Journal entry for Empirically supported treatment for PTSD

Three Key Points

Point one.

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that may develop after an event experienced or witnessed involving an actual or perceived threat to life (Rothbaum, Foa, & Hembree, 2007). Many different treatments help provide holistic interventions that work with PTSD treatment. Pharmacotherapy medication used in treating PTSD is selective serotonin reuptake inhibitors (SSRI's). The two SSRIs approved by the food and drug administration (FDA) are paroxetine and sertraline. Both medications have demonstrated strong evidence of working with treating PTSD (PsychArmor Institute, n.d). Psychotherapy interventions that maximize outcomes with the least amount of adverse side effects include those that are trauma-focused and have components of exposure and cognitive restructuring or stress inoculation training (PsychArmor Institute, n.d). Prolonged Exposure Therapy has parts of exposure and cognitive restructuring, as does Cognitive Processing Therapy (CPI). However, the main difference is in the degree of exposure, and cognitive restructuring is emphasized (PsychArmor Institute, n.d). Stress inoculation training also has evidence supporting it and is the only intervention that is not trauma-focused that includes components of exposure and cognitive restructuring (PsychArmor Institute, n.d). This writer chose Prolonged Exposure Therapy because it has positive evidenced-based support for its efficacy in treating PTSD (PsychArmor Institute, n.d). PE helps trauma survivors to emotionally process their traumatic experiences by safely confronting anxiety -arousing situations to decrease their excessive fear and anxiety (Rothbaum, Foa, & Hembree, 2007). There have been many studies conducted to determine what psychotherapies have the best potential outcome in treating PTSD. Trauma-focused therapies, including prolonged exposure therapy (PE), cognitive processing therapy (CPI), and eye movement desensitization reprocessing (EMDR), were the most consistent evidenced-based success with decreasing PTSD symptoms. All three of these approaches had similar positive short- and long-term outcomes. However, some studies have indicated that prolonged exposure therapy has consistently shown to be a little more positive than the other two.

Point two.

Cognitive-behavioral therapies are effective interventions in treating PTSD because of their behavioral and cognitive components. PsychArmor Institute (n.d) explains that unconditional stimulus, when presented with a conditioned stimulus, produces a conditioned response. When applied as an example to PTSD, a service member may experience a traumatic event such as having an improvised explosive device (IED) explode close to them. The serviceman responds through his or her limbic system with increased arousal of fear that affects the physiological lower brain self-protective system. The IED blast becomes a conditioned response, and things that were previously neutral and did not trigger hyperarousal now does when paired with the unconditional stimulus of the IED blast. The presenter explained that once the person experiences a traumatic event that impacted him or her to respond a certain way, he or she may experience a behavioral condition. When the same person experiences a seemingly neutral stimulus of the past such as sensory stimuli of sights, sounds, smells, and thoughts the person had at the time of the pairing can now provoke one's limbic system to produce a hyperarousal state in that person. The backbone of Prolonged Exposure Therapy is in Emotional Processing Theory. Theorizing that fear is represented in memory as a cognitive structure of a fear stimulus (sound of an IED exploding), fear response (fast heartbeat), and the meaning associated with the incentives (IED's are dangerous), and the reactions (rapid heartbeat triggers one to be afraid) (Foa, Chrestman, & Gilboa-Schechtman, 2009). PsychArmor Institute (n.d) further explains that there are a lot of meanings, beliefs, and interpretations that are part of the experience of the trauma itself. Therefore, the influence of symptoms afterward and through experience build fear structures that determine what things are dangerous and what they mean and how one should respond to them. Trauma memory is a specific type of fear structure that includes stimuli that were present during the trauma, physiological, behavioral, and cognitive responses all connected to the meanings associated with stimuli responses (PsychArmor Institute, n.d). When a person is now at home in a neutral environment with neutral stimuli, he or she may cognitively trigger his or her fear structure, thus producing a response that things are unsafe around them (PsychArmor Institute, n.d).

Point three.

PE works to improve PTSD symptoms by addressing the avoidance of trauma memories that have been a short-term fix to a long-term problem, though, has not allowed the person to work through a traumatic memory. When a traumatic memory has not been allowed to process with corrective information, then it will not change and may continue to trigger negative responses to that memory. PsychArmor Institute (n.d) explains that the trauma memory needs to open and be available for editing with corrective information. Exposure is a way to activate the trauma memory because as the person confronts the trauma reminders, thinking about the trauma with its cues and triggers within their environment, one's fear structure can then activated (Foa, Chrestman, & Gilboa-Schechtman, 2009). The person then can input corrective information, thus helping them see the event differently. Some of the erroneous cognitions frequently found with PTSD patients include the world is unpredictably dangerous. They may think people are untrustworthy and cannot be trusted, no place is safe, They can’t go anywhere and feel safe, and threats can come at any time, so they need to be ready to respond (PsychArmor Institute, n.d). Other erroneous thoughts may include that they are incompetent at the time of the trauma and, in the present time, could have should have done something different. They may think this could have been prevented; other people can get over it, so why not them (PsychArmor Institute, n.d). The purpose of exposure therapy is to help clients do things to get back on the recovery trajectory. Healing can occur by activating the client’s trauma memory and incorporating corrective information so that the clients can begin to see themselves, the world, and that trauma in a different way (PsychArmor Institute, n.d).

Christian worldview.

All people have a worldview that they hold to that allows them to conceptualize experience that makes sense to them and enables them to function. Traumatic experiences may tear down their worldview and alter one’s fundamental assumptions in life, including that they live in a just, logical, and benevolent world, thus forcing them to gravel with the unfairness of life. Harris, Currier, and Park (2013) describe a concept called global meaning that consists of one’s fundamental beliefs about the self, world, other people, and possibly a Higher Power that forms the foundation for understanding one’s life experiences. Traumatic experiences may challenge one’s global meaning and disrupt their beliefs of trying to make sense or construct meaning out of the experience (Harris, Currier, and Park, 2013). The age-old question of why bad things happen to good people and how could an allknowing, all-powerful, and all-loving God allow suffering to happen? Charles Templeton was a major religious figure in the United States that spoke to crowds of thousands about faith in Christ. However, he began to question and ultimately lose his faith in part, when confronted with good and evil with the horrors of the holocaust (Templeton, 1999). Many people followed Jesus when it benefited them, but when he went to the cross, everyone abandoned or betrayed him. Experiencing trauma can alter a person’s perception of his or her global system and cause psychological distress and bring one to a spiritual crisis left to question one’s faith and meaning (Harris, Currier, and Park, 2013). Trauma is part of life, and at some point, most people will endure some traumatic event. It is not the traumatic event that causes a person to have PTSD symptoms, but rather what meaning that person attributes to his or her traumatic experience. When someone is going through a difficult time, it is easy to share uplifting scriptural messages with them, to urge them to trust in God, to keep the faith, and to know God is always with them. Though these are all Biblical truths, they may not be appropriate for where the person is spiritually. Job lost his riches, his children, even to the point of losing his physical health (Job 1). His friends first came and sat with him, but then slowly, one by one began to accuse him of somehow causing his pain and suffering (Job 8-22). How does a person reconcile pain, suffering, and trauma? The whole message of Christ was that he went to the cross to pay the penalty of our sins and reconcile us back to his father through his shed blood provided us eternal life (Romans 5). The apostles were able to take the gospel to many parts of the known world, but most suffered traumatic deaths. Recently there was a woman that posted how sad and depressed she was on Facebook, and most people responded with an uplifting scripture that urged her to trust in God and be filled with his love; some even questioned where her faith was. The reaction of others only caused her to feel more broken and depressed. This writer asked her why she felt that way. She began to disclose how, as a child, she had been sexually abused for years and was struggling in her marriage relationship. This writer encouraged her to find a female Christian therapist that could walk with her through the path of healing through her traumatic memory. She needed help to understand and bring meaning to her experience. Scripture and good intentions of others were not going to help her until she was able to face her past and work through her thoughts and feelings connected to it.