Post Traumatic Stress Disorder is a class of anxiety disorder, which has been experienced by people who went through traumatic event, such as car accident, sexual assault, combat trauma any traumatic event that affects the person day to day living after the event. PTSD is characterized by the re-experiencing of traumatic event, usually by having nightmares, intrusive thoughts, avoidance of the triggers or stimuli associated with the event and symptoms of extreme hyper vigilance
The patients name is Carl, and he is middle age Native American Indian. He is married and has kids. He is currently working as a social worker helping other veterans to deal with their issues with PTSD. He joined Army when he was 17 and got an MOS as an aircraft controller. His first assignment was to assign people to different combat zones, and then review the casualty list, he found that assignment a specially distressing then transferred to direct combat assignment.
Demographic section of the program suggested that 15% of Vietnam veterans suffered from PTSD 15 years after the war, also Men are most likely suffer from PTSD related to combat exposure. Another assumption that we could make is that Carl did mention that he was from lower social economical class when he was growing up, I don’t believe that in this particular case his social economical status predisposition him to develop PTSD, but it most certainly pushed him to join the military.
Carl reports that he has been exposed to more than event during his deployment to Vietnam. In the interview he talked about the people back home wanting to know about the killing so on his next deployment he took pictures. When he showed the people the pictures they were horrified and did not want to talk with him again about the killings.
2. There were not hospitalizations for other illnesses in the video interview. It may be of the coping mechanisms that the patient developed. But the reported incidents reflect a different psychosis diagnosis. The patient appears to be in good health otherwise. The trauma may exacerbate in physical symptoms at a later date so that physicals should be scheduled every six months to rule out any disease conditions.
3. The diagnosis of PTSD is far reaching and difficult to live with as a family member of the patient also. Having known some men that have returned from Vietnam the breakup of the family is usually the result and the patient turns to alcohol or drugs to comfort the nightmares. It seems that the men were unable to sleep well. People in his family were also afraid to sleep because he would wake up in the middle of the night and think that he was on a killing mission. The whole family needs to go through counseling and not just the patient.
1. No problem killing -he just didn't did the job as well as I did. This is the sentiment that the patient felt. He was given a job to do and did it better than the person who was killed. It appears as though he had little or no emotional attachment to the fact that he killed another person. It was a kill or be killed mentality.
3. Describe any information you have observed about the development of the disorder. The disease seemed to have grown when he returned home and there was no one to talk to about the issues. He said that everyone wanted to know how many people he killed. An understanding of factors affecting treatment of PTSD is difficult for sufferers to obtain
1. There did not appear to be other medical conditions associated with the PTSD. Some of the effects of the determinants of PTSD do appear in this patient though as he is experiencing depression and anxiety. There are no reports of drug use or alcohol. Eating disorders can be evident but they are not exacerbated in this patient. Suicidal thoughts and actions appear often though
2. Did you observe any evidence of any psychosocial and environmental problems that might contribute to the disorder? The feelings of isolation added to the sense of not belonging in the home area. Also the belief of the people who questioned him about the killing seemed to be unbelievable to the soldier who was forced to face the worst of humanity.
3. Based on your observations, how would you rate the client’s overall functioning on a scale of 1-100. Please use a 1-100 scale where higher numbers indicate higher functioning. The client appeared to be functioning at a very high level but the deeper problems cause concern. For this reason I would rate his overall functioning at a 75 because the deep seated problems may cause concern in some unrelated issues. The former soldier needs a great deal of therapy to rid him of the feelings of estrangement . The hijacking of the brain as PTSD is called can affect the brain's overall functioning and requires a chronic stress response. This is the same as the fight or flight response. Life becomes a constant struggle that involves unbearable tension and emotional as well as physical exhaustion. Severe dissociative symptoms have been made known as a person cannot tolerate the traumatic experiences.
1. In your opinion, what are the appropriate short-term (1-3 months) goals for this intervention? The short term goals would be to begin a therapeutic treatment sessions. The sessions will begin with the facing of the issues with a fear desensitized approach. Since PTSD affects millions there are several different treatment theories and plans. In the short term, a complete psychological testing for the symptoms should be undertaken, as well as a physical exam. The patient needs to describe the event in clear and with as much detail as possible additionally with as much regard to the feelings at the time. Chemical dependency testing and groups therapy assignments need to be undertaken .
2. In your opinion, what are the appropriate long-term (6 months – 1 year and beyond) goals for this intervention? Long term approaches are contingent upon the fear resolution in the first 6 months. After the completion then the therapy will be conducive to successful facing the cause of the fear and adjusting to living in society in which those skills that were necessary as a soldier are not needed. It is important in the long term to lower the negative effect that the traumatic killing has caused on the patient. The patient needs to develop coping skills to carry out normal duties that do not involve killing but are needed for a role in society. The patient has to be able to talk about the killing in a perspective that does not raise emotional levels to the point of overtaking the narration as well as stopping any destructive behavior that might be elicited upon the retelling of the incidents.
The cessation of the destructive behaviors over the long term is the end results of the therapy. They are to be replaced by positive behaviors that can produce healing and acceptance of the past and be able to function in a high level in normal society.
3. Which therapeutic strategy or strategies seem most appropriate in this case (e.g group therapy, CBT, psychodynamic therapy, family therapy, and psycho pharmaceutical therapy)? Why?
There are three steps in the therapy of the patient. First is to help him learn to relax or systematic desensitization. The second step is to work with the patient to establish a fear hierarchy. This hierarchy is a list of fear provoking stimuli starting with those that are worse. And the third step is to systematically expose the victim to fear provoking stimuli.
2. Did you observe any evidence of any psychosocial and environmental problems that might contribute to the disorder? The flashbacks and feelings of re-experiencing the incidents occur at various times . This feeling of being back in the moment is a problem for most sufferers of PTSD.
3. Based on your observations, how would you rate the client’s overall functioning on a scale of 1-100. Please use a 1-100 scale where higher numbers indicate higher functioning.
PTSD is a never ending battle and as such the patient is at about a 75% functioning level to be able to obtain a level in society in which the PTSD does not intervene with normal functioning. Sometimes the uses of pharmacological interventions are possible without clustering effects . the patient needs to undergo more intense group counseling and emotional testing to acclimate to a society that thinks that killing is not an acceptable societal norm.
However, mindfulness based stress reduction with present centered group therapy on an ongoing basis is what several therapists are recommending.
3. Which therapeutic strategy or strategies seem most appropriate in this case (e.g group therapy, CBT, psychodynamic therapy?
Mindfulness based interventions may be acceptable for evidence based treatment for PTSD . Using this technique managed to measure an improvement of PTSD symptoms. A model for treatment is using group therapy for approximately one year. They meet in 16 weeks segments to offer intense group therapy sessions. Long term psychotherapy reduces the intensity of PTSD symptoms. Neurotic symptoms begin to diminish not disappear but positive steps are seen in their reduction.
The diagnosis of PTSD affects the whole community and is a problem that requires vigilant attention to the attendance of group therapy sessions. Family therapy is an important consideration. The solider is taught to kill as part of their job and as such the training is well received in the war zone. Turning off this training in regard to societal norms is not an easy task. However, successful treatment options are available. They are successful but not easy. It is to the credit of the soldier who is able to redirect his training to accomplish a successful transition to family life. The movie of American Sniper brings to light the problems that many veterans have in successfully rejoining life as a former soldier.
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