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Relationship status: in longterm same-sex relationship with Anne Family: parents and her four siblings (two of these are step-siblings), who all live interstate

Presenting issue(s):

  1. Anger at others – Finding it hard to understand. People (other than Anne) would not generally know she is feeling angry, but it is distressing her to feel this way so often.
  2. Worries she is overly-concerned with what others think, holds back expressing opinions especially when they might mean disagreeing with others, then feels annoyed at herself later for doing this. Sam says she ‘lacks confidence’, and gives as an example that she feels ‘stuck’ in a job she can perform easily but doesn’t push herself to find something else.
  3. Sexual abuse by older step-brother James over several years, she has gradually disclosed this to mother and biological sisters, but not to step-sister Jade. Jade is getting married in 3 months and Sam will have to see James for the first time in many years. She is very distressed by the thought of this, and is feeling guilty at not having offered any help to Jade with her wedding, as she can’t bear the thought of being around the family (mainly James) any longer than she has to.

Sam's presenting issues

Psychological trauma has been common and if it persists, it results into a PTSD. PTSD should therefore be prevented to minimize the effects of individual and societal suffering. The cause of PTSD is defined by a specific event that originates from a particular time and a specific place. This means that the people exposed to psychological trauma can be picked and preventive measures can be availed to them after being victims.

            Despite calls that early interventions are less influential in preventing PTSD, or can lead to more harm, they are widely employed to date. Employing this approach shows that uncertainty and controversy is still common in the sector even though a good number of people still apply these interventions with the hope of assisting an individual overcome traumatic state.

            This study aims at reviewing the evidence both on the general and comparative impacts and risk of using early interventions to treat PSTD in individuals under psychological traumatic experiences. This report will further consider a case study of Sam, who has been sexually abused since she was a lid until she recently opened up about the matter at the age of 21 (Koenig, Boucher, Oliver, Youssef, Mooney, Currier, Pearce, 2017

Counseling

            Most individuals have undergone a psychological traumatic experience of some type. Following a traumatic experience, it can get difficult to understand what to do for other persons, daily events can even be un-understandable and one may find it difficult to live a normal life. Seeking professional assistance from a counselor is vital in overcoming such situations:

  • Take part in social events – by getting involved in activities Sam enjoys, she will be reminded of who she is and she will be reconnect to real life
  • Come up with a daily routine to follow – Sam should maintain a routine after experiencing trauma to keep her grounded and will make her feel less like a victim.
  • Acknowledge the events she underwent as they are – Sam should be encouraged to acknowledge the experiences she underwent and address them accordingly because memories of her being abused can arise at any time. This will assist her recover from her past
  • Volunteer to help other individuals – many victims feel helpless after traumatic experience, one form of dealing with this is by offering volunteer services. Sam will be able to move on and be reminded of her strengths.
  • Don’t get isolated – it can be simple to be anti-social after a trauma, but building relationship with other people can be help Sam heal from her past. She should maintain a strong support system around her friends, family or support groups.
  • Sam should also seek for help – other individuals often find it difficult to ask for help after being in a traumatic experience. She should find when she is not coping with imperative since it assists her to move forward.
  • She should avoid drugs and alcohol – sometimes it is tempting to forget all the matter with the use of alcohol and drugs, but such events can cause a self-destructive behavior and won’t assist her to recover.
  • She should be involved in relaxation activities – Sam should try reducing her stress and ease tension with counseling, yoga, massage therapy and deep breathing since it assists in calming down and rationalizing her thoughts.

While other people can choose to be resilient in traumatic experiences, many may also become overwhelmed. For the situation of Sam, resilience became her option over many years that let to negative impacts leading to hate over male gender. However, counseling sessions should have been offered to Sam at an early stage to avoid the long term effects that she now exposes (Shamia, Thabet, Vostanis, 2015).

            Stress hormones emitted during a traumatic experience such as for the case of Sam have also shown an capability of causing a PTSD. This is because stress hormones can lead to consolidation of memory and studies also shows that high levels of adrenaline and cortical can affect normal memories. Sam might have tried to make sense of her being mistreated by her step-brother but had a hard time incorporating it to her schema. With time, disintegration is exhibited as symptoms of PTSD.

Treatment of Goals

            Creating a perfect treatment plan should be based on collecting appropriate information on the situation. To achieve this, effective steps should be made as for the case of Sam, so as to assist in providing the right picture she went through. An individual conducting this process should be a good listener and at the same time understanding the difficulties Sam underwent. This can involve issues such as:

  • Interpersonal conflicts
  • Issues related to Sam’s family of origin
  • Current and past emotional aspects of Sam
  • Sam’s self-esteem
  • Cultural aspects
  • Current and past social networks of Sam

To be successful in collecting the right data about Sam’s situation, integrating various sources of data is vital such as physical interview, clinical exam, collecting her social history, psychological interview and contacting her vital others such as school or even home is important.

The importance of early interventions

            However, there are five primary steps that should be conducted to achieve full treatment of goals in this case. These steps include:

  • Problem selection and determination
  • Long term goals
  • Short term goals development
  • Diagnosis

Long-Term Goals

            This approach needs an effective solution that aims at solving Sam’s situation in the long run. They must be stipulated in non-measurable conditions by describing the objective at the end of the treatment. The right goals for Sam include:

  • Identifying the problem of her being sexually abused with an appropriate ability for intimacy in her social life
  • Begin healing process giving a new interest of a perfect sexual contact
  • Understanding and controlling feelings when dealing with the sexual abuse of Sam is also important
  • Sam should be taught to recognize and accept the situation by avoiding sexualization of relationships
  • The sexual abuse should also be defined if it actually occurred
  • Finally, Sam should be taken as a survivor rather than a victim of sexual abuse

Short-Term Goals

            The short term goals that will be employed in treating Sam, should have a structure. This helps in case short term goals are not achieved, new strategies are put in place to intervene the situation. Strategies planned should be based on Sam’s needs and her presenting issue. Examples of short term goals and its strategies include:

  • Intensifying the number of open talks with Sam about her feelings and acceptance of the sexual abuse. She should be taken through several talks to enable her open up without feeling ashamed by reminding her that she had no role in the abuse but she was just exposed and she managed to survive the ordeal.
  • Encourage Sam to disengage herself with shame and let her admit she had not responsibility in the situation. Sam should be assisted to identify, express and process all the guilt connected to her emotional satisfaction, responsibility, physical pleasure linked to her situation. Sam should then be empowered to be able heal from her issues and let the situation be her testimony.

Psychological Interventions

            Psychological interventions that has been developed to prevent PTSD experience and includes psychological first aid (PFA); cognitive restructuring therapy; psychological debriefing interventions; trauma-focused cognitive-behavioral therapy (CBT); exposure-based therapy; psycho education; coping skills therapy; eye movement desensitization and reprocessing; and normalization. These therapies are helpful in preventing the development of PTSD and development of trauma related issues after a traumatic experience (Cook, Spinazzola, Ford, Lanktree, Blaustein, Cloitre, DeRosa, Hubbard, Kagan, Liautaud, Mallah, 2017). 

             Post-traumatic stress disorder (PTSD) should be addressed at an early stage since it causes distress and leads to a disabling condition that becomes hard to recover from. To control this disorder from affecting an individual, early and effective treatment should be done to minimize the occurrence of PTSD. The case of Sam is of no difference; therefore this process might have been beneficial to her to reduce the effects of trauma. The second phase involves the amelioration of the influence of PTSD after evaluating the rates of post-incidence prevalence of PTSD.

First Session

Psychological Debriefing, Critical Incident Stress Debriefing and Critical Incident Stress Management

            This is the best first approach for identifying and coming up with early interventions for stress related issues since it seeks to educate victims about the common response to trauma and assist them to share the experiences they have gone through. Provided that the prevalence of initial distress after going through a disastrous event such as for the case of Sam is greater than that of PTSD, the potential provides interventions to individuals with issues that remit impetuously. Early interventions for Sam should have involved confronting approaches of distressing process. Debriefing and critical incident stress debriefing (CISD) should have been applied as early intervention for Sam. This session assists in addressing the immediate psychological aftermath of such trauma.

CISD can be stated as a meeting of those affected by traumatic event such as for Sam that focus to minimize the effects of the situation by enhancing support and encouraging processing the experience of the abuses she had been exposed to. Critical incident stress management (CISM) is also another approach that Sam should have been taken through since it involves a stand-alone debriefing engagement that provide various components such as pre-trauma training, a follow-up and case management.

Counseling as a solution

Both approaches above should have been employed to speed the recovery process before Sam was exposed to harmful stress response that can affect the performance of Sam. However, these approaches do not guarantee to deliver early interventions or even cut the effects of PTSD. A single session has also been dubbed to be fruitless at times or even cause more harm to those debriefed (Currier, Holland, Drescher, 2015).

Second Session

PFA is a systematic set of assisting approach focused on minimizing the initial post-trauma distress and enhancing short and long term adaptive functioning. PFA is developed as an initial process of comprehensive disaster and it is designed around eight core actions. These are:

  • Stabilization
  • Information gathering
  • Contact and engagement
  • Information
  • Safety and comfort
  • Practical assistance
  • Connection with social supports
  • Information on coping support
  • Linkage with collaborative

PFA concept enhanced and its use needs assessment and clinical approach provides the complexity of presentations, need, variability of context, and logical constraints. PFA is usually applied by counselors and mental health responders. Two key advantages of PFA is its portability and can be offered in any place. This approach fits Sam since it can be delivered at her home. However, Sam was collaborative in this session since she was able to open up. Therefore, her response was positive that led to the next session (Burgdorf, Kroes, Zhang, Gross, Schmidt, Weiss, Disterhoft, Burch, Stanton, Moskal, 2015).

Third Session

            CBT is another important session that should have been employed to help Sam heal from her traumatic experience. This principle involves learning and conditioning to heal disorders and it applies components from cognitive and behavioral therapy. This approach could have help Sam in cognitive restructuring, exposure, and several coping experiences that can also be combined together to bring out the best results. Sam should have been needed to attend a weekly session that goes for 60-90 minutes either as individual or as a group (Meichenbaum, 2017)..

            Exposure-based therapy use confrontation with agitating stimuli and is applied regularly until anxiety is minimized. The exposure is used according to mental imagery from memory or employed series provided by therapist. For Sam, this session is vital for doing away with emotional response to traumatic stimuli. Sam will therefore be able to reduce the effects caused by avoidance of feared situations. This is always offered between 8-12 sessions taking 60-90 minutes (Hoge, Grossman, Auchterlonie, Riviere, Milliken, Wilk, 2014).

Fourth Session

            Furthermore, cognitive restructuring session should have been used to interpret the behavior of Sam. This theory assists in restudying thoughts and beliefs originating from a traumatic event and enhances awareness of dysfunctional trauma-related thoughts. It will then aim at rectifying those thoughts with relevant rational cognitions. This stage was not simple for Sam. Understanding her took more time than expected. However, at the end of the session, her thoughts and beliefs had been clear after employing appropriate rational cognitions. (Cohen, Mannarino, Deblinger, 2016).  

Fifth Session

In addition, coping skills therapy should be employed to help Sam overcome her traumatic experience since it involves training, biofeedback and stress inoculation therapy that aims at relaxing the mind of a victim. Sam should have been taken through several processes that involves muscle relaxation training, education, role playing and even breathing retraining. All these techniques are designed to manage anxiety. Coping skills are increased through this approach for the current situations reported. Taking Sam through this stage was easy. She was able to complete all the trainings successfully hence her relaxed mind at the moment. (Briere, Scott, 2014).

Creating a treatment plan

Sixth Session

EMDR incorporates imaginal exposure with concurrent induction of saccadic eye movements that are stipulated to assist in reprogramming brain work so that emotional effects of trauma can be addressed. Sam could have been guided to imagine a traumatic event, involve in negative cognition, and then express a conflicting positive cognition. Clinician will ask Sam to think of a memory while the clinician aims at the swift movement of the clinician’s fingers. After making over 10 movements back and forth, the clinician question Sam to give a rating of the memory and her belief in positive cognition. Even though earlier versions of EMDR were conducted in1 to 3 sessions, the latest standards takes place for 8 to 12 weekly sessions with 90 minutes each. The response from Sam was positive. Even though she had a hard time focusing at the beginning, she completed this session with a positive cognition (Briere, Scott, 2014).

            There are three phases of treating trauma that involves safety, process and examining.

Seek Safety

            This first step will seek to address traumatic conditions is to create safety on different levels. Sam should find a place to ground herself and feel safe from harm. She should then find a method to nurture herself. She should look for people in her life that can give her support, love, understanding and care. Family and friends should be the closest people to help Sam recover from her state. Furthermore there are organizations that can also assist, support and serve her also (Schimmenti, Passanisi, Caretti, Marca, Granieri, Iacolino, Gervasi, Maganuco, Billieux, 2017).

Process

            After feeling grounded, contained and safe, Sam should start to process the stages of experience that are still with her. She should look at her body and pick an appropriate movement that will assist her to relate better with herself and her feelings. A good therapist or group should be consulted so that Sam can open up and be honest. And as she will keep on with the process she will come up with coping skills and strengths based on safety and containments she will develop.

Examine

            After process approach is complete, life should move on. The aim is to keep in mind the traumatic experience that Sam went through but respond to emotional charge she has in the present. She can decide to reflect on any lesson learnt from such experience. What insights have she developed? She can even decide to make herself a note of the positive things she have learned (Treanor, Brown, Rissman, Craske, 2017). 

Conclusion

            There are several reasons why early interventions can be less influential:

  • PTSD involves a difficult etiology
  • It is hard to find which individual is exposed to continuous issues.
  • Early responses to trauma always shift and applies both normal and abnormal behavior
  • Dealing with disastrous events in early stage is also complex.
  • The contribution provided by early intervention is always unnoticeable.

The most effective sessions of CBT are those that takes weeks after trauma. In most cases, if the victim cannot tolerate CBT, the best option is to apply supportive counselling since it offers lower intensity of some components of brief CBT

            In early stages, effective treatment should be applied to symptomatic survivors. The following process should be followed in response to traumatic events:

  1. Avail concrete help, shelter and even food.
  2. The next stage involves soothing to reduce extreme emotion and improve controllability.
  3. Help survivors in painful and repetitive traumatic experiences.
  4. Treating particular syndromes.

Long-term and short-term goals

References

Mueser, K.T., Penn, D.L., Addington, J., Brunette, M.F., Gingerich, S., Glynn, S.M., Lynde, D.W., Gottlieb, J.D., Meyer-Kalos, P., McGurk, S.R. and Cather, C., 2015. The NAVIGATE program for first-episode psychosis: rationale, overview, and description of psychosocial components. Psychiatric Services, 66(7), pp.680-690.

Koenig, H.G., Boucher, N.A., Oliver, R.J.P., Youssef, N., Mooney, S.R., Currier, J.M. and Pearce, M., 2017. Rationale for spiritually oriented cognitive processing therapy for moral injury in active duty military and veterans with posttraumatic stress disorder. The Journal of nervous and mental disease, 205(2), pp.147-153.

Shamia, N.A., Thabet, A.A.M. and Vostanis, P., 2015. Exposure to war traumatic experiences, post?traumatic stress disorder and post?traumatic growth among nurses in Gaza. Journal of psychiatric and mental health nursing, 22(10), pp.749-755.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., DeRosa, R., Hubbard, R., Kagan, R., Liautaud, J. and Mallah, K., 2017. Complex trauma in children and adolescents. Psychiatric annals, 35(5), pp.390-398.

Currier, J.M., Holland, J.M. and Drescher, K.D., 2015. Spirituality factors in the prediction of outcomes of PTSD treatment for US military veterans. Journal of Traumatic Stress, 28(1), pp.57-64.

 Burgdorf, J., Kroes, R.A., Zhang, X.L., Gross, A.L., Schmidt, M., Weiss, C., Disterhoft, J.F., Burch, R.M., Stanton, P.K. and Moskal, J.R., 2015. Rapastinel (GLYX-13) has therapeutic potential for the treatment of post-traumatic stress disorder: characterization of a NMDA receptor-mediated metaplasticity process in the medial prefrontal cortex of rats. Behavioural brain research, 294, pp.177-185.

Hoge, C.W., Grossman, S.H., Auchterlonie, J.L., Riviere, L.A., Milliken, C.S. and Wilk, J.E., 2014. PTSD treatment for soldiers after combat deployment: low utilization of mental health care and reasons for dropout. Psychiatric Services, 65(8), pp.997-1004. Mott, J.M., Stanley, M.A., Street Jr, R.L., Grady, R.H. and Teng, E.J., 2014. Increasing engagement in evidence-based PTSD treatment through shared decision-making: A pilot study. Military Medicine, 179(2), pp.143-149.

Sloan, D.M., Unger, W. and Beck, J.G., 2016. Cognitive-behavioral group treatment for veterans diagnosed with PTSD: Design of a hybrid efficacy-effectiveness clinical trial. Contemporary clinical trials, 47, pp.123-130.

Meichenbaum, D., 2017. Stress Inoculation Training: A preventative and treatment approach. In The Evolution of Cognitive Behavior Therapy (pp. 117-140). Routledge.

Kinniburgh, K.J., Blaustein, M., Spinazzola, J. and Van der Kolk, B.A., 2017. Attachment, Self-Regulation, and Competency: A comprehensive intervention framework for children with complex trauma. Psychiatric annals, 35(5), pp.424-430.

Cohen, J.A., Mannarino, A.P. and Deblinger, E., 2016. Treating trauma and traumatic grief in children and adolescents. Guilford Publications.

Schiff, M., Nacasch, N., Levit, S., Katz, N. and Foa, E.B., 2015. Prolonged exposure for treating PTSD among female methadone patients who were survivors of sexual abuse in Israel. Social work in health care, 54(8), pp.687-707.

Meichenbaum, D., 2017. Stress Inoculation Training: A preventative and treatment approach. In The Evolution of Cognitive Behavior Therapy (pp. 117-140). Routledge.

Briere, J.N. and Scott, C., 2014. Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (DSM-5 update). Sage Publications.

Schimmenti, A., Passanisi, A., Caretti, V., La Marca, L., Granieri, A., Iacolino, C., Gervasi, A.M., Maganuco, N.R. and Billieux, J., 2017. Traumatic experiences, alexithymia, and Internet addiction symptoms among late adolescents: A moderated mediation analysis. Addictive behaviors, 64, pp.314-320.

Treanor, M., Brown, L.A., Rissman, J. and Craske, M.G., 2017. Can memories of traumatic experiences or addiction be erased or modified? A critical review of research on the disruption of memory reconsolidation and its applications. Perspectives on Psychological Science, 12(2), pp.290-305.

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