is 48%” (2013, p. 280)
However, “… a review of Veterans Affairs (VA) health care utilization covering the last 10 years, indicates PTSD was the most prevalent psychiatric disorder with approximately 217,000 cases.”(Wolf et. Al, 2015, p.339)
In a study on efficaciousness of Prolonged Exposure Therapy, “95.5% of participants demonstrated a reliable reduction in PCL scores, whereas 86.4% demonstrated a clinically significant change on the PCL.” (Wolf et. Al, 2015, p. 344)
Garske explains that Selective Serotonin Reuptake Inhibitors such as Zoloft and Paxil have been approved by the US Food and Drug Administration to treat PTSD symptomology (2011, p. 33).
Garske identifies that the more combat a soldier sees, the more likey they are to gain a PTSD diagnosis. He states that five or more fire fights will make a soldier 20% more likely to get the diagnosis (2011, p. 32)
Traumatic Neurosis
Gross Stress Reaction
War Neurosis
Combat Fatigue
Shell Shock
Soldier’s Heart
Interventions
PTSD Diagnosis
Cognitive Processing Therapy- Manualized treatment modality consisting of 12 sessions to challenge a person’s distorted thinking and negative beliefs about themselves, the world and other people.
Eye Movement Desensitization and Reprocessing-According to Sharpless and Barber, “EMDR is a structured and manualized treatment that combines elements of CBT, mindfulness, body-based approaches, and person-centered therapies.” (2011, p. 10)
Art Therapy- Art therapy is used to access parts of the brain that become inhibited during traumatic events. The process can bridge the gap between emotions, thoughts and words.
Prolonged Exposure Therapy- Manualized treatment made up of sections of exposure to avoided triggers and verbalized account of trauma. Client will learn about symptoms and the treatment process. The therapist will teach grounding techniques.
According to the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), A person must experience “exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways…” (2013, p. 271). They have to experience this first hand, either it happens to them or they witness it, it happened to a friend or family member, or exposure to repeated traumatic events.
Next a person must experience one or more intrusion symptoms. These could include, but are not limited too, dreams, intrusive thoughts, flashbacks.
Must be avoidant of triggering external or internal stimuli.
Negative changes with cognitions or mood.
Changes in arousal or reactivity. These could include, but are not limited to, reckless behavior, angry outburst, and hypervigilance.
Symptoms must last longer than one month and must cause impairment in social settings, home, or occupation.
Cannot be the result of substance use.
References
Please see attached reference page.