Pharmacological vs Psychotherapeutic Approaches to PTSD - Coursework Example

Pharmacological Verses Psychotherapeutic Approaches to PTSD Introduction When an individual experiences severe trauma, that individual often experiences what known as post-traumatic stress disorder (PTSD). This disorder is marked by the patient reliving the trauma, being hyper-vigilant, and experiencing avoidance behaviors. There are different treatments for this disorder, including pharmacological and psychotherapeutic. Therefore, there is a need to understand which kind of therapy would be most efficacious for the treatment of this disorder. This study will explain the two kinds of treatments, centering on cognitive behavioral therapy for the psychotherapeutic method, and the use of SSRIs for pharmacological interventions, and will propose a study that will ascertain which of these methods would be the most effective. What is PTSD? PTSD is a combination of symptoms which are physiological, psychological and behavioral in nature, which are preceded by some kind of trauma to the patient. The patient usually experiences a cluster of symptoms that have to do with intrusion, avoidance and arousal. It has a variety of symptoms including insomnia, which is often caused by nightmares; and physical symptoms, such as cardiovascular difficulties (Kar, 2011). Phifer (2012) has also found that chronic pain is generally a co-morbidity of PTSD. They found that the symptoms intrusion, which they termed re-experiencing, along with hyper-arousal are associated with pain. Cognitive Behavioral Therapy Cognitive behavioral therapy combines two effective therapies – behavioral therapy, which was founded by J. Wolpe (1958); and cognitive therapy, whom A. Beck developed in 1967. In the CBT approach, a person’s thoughts and beliefs are changed, and, since the way that the person responds to situations and how the person interprets these situations is based upon the thoughts and beliefs, the behavior is thus changed. According to Ellis (1962), mental disorders are caused, in part, upon irrational beliefs. According to Beck (1967, 1976), distorted thoughts contribute to mental disorders, such as depression and anxiety. The negative automatic thoughts (NAT) are at the conscious level. These are negative thoughts, assumptions and beliefs which are schematic and are accessed at the memory level (Bartlet, 1932). Beck states that the negative automatic thoughts are the contributors to depression and anxiety, in combination with negative schemas and maladaptive assumptions (Beck, 1967). Anxiety is caused, according to Beck et al. (1985), by the patient’s distortion of incoming information. This information is distorted so that danger is overestimated. At the same time, the patient’s ability to cope is underestimated (Beck, Emery & Greenberg, 1985). A patient appraises danger, which makes the patient experience physiological changes. These physiological changes cause anxiety, which causes the patient to appraise the possibility of danger even more acutely, thus setting off a vicious cycle (Simmons & Griffiths, 2009). According to Westbrook et al. (2007), CBT stops the negative processing of information by teaching the client how identify dysfunctional thoughts, and to appropriate evaluate these thoughts and appropriately respond to them. The CBT model has been used for PTSD patients. Sedler and Wagner (2006) conducted one such study regarding CBT and PTSD patients, comparing the efficacy of CBT for PTSD with that of Eye Movement Desensitization and Reprocessing (EMDR), which is another therapeutic model that might be used to treat PTSD. They found each model to be equally efficacious for the treatment of PTSD, and found that each model was effective in the treatment of PTSD. Likewise Kar (2011) also conducted a study on the efficacy of CBT on PTSD, noting that CBT has been a therapy that has been used for PTSD patients for many years. They conducted their study by examining literature about PTSD among various journals. They found that CBT has been used, effectively, on patients who have suffered PTSD as a result of terrorism, war, sexual abuse, being a refugee, and being a disaster worker. Medication Medication is another way to effectively treat PTSD. One such treatment is that of selective serotonin reuptake inhibitors (SSRI), which is used to treat PTSD, with the rationalization that these SSRIs are used to treat depression and anxiety, which are commonly associated with PTSD (Bryant and Friedman, 2001). Stein et al. (2009) found that a significant portion of PTSD patients saw a reduction in symptoms when they took medication, compared to those who took a placebo - 59% of patients had a reduction in symptoms when they took medication, compared to 39% of patients who took the placebo in their study. They, too, found that SSRIs worked most effectively out of the medications that were tried. David et al. (2006) further found that, after doing a PUBMed review, studies show that pharmacological interventions are effective for a PTSD patient, in that they prevent relapse and symptom exacerbation. They found that the SSRIs are the most effective treatment, and that other pharmacological treatments, such as anti-psychotics and anti-epileptic drugs, need further study to determine if these medications are effective. Study Design The study will focus upon 100 individuals who have been diagnosed with Post-Traumatic Stress Disorder – 50 patients will be given a drug protocol, and 50 patients will undergo cognitive behavioral therapy. The study will exclude individuals who have suffered anxiety or depression before the incident the traumatic incident. The symptoms associated with the PTSD should have been experienced by the patients for at least six months prior to the study. The patients will be recruited through mental health facilities. The patients who are in the pharmacological group will be given either an SSRI or a placebo. The patients who are in the CBT group will be given cognitive behavioral therapy that focuses upon the symptoms that they are experiencing. The following criteria will be used in recruiting the patients: 1) the patient must have experienced one or more of the following on a constant basis, within the six months prior to the study: depression, anxiety, persistent nightmares, persistent reliving of the incident, avoidance behaviors, and hypervigilance; 2) a minimum global scale of 7 for their stated symptoms; 3) no history of manic, hypomanic or cyclothymia; 4) no history of drug or alcohol abuse, nor no history of a personality disorder, using the criteria of the DSM-IV; and 4) no active medical illness. Before the study begins, each patient will be given a Likert Scale questionnaire, in which the patients are asked detailed questions about their current symptoms. The patients will fill this out to completion before they receive the treatment for which they have been randomly chosen to receive. The patients who are assigned to the cognitive behavioral therapy group will have three components to their therapy. The first is the cognitive behavioral therapy. This will consist of strategies and techniques which help the patients correct their maladaptive views and beliefs. Also included in this will be exposure strategies, where the patient will be exposed to the trauma in therapy, then given strategies to further cope with this trauma. The second component to the therapy will be lifestyle modification. In this case, the patient will be given strategies to overcome maladaptive lifestyle choices that he or she may have, and will be given information on how to adapt better ones. Included in this would be advice on getting more sleep, eating better, exercising more, and cessation of smoking, drinking or drug use. They will also be trained on how to handle stress in their daily lives, such as work stress or domestic stress. The third component to this therapy will be well-being therapy. In this part of the cognitive behavioral therapy, the patient will be trained on changing attitudes and beliefs which are detrimental to the well-being of the patient. The patient will also be trained on how to increase personal growth, and the behaviors which promote well-being will be reinforced. The patients who are given a drug protocol will be prescribed SSRIs. The patients will be monitored closely for any adverse reactions, and the patients will see their psychiatrist on a weekly basis to ascertain if there is any need for a dosage reduction or increase. Half of the patients who are assigned the drug protocol will be given a placebo. After six weeks, the patients in the study will be evaluated for their lingering PTSD symptoms. They will be given a questionnaire that asks them the current severity of their symptoms, by using a Likert Scale. The two classes of patients will be compared to one another – the patients who have received the pharmacology, and the patients who received the cognitive behavioral therapy. Both of these groups will also be compared to the placebo group, who only received the placebo and not the SSRIs. The patients will then continue on with their respective therapies. They will then be evaluated after another six months. They will, once again, be given an evaluation questionnaire in which they note their current symptoms on a Likert Scale. These scores will be compared to their previous evaluation, and also will ultimately be compared to their original evaluation of their symptoms. Independent and Dependent Variables The dependent variable will be how well the patients recover from their PTSD. The independent variable will be the method that is used to treat the patients, whether the method is pharmacological or through cognitive behavioral therapy. Purpose of the Study The purpose of this study would be to ascertain the efficacy of pharmacological intervention for PTSD, verses therapeutic intervention. The significance for this study will be to aid practitioners, going forward, about which is the protocols for treating PTSD is preferable. Sources Used Bartlett, F.C. (1932) Remembering: A Study in Experimental and Social Psychology. Cambridge: Cambridge University Press. Beck,A.T. (1967) Depression: Clinical, Experimental and Theoretical Aspects. New York: Harper & Row. Beck, A.T. (1976) Cognitive Therapy and Emotional Disorders. New York: International Universities Press. Beck, A.T., Emery, G. & Greenberg, R. (1985) Anxiety Disorders and Phobia: A Cognitive Perspective. New York: Basic Books. Bryant, R. & Friedman, M. (2001) “Medication and non-medication treatments of PTSD stress disorder,” Home, 14.2, 119-123. Davis, L., Frazier, E., Williford, R. & Newell, J. (2006) “Long-term pharmacotherapy for post-traumatic stress disorder,” Home, 20.6, 465-476. Fava, G. (1998) “Prevent of recurrent depression with cognitive behavioral therapy,” Archive of General Psychiatry, 55.9, 816-820. Kar, N. (2011) “Cognitive behavioral therapy for the treatment of PSTD: A review,” Neuropsychiatric Disease and Treatment, 7, 167-181. Phifer, J. (2011) “Pain symptomology and pain medication use in civilian PTSD,” Pain, 152.10, 2233-2240. Seidler, G. & Wagner, F. (2006) “Comparing the efficacy of EMDR and trauma-focused cognitive behavioral therapy in the treatment of PTSD,” Psychological Medicine. Available at: https://www.ptsdforum.org/c/gallery/-pdf/1-26.pdf Simmons, J. & Griffiths, R. (2009) CBT For Beginners. New York: Sage Publications. Wolpe, J. (1958) Psychotherapy by reciprocal inhibition. Integrative Psychological and Behavioral Science 3.4: 234-240. Read More