PTS3398 - POST-TRAUMATIC STRESS DISORDER: A COMPREHENSIVE OVERVIEW FOR MENTAL HEALTH CLINICIANS
by Michelle Lind, LCSW, DHSc, LIMFT, M-RAS
Dr. Michelle Lind is a licensed Social Worker with several years of experience providing clinical services as Social Worker and Sexual Assault Specialist to military personnel and their families. She is currently working as a special court appointed advocate and is on the faculty at Axia University of the University of Phoenix.
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The objective of this course is to provide the mental health clinician with a comprehensive introductory overview of Post-traumatic Stress Disorder and its treatment. When the trainee completes this course, he/she will:
1. Comprehend the causes and symptoms of PTSD
2. Understand the manifestations of PTSD in children
3. Identify the most commonly utilized treatment approaches for responding to PTSD
4. Comprehend the uses of Critical Incident Stress Management as a preventive approach for PTSD
5. Understand the uses and limitations for psychotropic medication approaches to PTSD
6. Comprehend common barrier to treatment for PTSD
This course is primarily designed for clinicians in the early or middle stages of their career, or for more advanced clinicians reviewing basic concepts in this area.
3 contact hours: Core clinical
Section I: INTRODUCTION
Section II: PTSD Facts and Statistics
Section III: Causes and Symptoms of PTSD
Section IV: PTSD in Children
Section V: Treatments for PTSD
Section VI: The Preventive Approach to PTSD
Section VII: Barriers to Treatment
References and Test
Section I: INTRODUCTION
Post-traumatic Stress Disorder, commonly abbreviated as PTSD, is a clinical syndrome that was formally recognized as a psychiatric diagnosis in1980. (American Psychiatric Association, 2005) PTSD usually occurs as a reaction to: 1) participation in; or 2) exposure to a violent, dangerous or otherwise traumatizing event that threatens one’s sense of safety or well being.
As a syndrome or disorder, PTSD typically consists of a constellation of different symptoms which develop as a response to exposure to the traumatic event. Symptoms include but are not limited too: increased arousal and heightened vigilance, anxiety producing recollection and re-experiencing of the traumatic event, and a number of associated affective and physiological after-effects, such as psychological numbing, confusion, difficulties sleeping, and difficulties sleeping, concentrating, and sustaining control over fear, anxiety and other feelings.
PTSD is typically associated with combat veterans; however, it can and does afflict many other people exposed to different kinds of trauma. Like other mental illness, PTSD has no boundaries; it does not discriminate based upon gender, education level, race, or socio-economic status.
There is some debate on whether the leading cause of PTSD is exposure to combat, sexual assault, or motor vehicle accidents, but because of the sheer number of the driving population, serious motor vehicle accidents may be the leading contributor, while combat-related PTSD receives the most attention.
Regardless of the leading cause, more attention is being brought to this syndrome than ever before. As veterans speak out to the media about the symptoms associated with this syndrome, PTSD has been gaining national coverage. As a result, more and more clinicians are now accepting the diagnosis of PTSD, and more and more people are seeking treatment.
It is important for today's clinicians to understand that this condition is not unique to veterans. Other people, including children, can develop this disorder as a result of a traumatic event or experience. Clients seeking help for the first time as adults often have a history of acute or ongoing traumatic experiences that served as the point of origin for their later emotional and psychological problems.
Adult Children of Alcoholics, sexual abuse survivors, survivors of physical and emotional abuse, and survivors of domestic abuse are all categories of people whose problems have their roots in traumatic experience and whose symptoms have some overlap with symptoms of PTSD. While the diagnoses for these clients may not meet the diagnostic criteria for PTSD, a clear and solid understanding of the mechanisms through which traumatic experience evolves into emotional, psychological, physiological and behavioral problems should be an integral part of each clinician’s foundation of understanding.
Additionally, treatment approaches for these kinds of problems will incorporate some of the principles of treatment for PTSD. As will be demonstrated in the section that examines the various approaches for treatment of PTSD, there will be many components of treatment that make sense for intervening with clients who are survivors of family chaos, violence and abuse.
One other group of patients warrants special mention here. Borderline Personality Disorder (BPD) appears to have a high degree of correlation with PTSD. One study of veterans with combat-related PTSD seeking treatment found that 76% of them also had a diagnosis of BPD. (Southwick, 1993) Likewise, another study found that approximately 56% of individuals with BPD also have a diagnosis of PTSD. (Zanarini, 1998)
Why are these two disorders so inter-related? Some current theories posit that BPD is primarily a symptom of ongoing and persistent reactions to stress and trauma. The trauma creates a state of relatively permanent hyper-arousal and hyper-vigilance that leads to personal disorganization and over-reactivity to emotional stimuli: the primary characteristics of BPD.
This in turn leads to a self-propagating cycle where the impulsive behaviors and difficulties managing emotion seen among people with BPD may also place a person at greater risk for experiencing further trauma, as they engage in impulsive behaviors that can lead to accidents, assaults, and the fraying of social supports. This same self-propagating process appears quite frequently in patients who suffer from chronic symptoms of PTSD.
There are two well-supported treatments for BPD, Dr. Marsha Linehan's Dialectical Behavior Therapy (DBT) and Drs. Anthony Bateman and Peter Fonagy's Mentalization-Based Treatment (MBT). Some of the skills taught in these treatments (for example, emotion regulation, emotional awareness (mindfulness), interpersonal effectiveness skills) have been incorporated into some of the research based approaches to treating PTSD. (Linehan, 1993)
It is likely that additional research will determine the extent to which BPD and PTSD overlap, and where distinctions can be drawn between the two diagnostic categories and the treatment for each. However, conscientious clinicians should have some familiarity with both areas of study, as well as some understanding of the key treatment approaches used in DBT and MBT.
Currently there is a sizeable shortage of healthcare providers with expertise in treating trauma-related mental disorders, and the need for trained professionals is growing. (Barnes, 2008) To meet the growing demand for competent care, clinicians must be equipped or trained to help those who have experienced severe trauma and who have perhaps developed PTSD.
Clinicians work in a variety of practice settings such as hospitals, private practices, schools, and other clinical arenas. As such, clinicians are often confronted with a multitude of presenting symptoms from the client. Although, clinicians do not necessarily need to become specialists or experts in the treatment of PTSD, they should nevertheless have a sufficient understanding of PTSD to diagnose it appropriately, provide routine support to stabilize it, and know how to make the appropriate referral.
Therefore, the clinician should have a store of knowledge to draw upon to complement what is presented by the client or documented in the patient's medical record. Additionally, clinicians should have known resources – clinicians who specialize in PTSD or response to acute trauma - to which they can refer a client who presents with PTSD.
This course will serve as a starting point for clinicians to understand these mechanisms, as well as the treatment approaches that are generally considered effective in responding to symptoms of PTSD.