Treatment of Post-Traumatic Stress Disorder - Essay Example

Single Client/Systems Research Assignment Post-traumatic disorder (PTSD) is a sequel of a psychiatric nature to a catastrophic or threatening stressful event or situation. Cognitive behavioral therapy has achieved great success in the intervention of PTSD. This research seeks to evaluate the effectiveness of cognitive behavioral therapy in the treatment of PTSD, the timeline taken for intervention and follow-up, methods of cognitive and behavioral intervention, and effects of their application on the client. The effectiveness of cognitive behavioral therapy in the treatment of PTSD is tested using single client/system designs which imply that there should be notable change in the status of the client at the end of the intervention. This paper follows the intervention through three phases; repeated measurement, baseline phase, and treatment phase. The results of the effectiveness of cognitive-behavioral therapy from review of vast literature provides a robust evidence that this type of therapy is immensely effective to patients with PTSD. 1. Cognitive-behavioral theory According to most of the theories, Post-traumatic stress disorder (PTSD) is attributed to disturbances in the memory which is caused by memory formation, bias, saliency or retrieval. As such, PTSD development and maintenance can be understood by understanding the alternations in the normal memory processes of the client (Norris & Sloane, 2007). When an individual experiences a traumatic experience, stress hormones are released and this has been implicated in the realization of PTSD. The stress hormones include adrenaline and cortisol which have been reported to disrupt the normal development of memory. Other hormones are responsible for consolidation of memory. Since PTSD is rooted in the functionality of the brain, cognitive-behavioral therapy is very effective as an intervention in helping the client recover from depression. Cognitive theories hold that the information in the individual’s central cognitive schema is not in alignment with the information related to a traumatic event. As such, an individual who has been exposed to a traumatic experience finds it hard to reconcile and make sense of the events of the trauma. As such, integration of the events into the existing schema becomes difficult. Prolonged disintegration leads to manifestation of behavior and symptoms which are categorized as PTSD (Bryant, 2003). Early intervention strategies are advocated for as they prevent acute development of PTSD. Cognitive-behavioral therapy has been used for a long time as an intervention strategy for PTSD. There are varying cognitive-behavioral therapy techniques but the approach of which one to use depends on the nature of the client. While a single technique can be used, in other cases, several techniques are blended together to form a perfect intervention for PTSD. Overall, all technique seeks to dispel all the negative emotions and alter irrational thought which are linked to a traumatic experience (Sones, Thorp & Raskind, 2011). The different forms of cognitive-behavioral therapy which have proven successful in intervention of PTSD include; Exposure therapy This type of therapy involves introduction of a frightening or stressful stimulus to the client until it reduces the avoidance of the feared situation. The confrontation is based on mental imagery which is taken from imaginal exposure by the therapist or from the memory. The confrontation is done until the symptoms of PSTD are reduced and take places 8 to 12 sessions either weekly or biweekly lasting about 60 to 90 minutes (Institute of Medicine. 2008). Stress Inoculation Training (SIT) These are intervention techniques which are designed to help the client cope with anxiety symptoms. The approaches used to enhance coping mechanism include role playing, breathing retraining, muscle relation training and education. This therapy can take 10 to 14 sessions ranging from 60 to 90 minutes long (Foa, Keane, Friedman, & Cohen, 2009). Cognitive Restructuring This strategy facilitates relearning of beliefs and thoughts which are generated from the traumatic experience. By teaching the client how to identify any dysfunctional beliefs or any trauma-induced irrational thought, such beliefs and thoughts can be replaced with more rational cognitions which are more adaptive. This type of therapy takes between 8 to 12 sessions ranging between 60 to 90 minutes long (Institute of Medicine. 2008). Eye Movement Desensitization and Reprocessing (EMDR) This intervention strategy uses a combination of concurrent induction of eyes movement with imaginal exposure. The client is asked to imagine and discuss the traumatic event while the therapist tracks the eyes. As such, the client engages in a negative cognition and then the therapist asks him/her to articulate a positive cognition which is completely incompatible with eh traumatic experience. 8 to 12 sessions biweekly taking 90 minutes long are sufficient to ensure results (Friedman, 2003). Cognitive-behavioral therapy intervention is to be tested using Single Client/System designs. The underlying principle of this design is that it should be possible to see notable change in the status of the client, community or agency during the intervention and at the end of the intervention is to be considered effective. Intervention takes place in three components; repeated measurement, baseline phase, and treatment phase. 2. Profile of the Client Jane is 30 year old and a mother to two boys, aged 6 and 3. She is a single mother living in a substandard apartment house. Jane is divorced and was married to a drunkard, a man who abused her both physically and emotionally. Jane was orphaned at a tender age of 3years and lived with her adoptive parents who never provided for her and was forced to tend for herself since she was young. She reveals that she was a student but was forced to drop out to work for her family. She is not well educated and therefore has to work odd jobs to provide for her children. In the next session, Jane expressed feelings of severe depression since her estranged in-laws have vowed to abduct her children and take them away her fro. This has made her to feel very immobilized, helpless and unable to offer adequate protection to her children. She has not been able to eat or sleep for some time now and has reported to have recurrent crying spells. In the past three months, she has lost 25 pounds of weight and has not been able to work for a week now. Recently, she has frequent spells of fatigue, anxiety and insomnia. Due to these problems, she is feeling frustrated and has been having suicidal thoughts. At this point, the intervention plans to work towards assessing Jane’s current situation, creation of contract and to target intervention for indicators like anxiety, suicidal thoughts and weight loss. 3. Research designs Research designs serve the purpose of monitoring the progress of the client during the intervention process. Using single-subject research designs offers the therapists continuing feedback which is more reliable and objective as opposed to a practitioner’s impression. There are different research designs some of which can be used either for monitoring only or for both practice evaluation and research purposes. Basic Design- A-B This is the basic single-subject design. It has repeated measurements, baseline phase and an intervention phase progressing at similar measures. The benefit with his design is that it has proven to produce better results within the shortest time possible. For instance, Jane has been having problems with lack of income and food for her children but she won’t go out of the house to search for work. She has been complaining of been rejected and everyone is rude and refused to give her work. The social worker suggest that she uses a point system for every time she fulfills all the job requirements, grooming, going to work early and working hard. Once a number of points are achieved, she would check the results to see her progress. After ten days, there was a significant improvement in Jane’s ability to provide for her children and retain her work. The disadvantage of this type of intervention is that, other factors may also have an impact on the results, other than the intervention. For instance, at the time the intervention started, Jane got an award of $100 dollars from her ex-husband for child support, for the first time. This helped her provide adequately for her children. A-B-A Design This is an intervention design which builds on the basic design by incorporating a post-treatment follow-up which includes repeated measures. It builds on the basic design by answering the question of whether there is a persistent of the effects derived from the intervention once treatment has been concluded. The follow-up period provides the opportunity to learn the length of the effects of the intervention. Multiple measures are included in the follow-up period so as to develop a follow-up pattern. The advantage of this type of design is that it allows the client to get long term assistance from the social worker and the intervention treatment by establishing an extended relationship. For instance, Jane is likely to rise from her PTSD and continue with a persistent effect provided her social worker or therapists will continue with the follow-up and monitoring. However, some clients are opposed to the idea of repeated follow-up measurements. A-B-A-B Design This design builds on the second intervention phase. This design is very effective in use for effective intervention in social work practice research due to replication of intervention. For instance, if Jane gets positive changes during intervention and then it is concluded, the effects of the intervention can be monitored during the follow-up session whereby replication of intervention is administered in case there is a reverse in the effects of the intervention during the follow-up period (Kam-fong Monit Cheung, 1999). However, for cognitive-behavioral therapy, the replication premise is taken as a problematic issue in social work research since the intervention effects are supposed to be persistent long after the intervention has been concluded without the need of replicating the intervention when the effects reverse. 4. Data Analysis & Limitation to the Study The phases of intervention are presented in the graph below. Graphing is important as it allows the social worker or the researcher to facilitate effective monitoring and evaluation of the effects of the intervention in order to determine the extent of intervention treatment on the patent. Visual analysis The visual analysis of this intervention will involve visual inspection of trend, level and variability (William Nugent, 2000) Trend inspection involves comparing the direction in the pattern of baseline and intervention phases. According to the graph on Jane’s behavior, the trend on both baseline and intervention phases are on a declining trend which means that the variables are declining in effect. Level inspection refers to the magnitude or amount of the target variable. The level of target variables in this case has declined from the baseline to intervention period. Variability of the results shows that the scores inside the baseline and intervention phase enhance easy assessment since they are not widely divergent. Trends can also be assessed by measuring the effects of the treatment through standard deviation. In the formula; d = me – mc/sp (d) is the standardized effect size for the outcome measured. The effects are measured against the control which is the effects prior to intervention. Me is the post therapy mean, mc is the control group mean while sp is standard deviation of both groups. The mean effects size of the data is about 0.80 while the standard deviation was more than 0.75. This indicates that there is a large positive effect of cognitive-behavioral intervention in PTSD patients due to reduction in the effects of the variables being measured. A major threat to validity in this case is history. There is no way that the repeated measuring in the baseline regulates for any historical events which may take place between the first intervention measurement and the last baseline measurement. In order to improve on this limitation, the researcher should make sure that the time between the two periods is kept at minimal. Furthermore, it is prudent to debrief the client and determine whether any extraneous event has taken place between the two periods. 5. Individual feedback The assignment was very challenging as it had several facets which needs to be combined together to make it a comprehensive piece. Collection of data to be used for drawing the graph was also tasking. On the positive note, the assignment gave me an opportunity to work on a real life case and link it to theory as opposed to just gathering information. I now have a clear understanding on how to perform cognitive-behavioral therapy as an intervention to a PTSD patient. References Bryant RA.(2003). Early predictors of posttraumatic stress disorder. Biol Psychiatry. May 1;53(9):789-95. PMID: 12725971. Foa EB, Keane, T. M., Friedman, M. J., & Cohen, J. (Eds.) ed. (2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (2nd ed.). New York: Guilford Press. Friedman MJ. (2003). Post-traumatic stress disorder: The latest assessment and treatment strategies. 3rd ed. Kansas City, MO: Compact Clinicals. Institute of Medicine. 2008.Treatment of PTSD: assessment of the evidence. Washington, DC: National Academies Press. Norris F, Sloane LB. (2007). The epidemiology of trauma and PTSD. In: Friedman MJ, Keane TM, Resick PA, eds. Handbook of PTSD: Science and practice. New York, NY: Guilford Press:78-98. Sones HM, Thorp SR, Raskind M. (2011). Prevention of posttraumatic stress disorder. Psychiatr Clin North Am. 2011 Mar;34(1):79-94. PMID: 21333841. Wood DP, Murphy J, McLay R, et al. (2009). Cost effectiveness of virtual reality graded exposure therapy with physiological monitoring for the treatment of combat related post traumatic stress disorder. Stud Health Technol Inform. 144:223-9. PMID: 19592768. Read More