Treatment Of Post-Traumatic Stress Disorder

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Treatment Of Post-Traumatic Stress Disorder

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Questions:
1.Compare post-traumatic stress disorders and adjustment disorders in terms of their clinical descriptions.

2.Discuss current research in the prevention and treatment of post-traumatic stress disorder.

Answers:

Introduction:
This paper provides an insight into clinical symptoms in patients suffering from post traumatic stress disorder and adjustment disorder and main clinical differences in both the condition. It also provides a detailed discussion on current research in the prevention and treatment of PTSD. The paper also develops arguments related to the effectiveness and utility of different interventions for PTSD.
1.Post-traumatic stress disorder (PTSD) is a kind of emotional disorder occurring in an individual after experiencing sudden trauma such as assault, natural disaster or sudden deaths of loves one (Barlow & Durand, 2015). According DSM-5 criteria for mental illness, for people to be diagnosed with PTSD, they must have a history of exposure to the traumatic event and symptoms like changes in cognition and mood, nightmares or flashback of event, trauma related thoughts and arousals like aggression, risky behavior and difficulty in sleeping (Friedman, 2014). Adjustment disorder is also a trauma or stress related disorder associated with abnormal reaction to life stressors in affected individuals. The main clinical symptoms of adjustment disorder include depressed mood, agitation, anxiety, withdrawal and poor social or work performance (Glaesmer et al., 2015). The main clinical difference between PTSD and adjustment disorder is that PTSD is a more severe form of disorder with long lasting symptoms. However, adjustment disorder is a disease of short duration. Hence, adjustment disorder can be regarded as a short term condition, where people fail to cope with major life changes and the symptoms are temporary, whereas PTSD is a long term and life threatening condition. The difference in severity of both disease is also understood from the fact that PTSD has been defined a specific mental disorder as per DSM-V criteria, but no such criteria exist for adjustment disorder.
2.PTSD is a several psychological disorder seen in people after a traumatic events leading to symptoms of avoidance, emotional numbing and hyperarousal. There are various challenges associated with treatment of PTSD in different individuals due to their individual life circumstances and differences in occurrence of symptoms overtime (Abdelghaffar et al., 2016). Hence, evaluating the current research on prevention and treatment of PTSD is essential to determines interventions which are most effective in promoting recovery of PTSD patient.
The review of current research has given insight about different preventive and treatment options to minimize disabling consequence in patients after traumatic events. Qi, Gevonden & Shalev,(2016) informed about interventions like cognitive behavioral therapy (CBT) to treat patient. The main purpose of CBT is to minimize symptoms by challenging patient’s beliefs about trauma and provide sense of control to patient to safely deal with trauma-related reminders. CBT is given to patient either individually or as group. However, the researcher argued that moderately positive outcomes have been found in patient and effectiveness of the intervention is found to be consistent in research studies. Rothbaume et al. (2012) showed that efficacy of CBT as an early intervention for patient is dependent on the type of traumatic events an individual has been exposed. Hence, according to this argument, studies investigating about CBT in people with different types of trauma are needed to understand its benefits as an early intervention for PTSD patient.
Kar, (2011) was found to most suitable research that reviewed the effectiveness of CBT for treating PTSD people with different types of trauma. In case of effectiveness of CBT for PTSD patients exposed to terrorism and war related trauma, it was found that CBT acted as a promising intervention for patients as the implementation of therapy improved social functioning of patients and reduced symptoms of PTSD. CBT was also found as an effective intervention for people with sexual assault and accident related trauma. However, there is limited evidence regarding effectiveness in refugee patients. Hence, from this evidence, it can be confirmed that CBT is an efficacious intervention to lower PTSD score in patients with different types of trauma events. Acute stress disorder is regarded as a precursor of PTSD, however reduction in number of patients meeting the criteria for PTSD after five session of CBT compared to those receiving counseling also suggest the effectiveness of CBT as a preventive method for CBT (Nixon Sterk, & Pearce, 2012).. To maximize the effectiveness of the intervention, there is a need to address methodological challenges like culture issues in implementing interventions, training needs of therapist and proper integration of CBT with internet (Kar, 2011). These considerations will further enhance the value of CBT for at-risk individuals.

Exposure therapy is also one of the behavioral therapy to treat PTSD. It is also a based theory based therapy where therapists encourage patients to re-experience the traumatic event instead of avoiding it. Such kind of exposure is found to reduce trauma-induced psychological disturbance in patient. For example, it is very common for patients experiencing traumatic events to avoid talking about the trauma or visiting the place associated with trauma. However, exposure therapy aims to reduce symptoms of fear and avoidance in patients. It is one of the effective first line treatments for PTSD (Rauch et al., 2012). A study by King et al., (2016) investigating about the impact of mindfulness-based exposure therapy (MBET) has revealed that mindfulness based training in exposure therapy minimizes the issue of early drop-out rate and increases emotional regulation in patients with PTSD. The study was done in two participants group- one receiving mindfulness based therapy and the other receiving group therapy. The assessment of PTSD symptoms before and after the therapy showed increased activity in anterior cingulated cortex, dorsal medial prefrontal cortex and left amygdale. This indicates that MBET therapy is effective in changing the neural processing of socio-emotional threat related to the traumatic event. Although the sample size was small, however the study gave good evidence regarding the effectiveness of the therapy in symptoms reduction for PTSD patients.
CBT is a behavioral intervention to reduce adverse symptoms and improve functioning in patients with PTSD. Apart from behavioral intervention, many pharmacological interventions is also used for the prevention and treatment of PTSD. Hydrocortisone is one of the pharmacological agents involved in treating patients with PTSD. The review of research on the effectiveness of hydrocortisone has revealed that moderate quality of evidence for the efficacy of the drug in treating PTSD development in adults. There are other drugs like propranolol, morphine and benzodiapine for treating the disorder, however there is limited evidence to prove their true impact on patient outcome (Amos, Stein & Ipser, 2014). Many drugs have been reviewed for efficacy and acceptability among PTSD patient group. Although, robust evidence for efficacy has not been found, however phenelzine has emerged as a good drug of choice and more future trials needs to be done to use its for treating PTSD (Cipriani et al., 2017).
Current research also gave indication about eye movement desensitization and reprocessing (EMDR) as an intervention for patients with PTSD. It is a kind of psychotherapy in which utilizes eye movements to support clients in safely processing distressing memories and beliefs. It is a validated and efficient treatment approach to address psychological and physiological symptoms in patient with adverse life experience (Shapiro, 2014). Nijdam et al., (2012) used randomized controlled trial method to compare the efficacy of eclectic psychotherapy with EMDR for PTSD. The assessment of two patient group on outcome measures related to anxiety, depression and clinical PTSD symptoms showed both interventions to be effectiveness. However, the advantage of EMDR compared to other therapy was that good response rate was achieved. This proves that EMDR can promote faster recovery of patients suffering from PTSD.
Conclusion:
From the review of current research on PTSD, CBT is identified as good preventive options for treatment of PTSD at the early stage of risk. In addition, exposure therapy and EMDR have emerged as effective interventions both in terms of clinical outcome and response received from patients with PTSD.

References:
Abdelghaffar, W., Ouali, U., Jomli, R., Zgueb, Y., & Nacef, F. (2016). Post-traumatic stress disorder in first episode psychosis: Prevalence and related factors. Clinical Schizophrenia & related psychoses.
Amos, T., Stein, D. J., & Ipser, J. C. (2014). Pharmacological interventions for preventing post?traumatic stress disorder (PTSD). The Cochrane Library.
Barlow, D. H., & Durand, V. M. (2015). Abnormal psychology: An integrative approach (7th ed.). Stamford, CT: Cengage Learning.
Cipriani, A., Williams, T., Nikolakopoulou, A., Salanti, G., Chaimani, A., Ipser, J., … & Stein, D. J. (2017). Comparative efficacy and acceptability of pharmacological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychological medicine, 1-10.
Friedman, M.J., 2014. PTSD: national center for PTSD. PTSD History and Overview. Retreived from: https://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.asp
Glaesmer, H., Romppel, M., Brähler, E., Hinz, A., & Maercker, A. (2015). Adjustment disorder as proposed for ICD-11: Dimensionality and symptom differentiation. Psychiatry research, 229(3), 940-948.
Kar, N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatric Disease and Treatment, 7, 167.
King, A. P., Block, S. R., Sripada, R. K., Rauch, S. A., Porter, K. E., Favorite, T. K., … & Liberzon, I. (2016). A pilot study of mindfulness-based exposure therapy in OEF/OIF combat veterans with ptsd: altered medial frontal cortex and amygdala responses in social–emotional processing. Frontiers in psychiatry, 7, 154.
Nijdam, M. J., Gersons, B. P., Reitsma, J. B., de Jongh, A., & Olff, M. (2012). Brief eclectic psychotherapy v. eye movement desensitisation and reprocessing therapy for post-traumatic stress disorder: randomised controlled trial. The British Journal of Psychiatry, 200(3), 224-231.
Nixon, R. D. V., Sterk, J., & Pearce, A. (2012). A randomized trial of cognitive behaviour therapy and cognitive therapy for children with posttraumatic stress disorder following single-incident trauma. Journal of Abnormal Child Psychology, 40(3), 327-337.
Qi, W., Gevonden, M., & Shalev, A. (2016). Prevention of post-traumatic stress disorder after trauma: Current evidence and future directions. Current psychiatry reports, 18(2), 20.
Rauch, M., Sheila, A., Eftekhari, A., & Ruzek, J. I. (2012). Review of exposure therapy: A gold standard for PTSD treatment. Journal of Rehabilitation Research & Development, 49(5).
Rothbaum, B. O., Kearns, M. C., Price, M., Malcoun, E., Davis, M., Ressler, K. J., … & Houry, D. (2012). Early intervention may prevent the development of posttraumatic stress disorder: a randomized pilot civilian study with modified prolonged exposure. Biological Psychiatry, 72(11), 957-963.
Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18(1), 71.

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