Eye Movement Desensitization And Reprocessing
Procedures for Assessment
Historically, the assessment process to determine diagnosed criteria for PTSD is completed by client self-reports and through therapist/provider interviews. There are limitations to this type of assessment as the primary information is derived from the client. Accurate information of their symptoms can be misrepresented or inaccurate. Relying on clients to recall a month long of their symptoms when they could be experiencing concentration abnormalities is generally not an effective means of collecting accurate information. A fundamental concern revolved around many clients having memory difficulties or simply not remembering all of their symptoms which can lead to misdiagnosis. In addition, many of the symptoms …show more content…
of PTSD are shared with other mental health diagnoses which make it additionally challenging to diagnose correctly. The psychological community was aware of these limitations and created a more measurable standard to evaluate for PTSD. The Clinician-Administered PTSD Scale or (CAPS) is a thirty item organized questionnaire designed to minimize misdiagnosis. The CAPS is seen as the optimum standard used in the field for screening for PTSD. The CAPS questionnaire was assembled to coincide with the diagnostic criteria found in the DSM-5 which allows for fluidity and clear cut acknowledgment of rule-out or rule-in guidelines for PTSD (Bauer et al., 2013).
Current Empirically Validated Treatments
Trauma Based Cognitive Behavior Therapy (CBT) is the most common therapeutic intervention for the treatment of Posttraumatic Stress Disorder. The basis for CBT is to educate the client that their thoughts, feelings and actions are correlated. The goal is for the client to understand how to acknowledge and recognize triggers and utilize resiliency by introducing a support system of protective factors. With CBT, there are specific treatment objectives that are created cooperatively between the therapist and client. During the client’s personal time away from sessions, the clients are actively keeping written documentation about their day and symptoms. This data is then utilized to measures progress or lack thereof during treatment planning (Urdang, 2008). In some cases CBT alone is not as effective as combining CBT with psychiatric treatment.
A study was conducted with survivors from the September 11, 2001 World Trade Center Terrorist Attack in which 37 adult survivors participated from December 2004 to February 2009. The study was conducted by Franklin R. Schneier, M.D., Professor of Clinical Psychiatry at Columbia University. The participants were divided into two groups. One group was treated with CBT and SSRI paroxetine medication and the controlled group was given a placebo and had CBT treatment only. The overall conclusion to the study was that there were significant gains in overall well-being for those that had combined treatment with psychiatric medication and CBT. This data was scored by utilizing a pretest CAPS exam and a posttest CAPS exam following the completion of the study. The study had limitations such as a small sample size which was due to the criteria of being a survivor of 9/11. In addition, there was difficulties with the location of the study and transportation. Furthermore, some participants did not agree to take medication. However, despite the limitations of this study, it provided data with an understanding that a combined approach to PTSD may prove effective for some clients (Combined Trauma-Focused CBT Plus Paroxetine for Terrorism-Related PTSD, 2012).
An alternative to CBT treatment is Eye Movement Desensitization and Reprocessing (EMDR) treatment.
EMDR was created by Dr. Francine Shapiro in 1990. This treatment is utilized to assist with symptoms of PTSD. When a traumatic memory or an unpleasant thought is introduced, these feelings can overpower one’s natural copings skills. The goal of EMDR is to reduce prolonged negative effects of damaging thoughts by creating positive coping mechanisms. EMDR treatment encompasses an eight phase plan which includes having the client retell their trauma while receiving sensory input that includes side to side eye …show more content…
movements.
Skeptics of this theory challenged the core foundation of the treatment by indicating that eye movements did not play a pivotal role and were purely hypothetical which makes testing the theory difficult. In addition, Dr. Shapiro was also heavily criticized for extending the duration and expenses of EMDR training making certification challenging. Many speculated that Dr. Shapiro took these actions as retribution for criticism about the effectiveness of EMDR treatment (Bardin, 2004).
Effects of the Disorder on Family and Caregivers
Sareen (2014) explains the impact of PTSD to society.
There is a strong association between PTSD and suicidal behavior, struggles with interpersonal problems, parenting difficulties, obesity, sleep disturbances, reductions in household income, and physical and mental health comorbidities. Self-medication of PTSD via the abuse of alcohol and drugs is also evident. As a result, there a substantial effect on the lives of not only those suffering from PTSD but also on the individual’s family and caregivers.
McFarlane and Bookless (2001) agreed that the impact of PTSD on personal relationships can be a major stressor. As a result, they conducted a longitudinal study analyzing these elements. Within this research, aspects of three points in time were evaluated; pre-traumatic being baseline behaviors prior to any traumatic incident, epi-traumatic which is identified as the point in time when the traumatic incident is happening or in the present, and post-traumatic in which the trauma had already occurred. People have a baseline way of managing relationships prior to their trauma which is usually symbolic of how one was raised. In due course, the traumatic event may cover these pre-traumatic ways of managing relationships with new ways of behaving. As a result, PTSD can be debilitating to one’s attachment behavior that is essential for affection. Ray & Vanstone (2009) refers to this concept as emotional numbing which can affect family
members just as negatively as anger.
Ray & Vanstone (2009) further argue that PTSD does not affect just the individual but that it impacts the health and well-being of all members of the family. The way the family functions as a unit is negatively impacted by the lack of family unity, parenting gratification, marriage satisfaction, and emotional security of the children. As a result, the study highlights the importance of having supportive family and friends when recovering from PTSD. There is a strong correlation between negative PTSD treatment outcomes and individuals without a support system. Consequently, the study recommends that effective treatment include friends and family as they must also heal. However, the treatment focus should remain on the helping sufferers improve their relationships with their existing social support system as well as helping them expand and form new relationships to serve as protective factors.
Potential Roles for Social Workers in Treatment
Social Workers play a pivotal role in the treatment and prevention of PTSD for their clients. A key objective for social workers and clinicians is to understand how to effectively take care of themselves as well as their clients. A majority of the people who become involved with trauma work are those who have been impacted by trauma in some form (Van der Kolk & Najavits, 2013). However, in some cases, the process of helping trauma victims can cause secondary traumatic stress. As clients discuss their trauma, social workers can be impacted by the distressing events and face an elevated risk of developing PTSD themselves. Adams (2007) stated that active social workers were twice as likely as the general population to experience PTSD. The Newsweek article shared that Social Workers often mistake their own symptoms for exhaustion instead of trauma and suggested that social workers learn to identify and treat their own problems.
In addition, Socials workers should be creative and passionate about trauma treatment for their client. They cannot erase past trauma. However, they can help instill protective factors into the daily routines of their clients to counteract against the symptoms of PTSD. A social worker’s job is to empower, motivate, and support their clients to reach their goals despite their traumatic pasts. They should work with clients to develop a treatment plan focused on overcoming their adverse conditions. The main idea being to break the cycle of chaos with the notion that they do have control and do not need to be prisoners to their past. Social workers need to ensure that clients do not use their traumatic history as a crutch to support negative choices. Instead, past trauma should be used to fuel their success and stop the cycle of despair.
Social Workers should look at all aspects of a client’s life when making decisions regarding treatment as what could be considered an influential factor for one client, may have little effect on another. Social Workers must offer hope and introduce coping mechanisms. Moreover, since the family and caregivers of those with PTSD are significantly impacted, treatment should also include focus on strengthening the client’s relationship with their existing support system and help them expand their support system to new areas.
Lastly, as social workers, more attention should be focused on continuity of care for clients. The ability for clients to have a consistent therapist or clinician can make a significant difference in their overall treatment. The hassle of clients having to retell their traumatic story to another new therapist can be a barrier to success. This process tends worsen their symptoms and weakens the chances of continued treatment. The turnover at various mental health clinics is a significant problem that does not get the attention it should. From a policy standpoint, there may be room for discussions regarding six month contracts for therapists prior to leaving the agency.
Historically, the assessment process to determine diagnosed criteria for PTSD is completed by client self-reports and through therapist/provider interviews. There are limitations to this type of assessment as the primary information is derived from the client. Accurate information of their symptoms can be misrepresented or inaccurate. Relying on clients to recall a month long of their symptoms when they could be experiencing concentration abnormalities is generally not an effective means of collecting accurate information. A fundamental concern revolved around many clients having memory difficulties or simply not remembering all of their symptoms which can lead to misdiagnosis. In addition, many of the symptoms …show more content…
of PTSD are shared with other mental health diagnoses which make it additionally challenging to diagnose correctly. The psychological community was aware of these limitations and created a more measurable standard to evaluate for PTSD. The Clinician-Administered PTSD Scale or (CAPS) is a thirty item organized questionnaire designed to minimize misdiagnosis. The CAPS is seen as the optimum standard used in the field for screening for PTSD. The CAPS questionnaire was assembled to coincide with the diagnostic criteria found in the DSM-5 which allows for fluidity and clear cut acknowledgment of rule-out or rule-in guidelines for PTSD (Bauer et al., 2013).
Current Empirically Validated Treatments
Trauma Based Cognitive Behavior Therapy (CBT) is the most common therapeutic intervention for the treatment of Posttraumatic Stress Disorder. The basis for CBT is to educate the client that their thoughts, feelings and actions are correlated. The goal is for the client to understand how to acknowledge and recognize triggers and utilize resiliency by introducing a support system of protective factors. With CBT, there are specific treatment objectives that are created cooperatively between the therapist and client. During the client’s personal time away from sessions, the clients are actively keeping written documentation about their day and symptoms. This data is then utilized to measures progress or lack thereof during treatment planning (Urdang, 2008). In some cases CBT alone is not as effective as combining CBT with psychiatric treatment.
A study was conducted with survivors from the September 11, 2001 World Trade Center Terrorist Attack in which 37 adult survivors participated from December 2004 to February 2009. The study was conducted by Franklin R. Schneier, M.D., Professor of Clinical Psychiatry at Columbia University. The participants were divided into two groups. One group was treated with CBT and SSRI paroxetine medication and the controlled group was given a placebo and had CBT treatment only. The overall conclusion to the study was that there were significant gains in overall well-being for those that had combined treatment with psychiatric medication and CBT. This data was scored by utilizing a pretest CAPS exam and a posttest CAPS exam following the completion of the study. The study had limitations such as a small sample size which was due to the criteria of being a survivor of 9/11. In addition, there was difficulties with the location of the study and transportation. Furthermore, some participants did not agree to take medication. However, despite the limitations of this study, it provided data with an understanding that a combined approach to PTSD may prove effective for some clients (Combined Trauma-Focused CBT Plus Paroxetine for Terrorism-Related PTSD, 2012).
An alternative to CBT treatment is Eye Movement Desensitization and Reprocessing (EMDR) treatment.
EMDR was created by Dr. Francine Shapiro in 1990. This treatment is utilized to assist with symptoms of PTSD. When a traumatic memory or an unpleasant thought is introduced, these feelings can overpower one’s natural copings skills. The goal of EMDR is to reduce prolonged negative effects of damaging thoughts by creating positive coping mechanisms. EMDR treatment encompasses an eight phase plan which includes having the client retell their trauma while receiving sensory input that includes side to side eye …show more content…
movements.
Skeptics of this theory challenged the core foundation of the treatment by indicating that eye movements did not play a pivotal role and were purely hypothetical which makes testing the theory difficult. In addition, Dr. Shapiro was also heavily criticized for extending the duration and expenses of EMDR training making certification challenging. Many speculated that Dr. Shapiro took these actions as retribution for criticism about the effectiveness of EMDR treatment (Bardin, 2004).
Effects of the Disorder on Family and Caregivers
Sareen (2014) explains the impact of PTSD to society.
There is a strong association between PTSD and suicidal behavior, struggles with interpersonal problems, parenting difficulties, obesity, sleep disturbances, reductions in household income, and physical and mental health comorbidities. Self-medication of PTSD via the abuse of alcohol and drugs is also evident. As a result, there a substantial effect on the lives of not only those suffering from PTSD but also on the individual’s family and caregivers.
McFarlane and Bookless (2001) agreed that the impact of PTSD on personal relationships can be a major stressor. As a result, they conducted a longitudinal study analyzing these elements. Within this research, aspects of three points in time were evaluated; pre-traumatic being baseline behaviors prior to any traumatic incident, epi-traumatic which is identified as the point in time when the traumatic incident is happening or in the present, and post-traumatic in which the trauma had already occurred. People have a baseline way of managing relationships prior to their trauma which is usually symbolic of how one was raised. In due course, the traumatic event may cover these pre-traumatic ways of managing relationships with new ways of behaving. As a result, PTSD can be debilitating to one’s attachment behavior that is essential for affection. Ray & Vanstone (2009) refers to this concept as emotional numbing which can affect family
members just as negatively as anger.
Ray & Vanstone (2009) further argue that PTSD does not affect just the individual but that it impacts the health and well-being of all members of the family. The way the family functions as a unit is negatively impacted by the lack of family unity, parenting gratification, marriage satisfaction, and emotional security of the children. As a result, the study highlights the importance of having supportive family and friends when recovering from PTSD. There is a strong correlation between negative PTSD treatment outcomes and individuals without a support system. Consequently, the study recommends that effective treatment include friends and family as they must also heal. However, the treatment focus should remain on the helping sufferers improve their relationships with their existing social support system as well as helping them expand and form new relationships to serve as protective factors.
Potential Roles for Social Workers in Treatment
Social Workers play a pivotal role in the treatment and prevention of PTSD for their clients. A key objective for social workers and clinicians is to understand how to effectively take care of themselves as well as their clients. A majority of the people who become involved with trauma work are those who have been impacted by trauma in some form (Van der Kolk & Najavits, 2013). However, in some cases, the process of helping trauma victims can cause secondary traumatic stress. As clients discuss their trauma, social workers can be impacted by the distressing events and face an elevated risk of developing PTSD themselves. Adams (2007) stated that active social workers were twice as likely as the general population to experience PTSD. The Newsweek article shared that Social Workers often mistake their own symptoms for exhaustion instead of trauma and suggested that social workers learn to identify and treat their own problems.
In addition, Socials workers should be creative and passionate about trauma treatment for their client. They cannot erase past trauma. However, they can help instill protective factors into the daily routines of their clients to counteract against the symptoms of PTSD. A social worker’s job is to empower, motivate, and support their clients to reach their goals despite their traumatic pasts. They should work with clients to develop a treatment plan focused on overcoming their adverse conditions. The main idea being to break the cycle of chaos with the notion that they do have control and do not need to be prisoners to their past. Social workers need to ensure that clients do not use their traumatic history as a crutch to support negative choices. Instead, past trauma should be used to fuel their success and stop the cycle of despair.
Social Workers should look at all aspects of a client’s life when making decisions regarding treatment as what could be considered an influential factor for one client, may have little effect on another. Social Workers must offer hope and introduce coping mechanisms. Moreover, since the family and caregivers of those with PTSD are significantly impacted, treatment should also include focus on strengthening the client’s relationship with their existing support system and help them expand their support system to new areas.
Lastly, as social workers, more attention should be focused on continuity of care for clients. The ability for clients to have a consistent therapist or clinician can make a significant difference in their overall treatment. The hassle of clients having to retell their traumatic story to another new therapist can be a barrier to success. This process tends worsen their symptoms and weakens the chances of continued treatment. The turnover at various mental health clinics is a significant problem that does not get the attention it should. From a policy standpoint, there may be room for discussions regarding six month contracts for therapists prior to leaving the agency.