Treatment Of Post Traumatic Stress Disorder In Children Using Psychotherapy - Essay Example

? Treatment of Post traumatic stress disorder in children using psychotherapy Treatment of Post traumatic stress disorder in children using psychotherapy From the onset of post- traumatic stress disorder, psychological interventions are the most successful method of treatment. Therapists have applied various psychological treatments like exposure therapy, stress inoculation training, cognitive therapy, psychodynamic psychotherapy as well as eye movement desensitization and reprocessing (EMDR) (Bisson & Andrew, 2009). Most therapists impose multiple forms of treatment before discovering the right type. Some may also try group therapy, individual therapy or even both of them (Mayo Clinic.com, 2011). For those Children suffering from this disorder, Psychological interventions are normally supported by those interventions developed for distressed adults. Although there is less experimental proof, regarding the efficiency of these interventions for the children than it is for the adults, age is the most suitable modification for the psychotherapy to work (Kaminer. et al, 2005). Most children only show minor crisis reactions when they experience a traumatic event. Due to this, not all children need psychotherapy intervention. However, children who suffer this disorder in severe forms need a psychological intervention, endowed by a trained therapist psychologist, or a psychiatrist (Hubpages.com, 2011). The expressive nature of PTSD is how the affected child will cope with the subsequent traumatic events. Prognosis of post- traumatic stress disorder may vary from patient to patient. In order to determine the right treatment on a particular child, therapists consider a number of variables. To determine the kind of treatment to use on a PTSD patient, it depends on how the affected person deals with and copes with life after experiencing a shocking incident. Environmental factors, socioeconomics, conditioning, nurture and nature, may verify the theories, treatment procedures and the techniques the therapists will use during the therapy session. Often, the patient chooses the approaches that are essential for his /her life even though the style of approach may dictate the therapeutic approach of the therapist (Brown, 2011). Helping the child to achieve a sense of mastery over the trauma and making him/her to feel secure again is the first step in psychotherapy intervention on a child suffering from PTSD. For the older children, their capability to recall the shocking event, narrate and reassess the traumatic event without feeling besieged provides them a sense of mastery and care from others. In order to attain this medication and relaxation training is appropriate. Helping the child and the parents to identify the signs and symptoms of PTSD is sometimes. By doing this, they will understand that there are several natural reactions that occurs when a child undergoes through a traumatic event like hyper-arousal, repeated recollections and numbing and yet these are not symptoms of a serious mental sickness. Much consideration is important since numerous emotional and behavioral consequences may arise after the traumatic event (Lubit, 2011). Cognitive Behavioral Therapy (CBT) Cognitive behavioral therapy (CBT) proofs to be the most hopeful means of managing and treating childhood PTSD. Most people believe that CBT works by disconnecting the coupling between the traumatic cognitive events and the nervousness response and supplants relaxation response and more thinking that is reasonable (Cottone, 2004). In the recent years, modernization has integrated the stipulation of CBT to those groups of children and adolescents who suffer from the post-traumatic stress disorder. This may proof to be advantageous since the young children may learn from each other and feel less secluded as they share their incidents. In addition to this, the approach is present in various guidebooks and the experts who are not normally qualified in child mental health may help the teachers to guide and console the affected children. Many youngsters who have experienced disasters such as earthquakes or wars can undergo through this therapy without any difficulties. This means that the CBT has proved to be the most appropriate therapy that will help the youngsters to overcome the fears, anger and insecurity they feel after a shocking event (Tareen. et al, 2006). The CBT procedures merge stress management and relaxation techniques, exposure techniques and cognitive reformation. Some of stress management approaches include progressive muscle relaxation, breathing techniques, avoiding thinking and having a positive attitude and image towards oneself and others. Cognitive restructuring aims at helping the child build acknowledgements that are more sensible and scientifically deal with cognitive alterations (Cottone, 2004). According to Cottone (2004), cognitive reformation deals with the every day coping, over responsibility, risk assessment and negative postulations concerning the traumatic experience. The reorganization of defective, post trauma cognitive systems helps to put the traumatic incident in an adoptive cognitive perspective. Both the stress management and the cognitive restructuring are applicable in schools and clinics. Cautious observation of symptomatology and therapeutic reactions during school achievements can assist in a transfer if required. When the symptoms change in harshness from gentle to a more painful, then a medical attention is essential. A modified theory of post- trauma stress disorder centers on the abnormal dispensation of trauma reminiscences and the deprived association of autobiographical memory. Memories of the event reappear impulsively or are easily activated and re-experienced as if they just occurred at the present, rather than the past. The therapy’s objectives are to change the trauma story, reorganize the negative thoughts that accompany the trauma and decrease the evasion. The affected person should narrate the story of the shocking event in as much particulars as expected. This will help in reconstructing the trauma story and exposure, helping the affected to progress his or her memory. Discovery of the sense they have for the traumatic event in their mind and the belief that they cannot be helped is recognized and changed and they develop a positive mind or attitude (Tareen. et al, 2006). Although controlled studies of CBT are few, the efficiency and use of cognitive behavioral therapy for the post-trauma stress disorder in children is more frequent than other forms of interventions. Debatably, the most exact studies have put more attention on trauma –focused CBT in sexually mistreated children although the CBT treatment have been extensive to children exposed to other types of traumas. Additionally, these studies have added to the rising evidence supporting the efficiency of trauma- focused CBT on measures of post-trauma stress disorder, behavior difficulties and depression in the children affected by this disorder. (Kaminer. et al, 2005). Trauma Focused-Cognitive Behavior Therapy (TF-CBT) Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is based on a clinic treatment that involves individual sessions with the child and the parent as well as a combined child-parent session. By learning cognitive theories about the development of PTSD in children, successful interventions for adult PTSD and for non-PTSD child anxiety disorders, turn into a well-versed treatment. The main aim of TF-CBT is to deal with the distinctive bio-psychosocial wants of children with PTSD or other difficulties linked to traumatic life experiences. The therapy is applicable to children who are aged between 3-18 years and have important and behavioral challenges that are associated to the traumatic life occurrences, even though they do not fulfill the diagnostic criteria of Post trauma stress disorder (CAARE Diagnostic and Treatment Center, 2011). During TF-CBT session, the child often narrates the episode of the trauma. TF-CBT also comprises techniques to help lower or decrease the worry and the stress the affected child may be undergoing. The therapy may include learning to adjust their thoughts and beliefs about the trauma that are not true. A good example is when a child experiences a shocking event and he or she may come to conclusion that the world is an insecure place where no one cares about him or her (National Center for PTSD, 2007). The therapists are required to explain in a suitable manner the etiology and the most common symptoms of PTSD and what the treatment requires, with the underlying principle behind it. The therapist should clearly explain this information to the child and the parent so that they can understand the root cause of PTSD (Tareen. et al, 2006). TF-CBT comprises the various important components including direct discussion of the traumatic event emotion education and emotion regulation skills, stress management, education about childhood trauma and Post-traumatic stress disorder, feelings, linking thoughts and behaviors associated to the trauma and heartening steady exposure to trauma reminders. It also embraces cognitive investigation and reframing of distress pertinent ascriptions and the sense of the trauma emotional dispensation of the upsetting event, personal security skills training, education about healthy individual relationship and coping with potential trauma reminders (CAARE Diagnostic and Treatment Center, 2011). This type of treatment approach is helpful when the memories of the trauma frequently disturb the child. However, some people doubts whether the therapist should request the affected child to think and remember the events when the trauma occurred. The therapist educates the child on how to relax while they think about the occurrence of the trauma. In that way, the child may gain much confidence and discard any past memories that cause fear and trauma. Several studies assert that TF-CBT is safe and efficient for the children suffering from PTSD. The parents should learn the coping skills that will enable them to help their children to overcome their problems (National Center for PTSD, 2007). Studies have proved that the participation in TF-CBT results in improvement in many areas of child functioning such as the reduced shame and abuse-related attributions. Other improvements include a reduction in the occurrence and brutality of trauma symptoms, decreased depressive and nervousness symptoms and reduced disorderly and sexualized behaviors. Due to the parents following the treatment instructions, major reductions in the levels of parental sorrows and improvements in the levels of parental support are evident (CAARE Diagnostic and Treatment Center, 2011). There is a significant attention in transferring TF-CBT to regular clinical settings in which most children obtain mental health care. In United States of America, public health centers are a main background for the liberation of a child mental health service. Many children who get exposed to shocking incidents originate from domestic violence shelters, multi service centers for asylum and immigrant children or substance abuse agendas. Currently, TF-CBT has been very effective and has produced noteworthy outcomes in common care and in National Child Traumatic Stress Network (Cohen. et al, 2010). The parenting section of TF-CBT comprises the request of standard behavior running and skills training used within the background of trauma-focused therapy. These parenting management components include reinforcement of positive behavior, increasing positive parent-child encounters, giving effective instructions, ignoring minor irritating behavior and meeting out consequences for misbehavior. These plans include behavior supervision and unambiguous behavior management strategies (Cohen. et al, 2010). Ultimately, the combined parent-child session conducted helps to accomplish skills, allow the child and the parent to share and converse the child’s distressing episode together, optimize relaxed communications, and to give education about individual protection and healthy sexuality (CAARE Diagnostic and Treatment Center, 2011). Exposure therapy The exposure therapy usually involves asking the subject to relieve the trauma imaginably. This therapy mainly involves creating a comprehensive present tense explanation of precisely what happened, creating an audio tape recording of it and requesting the individuals to listen to the tape repeatedly. Exposing the affected persons to prompts linked with the distressing event is another form of exposure therapy (Bisson & Andrew, 2009). A new approach to exposure therapy uses virtual reality plans that permit the affected to re-enter the setting in which he or she experienced the distress (Mayo Clinic.com, 2011). Exposure techniques may occur as either direct or indirect interventions. Direct exposure involves placing the child in the exact situation that caused the trauma. On the other hand, indirect trauma entails generating the events of the occurrence that caused the trauma to the child in a tape or conversation. Although exposure techniques may offer positive results, it is vital for the therapist to mix the approach with relaxation therapy to avoid the trauma-reminiscent response (Cottone, 2004). Exposure techniques also involve imaginal and in vivo exposure approaches. Imaginal exposure entails the affected child imaging slowly increasing terrified features of the traumatic event until the fear response stops through taming (Tareen. et al, 2006). In Vivo Therapy constantly confront the traumatic event in addition to stimulating imaginal exposure. However, In Vivo exposure therapy might lead to depression to the child. Due to this, the therapy only applies after the imaginal exposure (Hubpages.com, 2011). Exposure techniques might also entail either gradual or prolonged exposure. Both types of exposure involve experimenting to the conditions that produce fear and traumatic condition. In the case of gradual exposure, the therapist asks the child to explain the condition that was less traumatic and embarrassing then gradually progresses towards events that produced more fear and anxiety (Bol, 2008). In general, most therapists use gradual exposure on younger children rather than prolonged exposure. This is because the technique offers a detailed description of the events causing the traumatic event. Facilitation of this might occur by asking the child especially a teenager, to write down a report concerning the traumatic event. After this, the therapist and the child can go through this report over and over again. This is very helpful to the child since she or he can develop confidence over various traumatic events for the future (Kaminer. et al, 2005). In the case of prolonged exposure, it best suits older children and comprises anxiety management and psycho-education. This therapy involves the therapists inviting the affected child to confront and experience real traumatic situations. In addition, this form of exposure involves placing the affected child in a traumatic event for an extended period so that the child can recall the events of the occurrence. Although this form of exposure is primarily for adults, evidence show that several therapists have used the method to treat older children affected by PTSD (Rachamim. et al, 2009). Cottone (2004) argues that exposure techniques are not very appropriate for use in school settings. Conversely, the school therapist or psychologist can offer school-based supports for children and teenagers during exposure therapy. School-based supports during exposure treatment may comprise harmonization of communication among school staff, family members, and the treatment team; support with student symptom management and assessment as well as offering cognitive restructuring techniques. Play therapy For the young children unable to deal with trauma directly, play therapy is essential for their treatment. To help the children process their traumatic memories, the therapist uses games, and drawings (National Center for PTSD, 2007). In addition, play gives young children a chance to work through the trauma. On the other hand, play may regularly fail in PTSD and repetitive reenactment that is not pleasant may occur. Intervention is necessary if this occurs. The therapist should let the child understand that it will take time before the child feels safe again and about the fear of return of scary thoughts (Lubit, 2011). It is evident that play therapy is the most productive resource of treatment when dealing with concerns of younger children. The play therapy helps the child explore while still giving accounts related to their traumatization. For instance, when dealing with a sexually abused child, the therapist could help the child to talk about ways of treating another through giving them with a doll. In this case, the doll represents the morals and ethics given unto them by their caregiver, in addition to being an outlet of expressing their own victimization. In addition, a therapist may engage the child in explaining what the perpetrator did to them, to what extent of violation by the perpetrator, and they way the victimization made the child feel (Brown, 2011). Eye Movement Desensitization and Reprocessing Eye Movement Desensitization and Reprocessing (EMDR) is another form of therapy of treating childhood PTSD. It involves the patient focusing on a traumatic image, emotion, thought and a bodily sensation while at the same time receiving two-sided stimulation usually in the form of eye movements (Bisson & Andrew, 2009). The therapist focuses mostly on patient’s feared memories while concentrating on other things like listening to certain music or controlling eye movement (Hubpages.com, 2011). Since this is an information-processing treatment it integrates some traits from the other established treatments, including stress management and CBT. In EMDR, the therapist would be moving his fingers across the patient’s field of vision for 30 seconds as the patient focus on the painful sides of their memories. Afterward with the help of the therapist, the patient lets their mind go blank, and then point out whatever feeling, thought, memory, sensation or image that comes to mind. The therapist and the patient repeat this process severally until the patient no longer feels troubled. After attaining this state, the therapist helps the patient to concentrate on positive thought or belief and that in turn is held in mind while further sets of eye movements are performed so as to establish it in their memory (Tareen. et al, 2006). Although EMDR is efficient in treating of PTSD both in children and adults, some researchers claim that the eye movements are not needed to make it work (National Center for PTSD, 2007). Even though a number of studies have supported the use of EMDR in the treatment of adult and child PTSD, there are some controversies surrounding the treatment package. This is because not all of the studies were well controlled hence lacking clear evidence that the eye movement’s component play part to the effectiveness of the treatment further than other factors, such as exposure (Rachamim. et al, 2009). Psychodynamic psychotherapy Another form of therapy is psychodynamic psychotherapy. This focuses on integration of the traumatic experience and the life experience of the child as a whole. Childhood issues are normally felt to be important (Bisson & Andrew, 2009). In psychodynamic approach, the alliance between the patient and clinician is important. The therapy is usually eased by the clinicians’ empathic response to reported feelings of shame, vulnerability and helplessness. Therefore, the treatment focuses on the identification of the meanings of the traumatic event and trauma-related symptoms (Ruggiero, 2011). While there is a long habit of using psychodynamic psychotherapy to children exposed to traumatic events, lack of an evidence base is leading to a remarkable decline. However, when modified and used together with some of non-directive treatments like CBT techniques it can treat younger children below the age of 8 years. This method is evident to be very beneficial to young refugees (Tareen. et al, 2006). Other Therapies for treating PTSD Although Cognitive processing therapy (CPT) was initially for adult sexual assault victims, it is currently being modified for use by the traumatized children. In this method, the therapist identifies the child’s current cognitions, followed by the evaluation by both the patient and the therapist reasons any distorted cognitions, and finally using an accurate cognition they replace these distortions (Bol, 2008). In addition, being a trauma-focused intervention, CPT helps the patients undergo cognitive training for challenging dysfunctional cognitions, especially self blame, and then deal with the traumatic event through detailed writing (Rachamim. et al, 2009). Another psychological therapy used for treating and managing childhood PTSD is Supportive therapy. Children suffering from PTSD experience anxiety and other problems that interfere with a child's ability to take part in the normal developmental experiences of childhood. Such a child may find schoolwork and socializing hard. As a result, there arise other serious secondary problems. In order to keep such a child on track or get him back on track there is need for supportive therapy. It is therefore important for the parents to remain as calm and as connected to the child so as to resolve PTSD. In addition, the parents should shun from tainting the child with their own painful feelings and expressing the fear that the child is permanently damaged (Lubit, 2011). Cognitive Restructuring (CR) mainly helps the patient understand how he truly feels about his emotions and beliefs abut the meaning of the traumatic event and his attributions about themselves or the world, following the event. The goal of this therapy is to change patients’ pre-traumatic maladaptive cognitions and patterns of emotions. CR does not focus on the traumatic event itself but aims at changing trauma related cognitions. (Rachamim. et al, 2009). Another form of therapy is Anxiety Management Training, which includes a range of cognitive-behavioral treatment elements with the aim of reducing anxiety by teaching patients some approaches of controlling anxious responding (Ruggiero, 2001). They teach patients ways of preventing stress using different methods, for example thought stopping, breathing retraining and deep muscle relaxation (Rachamim. et al, 2009). Parental therapy is another therapy essential for managing and treating childhood PTSD. There are a number of reasons of including parental treatment in treating PTSD in children. The parents may gather some information about the child’s symptoms. The main reasons of including parents are to help them solve their own emotional upset about their child’s trauma, for appropriate parent support, to develop effective parenting and correct any cognitive distortions (Bol, 2008). In addition, there is also a consensus of inclusion of parents in the psychotherapeutic intervention for children with PTSD. This should involve some psycho-education, including information on how these can be managed in the child's home environment, and normalization and explanation of post-traumatic responses. In case the parents are also affected by trauma hence emotional distressed are first treated. The intervention is aimed at helping the parent explore and resolve these feelings so that they can respond better to the child’s emotional needs. In addition, the child’s teachers can also receive psycho education, so that they may realize and be responsive to the child's emotional needs by developing the right expectations and behavioral management methods (Kaminer. et al, 2005). School Based Group Intervention is a therapy involves assisting a group of patients as opposed to one individual in the other methods. This method is effective in suppressing hopeless perception among patients. It is very effective in treating refugee children suffering from PTSD (Hubpages.com, 2011). In addition, Psychological First Aid (PFA) has mainly been used by school-aged children and teens who have been victims of violence in their residential areas. PFA is mainly used in schools and traditional settings. It involves letting the children know that their reactions are normal through giving them comfort and support. The approach mainly teaches problem solving skills and calming. In addition, PFA helps the caregivers manage changes in the child's feelings and behavior (National Center for PTSD, 2007). In adult assault victims and non?traumatized children, the stress management approaches are effective in decreasing symptoms. This intervention help calm children who are anxious from a trauma through muscle relaxation and breathing techniques and increasing the child’s sense of control over negative thoughts through thought stopping and thought replacement (Bol, 2008). For a child to fully thrive and recover safety is pinnacle. In addition, it is important for a clinician to identify the real world variables and those identified by literature to complicate the trauma reaction and make it less amenable to direct treatment. Among the factors important for a child’s recovery include: relocating children to a place of safety, the ability to live in a safe environment and having traumatizing stimuli garnished so that they may survive, risk and protective factors directly associated with their trauma and dealing with any issues of grief and loss before dealing with the issues of PTSD. It is evident that children are most vulnerable to traumatic experiences that are based in abuse (Brown, 2011). References Bol, C. I. (2008). Trauma?Focused Therapy for the Treatment of Posttraumatic Stress Disorder in Sexually Abused Children. Counseling Psychology, 1, 1, 1-12. Bisson, J. & Andrew, M. (2009). Psychological treatment of post-traumatic stress disorder (PTSD). Retrieved from Brown, A. D. (2011). Post traumatic stress disorder in childhood. Retrieved from CAARE Diagnostic and Treatment Center. (2011). Trauma Focused-Cognitive Behavior Therapy. Retrieved from Cottone, C. C. (2004). Childhood Posttraumatic Stress Disorder: Diagnosis, Treatment, and School Reintegration. School Psychology Review, 33, 1, 127-139. Cohen, J. A. et al. (2010). Trauma focused CBT for children with co-occurring trauma and behavior problems. Child Abuse & Neglect, 34, 215-224. Hubpages.com. (2011). Child and Teen PTSD - Symptoms and Treatment. Retrieved from Kaminer, D. et al. (2005). Post-traumatic stress disorder in children. World Psychiatry, 4, 2, 121–125. Lubit, R. H. (2011). Posttraumatic Stress Disorder in Children Treatment & Management. Retrieved from < http://emedicine.medscape.com/article/918844-treatment> Mayo Clinic.com. (2011). Post-traumatic stress disorder (PTSD). Retrieved from National Center for PTSD. (2007). PTSD in Children and Teens. Retrieved from Rachamim, L. et al. (2009). Exposure-Based Therapy for Post-Traumatic Stress Disorder in Children and Adult. Psychiatry & Related Sciences, 46, 4, 274-281. Ruggiero, K. J. (2001). Treatment for Children with Posttraumatic Stress Disorder. Clinical Psychology Science and Practice, 8, 2, 210-222. Tareen, A. et al. (2006). Post-traumatic stress disorder in childhood. ADC education and practice, 92, 1. Read More