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Examining interventions for post traumatic stress disorder nursing essay

Initial Screening Several brief tools have been developed to screen for exposure to a Criterion A traumatic event, which allows for rapid identification of persons at-risk for PTSD.

Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment

These screening tools are especially relevant to busy settings that necessitate that a large amount of data be collected in a short period of time, such as primary care clinics [ 20 ]. Although there is no gold-standard trauma-exposure screener [ 19 ], several options with growing support in the literature exist [ 2122 ]. Questionnaires such as the Trauma Assessment of Adults [ 21 ], the Brief Trauma Questionnaire [ 23 ], the Life Events Checklist [ 24 ], and the Trauma Life Events Questionnaire [ 22 ] all have psychometric support for evaluating exposure to potentiality traumatic events.

In addition to trauma exposure screeners, abbreviated PTSD symptom screeners are frequently used to determine the need for more in depth clinical interviews. Diagnosis After initial screening, more advanced assessment procedures should be conducted to establish clinical diagnosis of PTSD based on the DSM-5 diagnostic criteria. In general, these diagnostic assessments can take up to several hours to complete and require significant training to administer.

Symptom Severity and Treatment Tracking Once a PTSD diagnosis has been established, symptom frequency and severity are the next essential components to treatment planning and monitoring. A number of measures have been developed for monitoring PTSD symptoms.

These measures are generally brief, self-report assessments of the 20 symptoms associated with PTSD. These provide quick feedback regarding symptom severity and include cutoff scores to inform diagnostic status [ 192933 ].

Separate trauma-specific versions of symptom severity measures have also been developed e. Evidence-Based Treatments Is PTSD primarily a biological or psychological phenomenon, and relatedly, are psychosocial or pharmacological treatments more appropriate?

This question sets up a false dichotomy, as PTSD is rooted in both biological and psychological factors with regard to onset of symptoms, development of PTSD diagnosis, and maintenance of the disorder.

Studies demonstrate that biological differences [ 36 ] and psychosocial differences [ 1437 ] contribute to the risk for developing PTSD. Experimental research additionally provides evidence that both biological and psychological interventions delivered relatively soon after trauma exposure have the potential to mitigate or even prevent in the case of psychotherapy for Acute Stress Disorder the development of PTSD [ 3839 ].

Furthermore, across several controlled clinical trials, both pharmacological [ 40 ] and psychological [ 41 ] interventions have been shown to significantly reduce PTSD symptoms. Altogether, the extant literature provides a strong case that PTSD is rooted in both biological and psychological underpinnings.

The more pressing question, then, is which intervention pathway provides the most potent and persistent symptom reduction, and for which patients?

The following section reviews evidence-based psychological and pharmacological treatments. Exposure-based interventions are the most empirically supported treatment modalities for PTSD [ 4142 ]. The early roots of exposure-based therapies rest in the development of behaviorism in the 1920s, when Pavlov [ 42 ] demonstrated that fear could be both conditioned and extinguished through learning examining interventions for post traumatic stress disorder nursing essay.

For example, repeatedly pairing the presentation of a tone with an uncomfortable shock eventually led to an automatic fear response to the tone even in the absence of a shock.

Furthermore, repeatedly playing the same feared tone without the shock eventually reduced or extinguished the fear response to the tone. Exposure-based behavioral therapies for PTSD are rooted in these same straightforward principles. The therapist helps the patient to systematically approach, instead of avoid, safe but feared stimuli e. Though this basic principle is common to all exposure-based therapies across anxiety disorders, the necessity of defining the therapy provided in the context of clinical trials led to the development of specific, session-by-session exposure therapy protocols for the treatment for PTSD.

PE is an 8-to-15-session protocol, typically provided in weekly or bi-weekly, 60-to-90 minute sessions [ 4344 ]. In the beginning of PE, patients are taught a brief relaxation breathing exercise, and they receive psycho-education about PTSD symptoms and factors that contribute to the maintenance of PTSD e. Over the next several sessions, the patient revisits and describes the trauma memory aloud for a prolonged time e.

This is called imaginal exposure. In addition, the patient is taught to approach safe, trauma-related situations that have been avoided because they remind the patient of the trauma. This is called in vivo exposure. Notably, researchers have found that dropout can be higher in community settings [ 4647 ] although dropout rates do not differ between exposure and non-exposure therapies for PTSD [ 47 ].

A meta-analysis pooled across 13 studies found large effect sizes of PE relative to control groups at post-treatment, and medium to examining interventions for post traumatic stress disorder nursing essay effects at follow up time points [ 41 ].

Evidence also suggests that PE can produce further symptom reduction among patients with only partial response to pharmacotherapy [ 48 ].

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  • Furthermore, across several controlled clinical trials, both pharmacological [ 40 ] and psychological [ 41 ] interventions have been shown to significantly reduce PTSD symptoms;
  • Separate trauma-specific versions of symptom severity measures have also been developed e.

Cognitive-Based Therapies Over time, the field of psychotherapy has expanded to include cognitive-based treatment techniques in addition to exposure-based techniques. Though PE is categorized as a cognitive-behavioral therapy, and its exposure-based protocol does produce changes in negative thinking patterns associated with PTSD [ 49 ], the intervention strategies themselves are primarily behavioral rather than cognitive.

Cognitive Processing Therapy CPT; [ 5051 ] on the other hand, relies more heavily on interventions that directly target maladaptive thinking patterns. CPT, alongside other cognitive-based therapies for PTSD, emphasizes the role that maladaptive or inaccurate interpretation of a situation plays in maintaining disorders such as PTSD, and intervenes directly with the thoughts rather than the resulting behaviors.

This is read aloud and discussed with examining interventions for post traumatic stress disorder nursing essay therapist. The therapist begins to gently question any potential maladaptive thinking patterns, thereby helping the patient discover over-generalized or unhelpful automatic thoughts. Over time, the therapist works with the patient to develop strategies for generating more useful or accurate thinking patterns.

In the standard CPT protocol, the patient additionally writes one to two detailed accounts of the trauma and reads this account aloud in session. At the end of treatment, the patient re-writes the impact statement, which is used to evaluate treatment gains.

The 12-session CPT protocol can be disseminated effectively in either a group or individual format [ 51 ]. Numerous trials have found CPT to be superior to a wait-list control group [ 535556 ] and one study has demonstrated its equivalence to PE [ 55 ]. One dismantling study suggests that CPT may be equally efficacious with and without the written account of the trauma [ 57 ]. Subsequent analyses of this data qualified these results, demonstrating that those with higher levels of dissociation especially depersonalization responded best to the full protocol, and those with lower dissociation responded more rapidly to CPT without the trauma account [ 58 ].

Of note, other cognitive therapy protocols [ 59606162 ] or combined exposure and cognitive therapy protocols [ 6364 ] have shown promising results [ 41 ].

Eye Movement Desensitization and Reprocessing. EMDR hypothesizes that the trauma memory, if not fully processed, examining interventions for post traumatic stress disorder nursing essay stored in its initial state, preserving any misperceptions or distorted thinking patterns that occurred at the time of the trauma.

At the outset of EMDR, patients are trained in strategies for managing negative emotions. During the reprocessing phase, the therapist asks the patient to bring to mind a vivid visual representation of the traumatic memory, along with the distorted belief i. The patient visualizes the memory while continuing to engage in the bilateral stimulation.

The patient is asked what experiences emerge next e. The patient later practices thinking the desired thought e. The bilateral eye movements in EMDR are somewhat controversial. In support of the use of this strategy, van den Hout and colleagues [ 67 ] found that bilateral eye movements during autobiographical memory recall reduce vividness and emotions attached to the memory though their research was conducted in healthy controls rather than in PTSD patients.

Developers of EMDR hypothesize that bilateral eye movements therefore reduce distress attached to the trauma memory, thereby reducing avoidance, and allowing for increased attention to more adaptive thinking patterns that are then attached to the traumatic memory [ 65 ]. A recent meta-analysis further supports that bilateral stimulation eye movements are not the only potential form of bilateral stimulation used in EMDR impacts memory in ways that might facilitate PTSD treatment [ 68 ].

Other researchers have hypothesized, however, that the exposure-based components of EMDR are all that is required, and a review of dismantling studies has demonstrated that the EMDR protocol works just as well without the bilateral stimulation component [ 69 ]. Regardless of the validity of its theoretical underpinnings, EMDR has empirical support in that it consistently outperforms no-treatment controls and demonstrates similar outcomes to exposure- and cognitive-based psychotherapies for PTSD [ 4170 ].

Relaxation-Based Psychotherapies Although less frequently studied and supported in the more recent literature, relaxation-based psychotherapies are another type of psychotherapy for PTSD.

Relaxation skills are trained and practiced in sessions using techniques such as behavioral rehearsal and imagery, modeling, and role-play. Evidence-Based Pharmacological Treatments Although psychotherapeutic interventions are the first and most supported option for the treatment of PTSD, there are several evidence-based pharmacological treatments available.

In contrast to psychological interventions, pharmacotherapies can be provided in most clinical settings and require much less time and effort on the part of the patient e.

The foundation of pharmacological treatments is supported by a growing literature for the association between PTSD and dysregulations in neurotransmitter and neuroendocrine systems [ 77787980 ].


For the purposes of this review, we have focused on the current medication options with the most evidence, and therefore omitted older e. SSRIs have a broad effect on PTSD symptoms, including improvements in re-experiencing, avoidance, numbing, and hyper-arousal symptoms, and related quality of life improvements associated with the symptom reductions [ 81 ].

Other agents, such as fluvoxamine and citalopram, also have received support for the treatment of PTSD [ 8687 ]. Interestingly, paroxetine also has been shown to potentially address cognitive deficits associated with PTSD, in addition to the clinical symptoms [ 88 ]. Longer trials of SSRIs 36 weeks have been associated with a higher percentage of treatment response compared to the standard 12-week trials [ 89 ].

Unfortunately, independent of the duration of the trial, the discontinuation of SSRIs is associated with the relapse of PTSD symptoms [ 818390 ]. In contrast, symptoms typically remain stable or continue to improve after completion of evidence-based psychotherapy for PTSD [ 91 ].

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Two common examples are trazadone, an antidepressant serotonergic agent with a sedating side effect, and prazosin, an antiadrenergic agent that has been studied in the treatment of sleep and nightmares in PTSD. Prazosin has received increased attention as of late after randomized clinical trials demonstrating its effectiveness for PTSD-related sleep disruptions and nightmares, as well as global functioning and PTSD symptoms [ 92 ].

While pharmacological treatments have shown some promise, more investigation and advancement in this area is needed. One of the most important concerns with the sole use of pharmacotherapy for PTSD treatment is the evidence that discontinuing treatment can be associated with relapse [ 818390 ]. Although relapse is relatively infrequent after one responds to an evidence-based psychotherapy for PTSD [ 91 ], a proportion of patients either drop out of therapy prematurely or do not respond to therapy [ 464754 ].

It is therefore critical to continue to investigate new strategies to improve upon the available treatments for PTSD. One novel line of research has investigated the potential to enhance mechanisms of learning during cognitive behavioral therapies such as those used for PTSD by administering medications that could facilitate fear extinction, for example, d-cycloserine, yohimbine, methylene blue, MDMA, and oxytocin [ 9394 ].

However, pharmacological augmentation of learning mechanisms is still in its infancy and will require much further exploration before these strategies can be recommended as standard treatment techniques for PTSD. Another line of cutting edge research involves priming the trauma memory through a reminder, and then preventing reconsolidation of the primed memory through pharmacological blockade [ 95 ].

1. Introduction

Although some evidence suggests that this technique reduces emotional reactivity to the trauma memory [ 95 ], findings in this newer area of research are very preliminary and somewhat conflicted [ 39 ]. Innovative treatments outside the realms of psychotherapy and pharmacotherapy, such as neuronal feedback and brain stimulation techniques [ 96 ], are also being explored and may help reduce PTSD symptoms, particularly in treatment-resistant patients.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of NIDA, Department of Veterans Affairs, or the United States government. Conflicts of Interest There are no conflicts of interest to disclose. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. A review of acute stress disorder in DSM-5.

Prediction of posttraumatic stress disorder by immediate reactions to trauma: A prospective study in road traffic accident victims. A prospective examination of post-traumatic stress disorder in rape victims.

Post-traumatic stress in survivors of an airplane crash-landing: A clinical and exploratory research intervention. Prediction of remission of acute posttraumatic stress disorder in motor vehicle accident victims. Intentional and non-intentional traumatic events. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.

Predictors of posttraumatic stress disorder and symptoms in adults: