autism research paper part 2
oreomocha12
ptsd_example_paper.pdf
PTSD 1
PTSD: To live or continue reliving?
Loyola Marymount University
Summer Session 1
Social, Emotional, and Behavioral Functioning EDSS 6379
06/23/2014
Lindsey Provencher
PTSD 2
Abstract
In the United States, the projected lifetime risk for posttraumatic stress disorder (PTSD) at age
75 is 8.7% (American Psychiatric Association, 2013, p. 276). Although people of all ages can
develop PTSD, adults who encounter the disorder often express more symptoms of hyperarousal,
avoidance, and emotional outbreaks as time progresses than young adults (American Psychiatric
Association, 2013, p. 276). Through the development of a literature review, this paper examines
the etiology and prevalence of PTSD in adult populations, particularly in the case of motor
vehicle accidents. Various treatment options will be analyzed, including cognitive therapy,
virtual reality exposure therapy, narrative reconstruction, and a guided self-help program.
Keywords: adults, posttraumatic stress disorder, motor vehicle accident (MVA)
PTSD 3
Vignette (Case Study)
One weekend, Mary, a middle-aged woman, and two of her closest friends decided to go
on a short trip. Although she had never driven it before, she borrowed her friend’s motor home
to provide a more cost effective vacationing experience. While Mary was driving the motor
home on a windy, mountainous road, she veered right to give herself more space to clear the
turn, but this maneuver caused her to accidentally crash into a motorcyclist traveling behind her.
She jumped out of the vehicle and tried to help him, but he was pinned underneath the motor
home. Due to excessive heat and dry climate, the vehicle then caught on fire and began a
brushfire. She stood helpless and horrified as the motorcyclist burned to death before her eyes.
Mary has no prior history of mental illness; however, it has been six months since the accident
and she still experiences terrifying flashbacks regularly and is frightened to even enter an
automobile.
Literature Review
According to statistics presented by the U.S. Department of Transportation,
approximately 32,850 people were killed in motor vehicle accidents in the year 2013. This is a
chilling statistic being that millions of people drive on the roads each day and in a split second, a
life altering collision may occur. Although small alterations may be implemented to increase
motor vehicle safety, no one is entirely immune from the possibility of witnessing or becoming
involved in a life threatening collision. Through the development of an extensive literature
review, this paper aims to assess the regularity in which posttraumatic stress disorder (PTSD)
will occur following a severe motor vehicle accident. An analysis of the available treatments
will also be provided, ultimately determining the best method of treatment for the case study of
Mary.
PTSD 4
Prevalence
“In the United States, projected lifetime risk for PTSD using DSM-IV criteria at age 75
years is 8.7%” (American Psychiatric Association, 2013, p. 276). Individuals of all ages,
genders, and races are diagnosed with this disorder each year; however, some populations
demonstrate greater lifetime exposure to trauma such as veterans, police officers, firefighters,
rape victims, and genocide survivors. Although victims of near death experiences may develop
PTSD, witnessing a traumatic event or hearing about a trauma experience by a loved one may
also result in the development of the disorder. Within the U.S., comparing Caucasian individuals
with minority groups, higher rates of PTSD have been reported among Latinos, African
Americans, and American Indians as opposed to Asian Americans (American Psychiatric
Association, 2013, p. 276). Prevalence of PTSD also differs among countries; Europe, most
Asian, African, and Latin American countries document rates ranging from .5% to 1%
(American Psychiatric Association, 2013, p. 276). In terms of gender, PTSD is both more
common and generally persists for longer durations among women (American Psychiatric
Association, 2013, p. 278). Despite the fact that environments differ depending on culture and
geographic location, women are more likely to experience rape and interpersonal violence,
providing heightened exposure.
Although posttraumatic stress disorder is a common psychological illness among
individuals who have experienced trauma, the diagnostic category of PTSD did not exist until
1980, when it was first included in the DSM III (Cukor et al., 2009). Victims of an array of
tragedies experienced flashbacks, dissociative symptoms, and disturbances, but went
undiagnosed and untreated for decades. An article published in 1996 by Buckley, Blanchard,
and Hickling, references a statistic presented by the National Comorbidity Survey, reporting a
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lifetime prevalence of 8% for posttraumatic stress disorder in Americans between the ages of 15
and 54 (Kessler et al., 1995). Although nearly twenty years have past since this publication, the
prevalence of PTSD today is rather comparable, having increased by just .7%. Despite the fact
that many veterans experience PTSD, women are more than twice as likely to develop this
disorder than men due to the disproportionate possibility of sexual assault and an increased
likelihood of blaming oneself for the trauma experienced (U.S. Department of Veteran, 2014).
In terms of motor vehicle accidents specifically, it has been estimated that 800,000 new cases of
PTSD result from these collisions (Blanchard & Hickling, 2004 as cited in Beck et al., 2007).
Berna et al. (2012) reports, “Motor vehicle accidents are frequently followed by post-traumatic
stress disorder at six months in between 4 and 25.4% of victims” (Harvey & Bryant, 1998;
O’Donnell et al., 2004). This large range may be due to lack of diagnosis or discontinued
treatment, as is the case with many mental health disorders (Zatzick et al., 2003 as cited in Berna
et al., 2012). Some victims may have been diagnosed with acute stress disorder (ASD) rather
than PTSD, failing to include these cases in national PTSD statistics. Due to the fact that ASD
and PTSD have nearly identical symptoms, ASD involves short-term disturbances, lasting from
one to thirty days, while PTSD is chronic and can be diagnosed if symptoms have persisted one
month or longer (U.S. Department of Veteran, 2014).
Correlations
A variety of studies examining PTSD in the lives of war veterans and sexual assault
victims have been conducted; however, few studies document the development of PTSD
following motor vehicle accidents (Berna et al., 2012; Beck et al., 2007; Buckley et al., 1996).
One particular study, consisting of 155 adult participants, utilized several questionnaires, such as
the Peritraumatic Distress Inventory (PDI) and Clinician-Administrated PTSD Scale (CAPS),
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immediately after the automobile accident as well as 24-26 weeks after the trauma (Berna et al.,
2012). The findings of this study report the development of complete PTSD in 7.74% of
participants, while 25.81% exhibited subsyndromal conditions that were not severe enough to
diagnose. Perception of life threat is the primary predictive factor believed to have differentiated
the complete PTSD group from the subsyndromal group (Berna et al., 2012). In another study,
conducted by the Cooperative Health Research in the Region of Augsburg, Germany, 4,261 adult
participants were selected, examining the form of trauma and the frequency of exposure in
relation to PTSD development (Lukaschek et al., 2013). Although 40.5% of subjects had
experienced an event commonly associated with PTSD during their lifetimes, only 51
participants (1.7%) met the criteria for complete PTSD, while 271 participants (8.8%)
demonstrated symptoms of partial PTSD (Lukaschek et al., 2013). This study specifically noted
that women were found to be at 1.7 times higher risk for PTSD than men and generally develop
the disorder under differential traumas. Women often encounter PTSD after experiencing sexual
assault or the death of a close relative, while men endure natural disasters or war related
nonsexual assaults (Lukaschek et al., 2013). A similar study specifically concerning motor
vehicle accidents, consisted of 96 adult participants, but focused on the development of delayed
PTSD (Buckley et al., 1996). Immediately after the incident, clients were diagnosed as
subsyndromal or non-PTSD, developing the disorder six to twelve months after the accident.
The results of this study reveal seven of the 96 participants injured in motor vehicle accidents
developed delayed onset PTSD. No differences existed between delayed and non-PTSD groups
in terms of prior trauma, demographic characteristics, age, gender, or ethnicity (Buckley et al.,
1996). The determining factor was instead the level of social support present prior to the
collision (Buckley et al., 1996). Through the evolution of a unique rationale, each article
PTSD 7
documents the relationship between motor vehicle accidents and posttraumatic stress disorder.
Findings were very similar to those provided in the DSM-V; however, race was not highlighted
in the journal correlations contributed. Overall, the vital information presented in this section
concerns perception of life threat in the development of the disorder, higher risk in women,
differential trauma based on gender, and the pivotal component of social support.
Past Studies
Past studies have further demonstrated the significant relationship between a variety of
traumas, including motor vehicle collisions, and PTSD. A study conducted by Ozer et al. (2003)
identifies seven predictors of PTSD including: history of prior trauma, psychological problems
prior to the target stressor, psychopathology in the family of origin, perceived life threat,
perceived support following the trauma, peritraumatic emotional responses, and peritraumtaic
dissociation (as cited in Berna et al., 2012). Predictors highlighted in the prevalence and
correlation sections of this paper include perceived life threat and social support following the
trauma. When factors such as these are consistently addressed in empirically based research
articles, reliability increases and therapists should provide special attention to these components
when working with clients.
Additional past studies have reported increased confusion and disorganization in the
memories associated with the trauma in individuals who have been diagnosed with PTSD
(Halligan et al., 2003 as cited in Peri & Gofman, 2014). If memories are distorted or limited,
victims may feel personally responsible for the trauma or fail to recall details of the incident,
possibly resulting in increased symptoms of PTSD and lack of desire to pursue treatment. Many
empirically based treatments are available to clients experiencing PTSD such as narrative
reconstruction, virtual reality exposure, cognitive therapy, seven-day intensive therapy, and self
PTSD 8
guided treatment. All have demonstrated some statistical significance, revealing both successes
and failures. Treatment methods should be selected based on the unique needs of the client and
his/her level of comfort during the treatment process.
Definitions
According to DSM-V criteria, posttraumatic stress disorder (309.81) can be present in
individuals older than six years of age after directly experiencing or witnessing a traumatic
event, learning that a trauma occurred in the life of a loved one, or experiencing excessive
exposure to aversive details relating to the trauma (American Psychiatric Association, 2013, p.
271). Symptoms include the presence of recurrent, intrusive, and involuntary distressing
memories, dreams, flashbacks, or psychological reactions to internal or external cues resembling
the trauma (American Psychiatric Association, 2013, p. 271). On the other hand, PTSD also
includes the avoidance of distressing memories and reminders such as specific places, people,
and discussion topics related to the traumatic event (American Psychiatric Association, 2013, p.
271). A change in mood and cognitive abilities is also representative of PTSD. Individuals may
begin forgetting details related to the event, developing distorted recollections of the cause and
consequences of the incident, becoming detached from others, and remaining in a negative
emotional or irritable behavioral state (American Psychiatric Association, 2013, p. 272). The
listed symptoms must be present for one month or longer.
Due to its prevalence, the symptoms of PTSD are widely known and understood to be a
psychological disorder. Lukaschek et al. (2012) is the only referenced journal article presenting
a thorough definition of the disorder. PTSD is explained to be “a prolonged stress response
syndrome whose symptoms develop in the aftermath of extremely stressful life events of
exceptionally threatening or catastrophic nature” (International Classification, 1992; Green, 2000
PTSD 9
as cited in Lukaschek et al., 2012). This definition is essentially the same as that provided by the
DSM-V; however, stress is the focal point, while DSM-V criteria uses the word trauma
throughout, only implementing the word stress in the name of the disorder. It seems as though
PTSD would be looked upon as less severe under the journal definition being that stress is a
word used on a daily basis to explain the overwhelming tasks of everyday life. The word trauma
provides an increased level of severity and urgency that is associated with major crises.
The additional journal articles referenced assume the reader has previous knowledge of
PTSD, therefore highlighting instead the cause, time period, or prevalence of symptoms in
participants who have encountered trauma. Several of the quantitative studies referenced utilize
the measurement tool of the Clinician-Administered PTSD scale (CAPS). CAPS is an
assessment occurring during a semi-directed interview, focusing on the three dimensions of
PTSD: intrusion on re-experiencing, avoidance, and neurovegetative hyperarounsal (Ehlers et al.,
2014; Lewis et al., 2013; Berna et al., 2012; Beck et al., 2007; Buckley et al., 1996). Although
categorizations may appear limited, seventeen symptoms of PTSD can be assessed using solely
these three dimensions. Furthermore, the remaining articles address additional symptoms
including intimate relationship distress, dissociation with reality, and possible comorbidity with
substance use disorder (Brown-Bowers et al., 2012; Peri & Mordechai, 2014; Gielen et al.,
2014). DSM-V criteria presents a more concise and thorough explanation of the disorder,
however this information coupled with elaboration from journal articles leaves little unexplained.
The DSM-V also includes three specifiers when assessing PTSD criteria:
depersonalization, derealization, and delayed expression. Both depersonalization and
derealization involve feelings of detachment. Depersonalization is described as a feeling as if
one were an outside observer, viewing actions in slow motion or as if life were a dream
PTSD 10
(American Psychiatric Association, 2013, p. 272). Derealization is very similar, but focuses on
experiences that are distorted or unreal, a differential reality. When a victim experiences delayed
expression, he/she meets all the necessary criteria to be diagnosed with PTSD, but symptoms do
not arise until at least six months after the trauma has occurred (American Psychiatric
Association, 2013, p. 272). Buckley et al. (1996) conducted a study surrounding the topic of
delayed expression, discovering that lack of social support prior to the experienced trauma was
detrimental to delayed development. Regardless of the dissociative symptoms present, social
support appears to be a logical component, bringing the victim back to reality and providing
treatment options.
Comorbidity
Due to feelings of fear, confusion, loss of control, sadness, and detachment, PTSD is
often experienced in addition to a variety of other mental health disorders. According to the
DSM-V, “Individuals with PTSD are 80% more likely than those without PTSD to have
symptoms that meet diagnostic criteria for at least one other mental disorder (e.g., depressive,
bipolar, anxiety, or substance use disorders)” (American Psychiatric Association, 2013, p. 280).
In the case of substance use disorders (SUD), PTSD victims are often attempting to self-
medicate. Victims may then enter rehabilitation facilities in attempt to treat their addictions,
while PTSD, the antecedent causing self-medication, has never been treated. Based on this
cycle, PTSD is severely under diagnosed among SUD clients (Gielen et al., 2014). Comorbid
substance use disorders as well as conduct disorders are more common among men than women
(American Psychiatric Association, 2013, p. 280). Co-occurrences of PTSD and major
neurocognitive disorders have also been experienced, although U.S. military personnel involved
in the wars in Afghanistan and Iraq have recently noted PTSD in addition to traumatic brain
PTSD 11
injuries (American Psychiatric Association, 2013, p. 280). Suicidal ideation is also a concern
when working with clients overcoming trauma, specifically traumas in the realm of abuse. As
time progresses, comorbidity can easily occur, increasing the difficulty of assessing causality and
creating a more challenging treatment process.
Etiology
Development and Course
Individuals of all ages, from less than one year old to elderly, can experience PTSD.
Symptoms generally surface within three months of the trauma; however, delayed expression
does occur, which was described in the definitions section of the paper (American Psychiatric
Associatoin, 2013, p. 276). Trauma victims who demonstrate PTSD symptoms immediately
after the incident will be initially diagnosed with acute stress disorder. After one month of
continued expression, victims may be diagnosed with PTSD. Approximately one-half of adults
will recover entirely within three months, but others will continue experiencing symptoms for
extensive lengths of time ranging from twelve months to fifty years (American Psychiatric
Association, 2013, p. 277). PTSD criteria is slightly different for children under the age of six
years old being that they demonstrate fear or detachment through play and storytelling.
Adolescents and younger adults indicate delayed participation in new activities such as driving
and dating, become aggressive or irritable leading to negative peer relations, and may appear to
have lost motivation to establish future goals (American Psychiatric Association, 2013, p. 277).
Individuals who had experienced trauma during youth or young adulthood will often express
fewer symptoms of hyperarousal, avoidance, and negative emotions as they proceed later into
adulthood (American Psychiatric Association, 2013, p. 277). On the other hand, adults who
have experienced trauma later in life will likely indicate more avoidance, hyperarousal, and
PTSD 12
emotional outbreaks than young adults, which has been correlated to negative health perceptions
and increased risk of suicidal ideation (American Psychiatric Association, 2013, p. 277).
Lukaschek et al. (2013) conducted a study from 1999-2001, surveying lifetime exposure to
various traumatic events and the response of existent stressors, specifically intrusion, avoidance,
and hyperarousal. Consistent with the presented developmental differences, participants aged 52-
61 years of age were significantly more likely to have partial PTSD, while those 62-71 years of
age were more likely to have full PTSD. Although PTSD symptoms regardless of age are
similar in terms of altered moods and behaviors, the progression of the disorder does change
based on the developmental level of individuals and the challenges faced at each stage of life.
Risk and Prognostic Factors
PTSD is commonly thought to ignite based solely on environmental origins albeit some
individuals experience heightened risk. Risk factors can be categorized into three clusters:
pretraumatic, peritraumatic, and posttraumatic. Pretraumatic encompasses temperamental,
environmental, and genetic factors present before the trauma has occurred. Temperamental
elements include childhood emotional difficulties acquired before the age of six as well as prior
mental disorders such as anxiety, externalization, depression, panic attacks, and obsessive-
compulsive disorder (American Psychiatric Association, 2013, p. 277). Environmental
considerations are particularly representative in populations of lower socioeconomic status:
lower education, economic deprivation, family dysfunction, lower intelligence, minority racial
status, and family psychiatric history (American Psychiatric Association, 2013, p. 277).
Genetically, women and younger children are at increased risk of exposure to trauma.
Peritraumatic factors are strictly environmental, but involve the actual traumatic experience
itself. PTSD risk considers the severity of the trauma, perceived life threat, personal injury,
PTSD 13
interpersonal violence, and the level of dissociation during the event (American Psychiatric
Association, 2013, p. 278). Confirming this information, Berna et al. (2012) discovered
significant correlations between the perception of life threat, intensity of re-experiencing and
hyperarousal, initial dissociation scores, and the frequency and intensity of avoidance.
Perception of life threat was found to be the most decisive factor in the development of PTSD,
but avoidance was expressed as the primary defense mechanism (Berna et al., 2012). Lastly,
posttraumatic circumstances are both temperamental and environmental. Temperamental
elements “include negative appraisals, inappropriate coping strategies, and development of acute
stress disorder” (American Psychiatric Association, 2013, p. 278). Environmental elements
incorporate repeated exposure to reminders of the trauma, financial losses, negative life events,
and lack of social support (American Psychiatric Association, 2013, p. 278). Several journal
articles analyzed, document the importance of increasing social support, establishing positive
coping mechanisms, and increasing resilience in attempt to prevent the development of PTSD
(Brown-Bowers et al., 2012; Lukaschek et al., 2013; Buckley et al., 1996).
Cultural and Gender Related Components
Cultural expressions as well as geographic locations influence people’s experiences and
their reactions to crises. For example, people in Rwanda and Darfur have lived in regions of
genocide, while Mexican immigrants traveling to the U.S. have been physically assaulted or
imprisoned. It is not necessary to estimate which trauma has been more threatening than the
other, but rather to understand that expressions of PTSD symptoms may materialize differently.
Avoidance, numbing, and distressing dreams may emerge through indications of dizziness,
shortness of breath, heat sensations, panic attacks, and unexplainable behaviors (American
Psychiatric Association, 2013, p. 278). None of the journal articles provided feature cultural
PTSD 14
expressions of PTSD; however, the gender differences proposed parallel those reported in the
DSM-V. Due to the fact that women are more likely to become victims of sexual assault and
interpersonal violence, PTSD is more prevalent among females and generally persists for longer
periods of time (American Psychiatric Association, 2013, p. 278). Lukaschek et al. (2013)
discovered the women are 1.7 times more likely to develop full PTSD and generally report
trauma associated with the death of a close relative or sexual assault, while men experience
traumas relating to accidents, natural disasters, and nonsexual assaults. Women are also more
likely to express self-blame and feel personally responsible for the trauma that occurred (U.S.
Department of Veteran, 2014). When diagnosing and assessing the risk of PTSD, consider
cultural and gender related influences that may assist in predicting the development of symptoms
and the progression of the disorder.
Treatments
Cognitive Therapy
A wide variety of therapeutic techniques are available to clients diagnosed with PTSD;
however, treatments must be chosen based on each client’s unique experiences and impairments.
One very popular form of therapy in the treatment of any mental health disorder is cognitive
therapy. Cognitive therapy is explained as a goal-oriented and collaborative treatment focusing
on the cognitive idea that “the way people perceive their experiences influences their emotional,
behavioral, and physiological reactions” (Beck, 2010). A study by Ehlers et al., (2013)
implemented cognitive therapy techniques for the treatment of PTSD in a routine clinical setting.
Based on the array of traumas encountered in clinical settings, this study aimed to determine the
effectiveness of cognitive treatment on PTSD clients under the care of routine clinical therapists
who had received specialized training in the treatment of PTSD. A total of 330 patients agreed
PTSD 15
to participate in the study and receive treatment. Individual treatment sessions were conducted
in English. The average number of sessions attended by participants was 10.6 (Ehlers et al.,
2013). Results reveal that majority of the clients treated demonstrated improvements in PTSD
symptoms as well as a significant lessening in symptoms of depression and anxiety. Participants
who had attended sessions irregularly or dropped out of the program documented poorer
outcomes. Time lapsed since the trauma as well as the clinical experience of the therapist also
impacted client progress. Trainee therapists exposed slightly lower patient outcomes than
experienced PTSD therapists. According to this information, cognitive therapy has proven to be
a successful form of treatment; however, treatment is most effective when clients enter therapy
regularly with an experienced therapist soon after the trauma.
Virtual Reality Exposure Therapy
Virtual reality exposure therapy (VRET) is another form of treatment that has proven
successful when working with clients diagnosed with PTSD, specifically in cases of motor
vehicle collisions. Beck et al., (2007) recruited individuals through newspaper ads and referrals
who had experienced motor vehicle accidents in the past six months. Seven females and one
male participated in the study. The mean age was 49.5. Two participants were African
American and six were Caucasian. Treatment consisted of ten individual sessions. The first two
were strictly educational, providing information about PTSD symptoms and virtual reality
exposure therapy. The remaining eight sessions each lasted 90 minutes in length, utilizing
virtual reality simulators and non-collision related motor vehicle scenarios. The client would
take turns sitting in both the driver and passenger seats, while the therapist would sit next to the
client in the role not taken, attempting to build positive coping strategies through the
enhancement of relaxation skills. After treatment, 76% of participants reported 50% or more
PTSD 16
reduction in the subjective units of distress scale (SUDS). There was an average 40% reduction
in total CAPS score. Although the small sample size is a major limitation to this study, causing
lack of generalizability, the simulation exercises provided resemble cognitive behavior
techniques of increasing exposure to the fear over time in small increments. More studies need
to be conducted before VRET can be considered a sound, empirically based form of therapy, but
the findings presented by Beck et al. (2007) highlight promising possibilities.
Narrative Reconstruction
Narrative reconstruction is a unique form of trauma therapy focused on the creation of a
detailed and chronological reconstruction of memories surrounding a traumatic event. Peri and
Gofman (2014) conducted a study composed of six participants. Three clients experienced
PTSD due to motor vehicle accidents, two had been victims of sexual assault, and one survived a
train crash. Treatment consisted of twelve weekly sessions of sixty minutes. A sample
recording and videotape was gathered during each session to insure ethical and legal obligations
were upheld. During sessions, the therapist and client would sit across from one another while
the client discussed thoughts and feelings related to the trauma in a step-by-step sequence. The
therapist typed on a computer, creating a slow progression of the session, allowing the client to
recollect while recording the entire narrative as the client had expressed it. At the beginning of
each session, the therapist read the entirety of the transcript to the client, often causing new ideas
to surface, which were then integrated in the appropriate location of the narrative before
continuing where the previous session had ended. The narrative progresses “until the point in the
event when the person regained composure and a sense of control” (Peri & Gofman, 2014).
Results indicate highly effective reductions in PTSD symptoms. Pretreatment to follow-up
changes in CAPS scores are revealed in an effect size of 1.66. As exposed in cognitive therapy,
PTSD 17
narrative reconstruction produces greater results when clients receive treatment four to six
months after trauma. Although positive results were produced, additional studies need to be
conducted with larger sample sizes. This form of therapy appears especially difficult in the sense
that the client is retelling the story repeatedly for many weeks; however, chronologically
compiling all of the details may create closure and lessen the regularity of distressing dreams
because the client is not avoiding the matter but pushing the trauma to the conscious to be
addressed in a logical manner.
Guided Self-Help Program
The final form of PTSD treatment that will be assessed is a guided self-help program.
Due to a shortage of qualified therapists providing PTSD treatment, Lewis et al. (2013)
developed an eleven module guided self-help program that was available to the nineteen
participants both online and as a hardcopy. Three phases of a pilot program were enacted, but
the final product was designed to be delivered over eight weeks or less. The first one-hour
session was led either face to face or over the phone by a clinical therapist. The remaining
sessions were conducted through modules performed at home included readings on the topic of
change, multiple choice quizzes, and exercises to be completed with a therapist. Modules were
psychoeducational, teaching a variety of skills including: relaxation methods, advice on sleep
hygiene, cognitive techniques, imaginable exposure, relapse prevention, and positive
interpersonal relationships (Lewis et al., 2014). Participants spoke with therapists about their
progress and kept a detailed journal documenting thoughts and feelings throughout. Results
indicate five of the ten participants from pilot study one and six of the nine participants from
pilot study two showed clinically significant improvements (Lewis et al., 2014). The guided
self-help program appears to be a practical solution to the dilemma of a shortage of therapists,
PTSD 18
but more severe cases of PTSD demand greater attention. When a severe psychological disorder
is present, people require interaction and discussion with others to grasp reality once again.
Removing regular sessions with a clinical therapist prevents client’s ideas from being directly
challenged or empathized, eliminating the crucial factor of the therapeutic alliance.
Conclusion
The purpose of this paper is to examine the illness of posttraumatic stress disorder,
gathering diagnostic information from the DSM-V, while analyzing peer reviewed journal
articles regarding treatment options. Research direction was provided by the initial case study of
Mary, a middle-aged woman driving a motor home who killed a motorcyclist. Due to the
disproportion of females experiencing PTSD more frequently and for longer durations, Mary
must begin receiving treatment immediately. Based on her age, Mary is likely to express high
rates of avoidance, hyperarousal, and emotional outbreaks, which may lead to suicidal ideation.
In terms of treatment, cognitive therapy is always an option; however, virtual reality exposure
therapy and narrative reconstruction in tandem are particularly intriguing for her case. Narrative
reconstruction therapy may help to organize her memories and gain closure. If she
chronologically details the events that occurred, she can discover the personal significance of the
incident and its impact on her life. Since she is impaired by her fear of entering automobiles,
virtual reality exposure therapy would allow her to take small virtual steps from watching a
computer screen, to entering a virtual car, to driving a virtual car, ultimately beginning to drive
an automobile on the streets again in the near future. Posttraumatic stress disorder is a common
illness that can impair the life of any individual of any age, race, and gender who has endured
trauma. Some populations are at a greater risk than others, but regardless of the situation, the
sooner an individual receives treatment, the higher the probability of symptom reduction.
PTSD 19
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