Treating Post-traumatic Stress Disorder After Abuse

According the National Domestic Violence Hotline (n.d.), every minute an estimated twenty-four individuals become victims of rape, physical violence and/ or stalking by an intimate partner. This type of abuse is known as Domestic Violence (DV) or Intimate Partner Violence (IPV). Prolonged exposure to intimate partner violence can lead to Post- Traumatic Stress Disorder (PTSD) for some people (Peterson, 2016). For the purpose of this therapeutic study, a woman known as Brittany (pseudonym) will be discussed. The utilization of best practice therapeutic approaches will be discussed for their benefits in potentially relieving symptoms of Brittany’s PTSD.

Patient History

Before discussing the best therapeutic approach to ease Brittany’s symptoms, it is important to understand her background. Brittany is a Caucasian 30-year-old female who recently moved to a small urban area with her parents. In the last two years, she divorced her spouse of eight years. Brittany was hospitalized in the ICU for six months before her divorce due to severe physical abuse from her ex-husband. She sustained multiple broken bones and required extensive physical therapy from the damage done to her body. Brittany’s husband, Michael (pseudonym) began abusing her emotionally during the first of their marriage. Michael’s abuse went from emotional to physical as their marriage continued.

Mental Illness (Post-Traumatic Stress Disorder)

Due to the extent of the abuse that Brittany endured, she began to recluse inside her parent’s home. She filed a restraining order against her husband during the divorce to keep him from coming near her, but she still had fears that he might come to the area her parent’s reside in. Brittany’s parents encouraged her to seek therapy after noticing that she suffered from frequent nightmares and would begin to panic (flinching, increased heart rate, and crying) upon someone approaching and touching her shoulder from behind. During this time, she also stopped talking to friends and family. Since moving in with her parents, she has been leaving the house less frequently.

According to the DSM-V (2013), Post-Traumatic Stress Disorder diagnosis is made up of eight components listed from A-H. Criterion A requires a stressor such as domestic violence to occur. Criterion B is the requirement for intrusion symptoms. Criterion C is avoidance of behaviors or situations that cause thoughts, feelings, or external stimulus that reminds the individual of the trauma. Criterion D and E negatively impact arousal, cognition, mood, and reactivity (Tracy, 2016). The final three criterion, duration, functional significance, and exclusion, requires that symptoms have lasted longer than one month, has affected the client’s social and /or occupational life, and is not caused by medications or other illness (Tracy, 2016).

Brittany meets the criterion for Post-Traumatic Stress Disorder due the issues that followed the trauma caused by the domestic violence from her ex-husband. Brittany experiences frequent nightmares where she dreams, she is back in her marital home reliving abusive situations. Brittany also experiences flinching and has a panic response when someone taps her shoulder or approaches her from behind. Brittany’s life is affected by her PTSD, because she purposely avoids leaving the house to avoid the possibility of see someone or something that will remind her of the abuse she endured. Brittany struggles with extremely low self-esteem, the inability to enjoy previously enjoyed activities, and many other symptoms. Brittany’s social life has been greatly affected by the symptoms of her PTSD. It has also affected her occupational life because she isolates herself inside of her parent’s home. Brittany has taken a job working at home but has frequent call outs due to the severity of her nightmares and agitation.

Treatment /Therapeutic Approaches

[bookmark: _Hlk9705027]Post-Traumatic Stress Disorder is a mental illness that has no known cure. However, when it comes to treatment, there are a multitude of approaches that can be utilized. Everyone who has been diagnosed with PTSD can respond differently to these various treatments. It is important to meet the unique needs of each client and not try to utilize a one size fits all approach.

Cognitive Behavioral Therapy (CBT) Approaches

Prolonged Exposure Therapy (PE) and Narrative Exposure Therapy (NET) both work towards helping the client reduce their PTSD symptoms by helping them confront the distressing memories of the traumatic events they endured. These approaches work with the client and therapist to create a non-distorted narrative of what occurred. Both of these therapeutic approaches can be highly effective when it comes to treating the symptomology of PTSD. Unfortunately, PE and NET have shown high dropout rates from treatment, unwanted lingering symptoms, and even failure to alleviate symptomology (Halvorsen, Stenmark, Neuner, & Nordahl, 2014).

Dialectical Behavioral Therapy (DBT) is a cognitive behavioral treatment approach that can be useful in treating the symptoms of PTSD. DBT focuses on mindfulness, tolerance to distress, emotional regulation, and interpersonal effectiveness (Panos, Jackson, Hasan, & Panos, 2014). This cognitive behavioral approach is often utilized in both a one on one therapeutic setting and a group therapy setting. According to Echeburúa, Sarasua, and Zubizarreta (2014), this approach can potentially be helpful for the emotional and social welfare of victims of IPV.

Cognitive Processing Therapy (CPT) is a cognitive behavioral treatment that focuses on the client’s worst traumatic event in how it relates to the individuals, the people in their lives, and in relation to the rest of the world. The goal of CPT is more balanced thinking (Iverson, 2011). Being able to identify the connections between cognitive process, emotions, and events helps the therapist assist in developing an alternative way of thinking. CPT involves completing homework assignments that consists of writing about these traumatic events and reading them daily including during sessions (Iverson, 2011). Worksheets are also provided to help the client recognized distortions in their thought processes. In the study conducted by Iverson, Resick, Suvak, Walling, and Taft (2010;2011;), the researcher found that women who had been recently exposed to intimate partner violence were less likely to complete CPT. Though, women who had endured past IPV and are no longer involved with their partner were more likely to complete and benefit from CPT.

Pharmacotherapy

Pharmacotherapy is an alternative option for treating Post-Traumatic Stress Disorder. The medications prescribed as treatment for PTSD are known as selective serotonin reuptake inhibitors (SSRIs) and include drugs such as Paxil, Zoloft, and Prozac (Lee, Schnitzlein, Wolf, Vythilingam, Rasmusson, & Hoge, 2016). While medications are always a different option for treatment, they are not considered best practice approach. Psychotherapy is considered the best practice option before pharmacotherapy according to the National Center for PTSD (Jefferys, 2018).

References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
2. Echeburúa, E., Sarasua, B., & Zubizarreta, I. (2014). Individual Versus Individual and Group Therapy Regarding a Cognitive-Behavioral Treatment for Battered Women in a Community Setting. Journal of Interpersonal Violence, 29(10), 1783–1801. https://doi.org/10.1177/0886260513511703
3. Halvorsen, J. Ø., Stenmark, H., Neuner, F., & Nordahl, H. M. (2014). Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial. Behaviour Research and Therapy, 57,21-28. doi:10.1016/j.brat.2014.03.010
4. Iverson, Katherine M. (2011). ‘Cognitive–behavioral therapy for PTSD and depression symptoms reduces risk for future intimate partner violence among interpersonal trauma survivors’. Journal of consulting and clinical psychology (0022-006X), 79 (2), p. 193.
5. Iverson, K. M., Resick, P. A., Suvak, M. K., Walling, S., & Taft, C. T. (2010;2011;). Intimate partner violence exposure predicts PTSD treatment engagement and outcome in cognitive processing therapy. Behavior Therapy, 42(2), 236-248. doi:10.1016/j.beth.2010.06.003
6. Jefferys, M. (2018, October). National Center for PTSD. Retrieved from https://www.ptsd.va.gov/professional/treat/txessentials/clinician_guide_meds.asp
7. Lee, D. J., Schnitzlein, C. W., Wolf, J. P., Vythilingam, M., Rasmusson, A. M., & Hoge, C. W. (2016). Psychotherapy versus pharmacotherapy for posttraumatic stress disorder: Systematic review and meta-analyses to determine first-line treatments. Depression and Anxiety, 33, 792-806. doi:10.1002/da.22511
8. National Domestic Violence Hotline, (n.d.). Get educated. Retrieved May 16, 2019, from http://www.ndvh.org/get-educated/
9. Panos PT, Jackson JW, Hasan O, Panos A. (2014). Meta-analysis and systematic review assessing the efficacy of Dialectical Behavior Therapy (DBT). Research on Social Work Practice. 2014;24(2).
10. Tracy, N. (2016, February 17). Is PTSD a Mental Illness? PTSD in the DSM-5, HealthyPlace. Retrieved on 2019, May 15 from https://www.healthyplace.com/ptsd-and-stress-disorders/ptsd/is-ptsd-a-mental-illness-ptsd-in-the-dsm-5