Brown, R. C., Witt, A., Fegert, J. M., Keller, F., Rassenfofer, M., & Plener, P. L. (2017). Psychosocial interventions for children and adolescents after man-made and natural disasters: A meta-analysis and systematic review. Psychological Medicine, 47(11), 1893-1905. Web.
Thulin, J., Kjellgren, C., & Nilsson, D. (2019). Children’s experiences with an intervention aimed to prevent further physical abuse. Child & Family Social Work, 24(1), 17-24. Web.
These two articles focused on different traumatic events that adversely affected individuals involved. On the one hand, Brown et al. (2017) considered large events, including natural disasters, war, terrorism acts, and accidents. A shared feature of all these phenomena is that they are unpredicted, uncontrolled, and involve multiple victims. Brown et al. (2017) mention that these events “often lead to psychiatric impairment in child and adolescent survivors,” while specific consequences include depression, anxiety, and others (p. 1893). On the other hand, Thulin et al. (2019) draw attention to physical abuse of children, which is a critical issue according to the World Health Organization. Since the traumatic event implies physical effects, psychological consequences also arise because this issue makes children experience “behavioral problems and trauma symptoms” (Thulin et al., 2019, p. 17). Thus, mass disasters and physical abuse adversely affect children and adolescents.
The selected articles comment on specific interventions to help the people overcome the consequences. Brown et al. (2017) focus on a few treatment options, including cognitive-behavioral therapy (CBT). Since mass disasters expose survivors to negative thoughts, depression, and anxiety, children require assistance to overcome them. That is why CBT provides children with psychoeducation, helps them acquire cognitive coping skills, and creates trauma narratives to turn adverse events they suffered into sense-bearing experiences (Brown et al., 2017). Thulin et al. (2019) advocate for using combined parent-child cognitive-behavioral therapy (CPC-CBT). This intervention is applied “to reduce parental violence, to increase the child’s well-being, and to support parents in developing nonviolent parenting strategies” (Thulin et al., 2019, p. 17). Consequently, CPC-CBT meets the children’s needs and helps manage psychological trauma symptoms because this intervention shares features of traditional CBT by including psychoeducation.
The articles under review have arrived at approximately the same conclusions regarding the interventions’ effectiveness. According to Brown et al. (2017), CBT leads to a substantial reduction of adverse symptoms. However, the researchers demonstrate that the intervention’s effectiveness significantly depends on the skill of social workers, meaning that a higher level of training leads to better results (Brown et al., 2017). Furthermore, there are no significant differences in the outcomes among CBT, eye movement desensitization and processing, and narrative exposure therapy for children (Brown et al., 2017). Thulin et al. (2019) rely on qualitative analysis of children’s responses to assess the effectiveness of CPC-CBT. The authors admit that the intervention led to positive transformations in families, which included violence cessation and improved parent-child relationships (Thulin et al., 2019). That is why it is possible to conclude that CBT and CPC-CBT are effective in managing traumas.
It is possible to mention that individuals’ needs do not significantly differ depending on whether a national or interpersonal trauma is involved. In particular, such events adversely affect people’s psychological well-being. Simultaneously, individuals start suffering from some trauma symptoms, including depression, anxiety, stress, and others. That is why it is possible to use similar interventions to help individuals overcome adverse challenges. However, the most evident difference refers to the fact that mass events do not guarantee physical harm, while this issue is a necessary consequence for physical abuse victims. This discrepancy results in the fact that physical abuse victims require an intervention that could protect them from the immediate harmful impact that comes from other people. Consequently, CPC-CBT involves both parents and children to ensure that the problem is addressed from both sides.
Kai’s diagnosis is F43.10 Posttraumatic Stress Disorder (PTSD) without any specifiers. Relevant Z codes include Z63.0 Relationship Distress with Spouse or Intimate Partner and Z65.5 Exposure to Disaster, War, or Other Hostilities.
According to DSM-5, multiple symptoms result in the fact that Kai is diagnosed with PTSD. Ten months ago, the patient returned to civilian life from Iraq War, where he was exposed to actual death. Kai currently has distressing dreams and efforts to avoid them. Simultaneously, Kai has a persistent negative emotional state, diminished interest in his sons’ lives, irritable behavior, and sleep disturbance. These conditions last for more than one month and lead to essential impairment in social and occupational areas. DSM-5 also stipulates that people with PTSD are often subject to some comorbidities. For Kai, they are F41.1 Generalized Anxiety Disorder because the patient suffers from feeling on edge, irritability, and sleep disturbance and F10.20 Alcohol Use Disorder since Kai and his wife report alcohol abuse.
Even though a few diagnoses have been identified, PTSD is the first area of focus. If I were Kai’s social worker, I would begin by introducing a specific intervention to address the given condition. According to research evidence, Eye Movement Desensitization and Reprocessing (EMDR) is among the most requested treatment options to address PTSD (van der Kolk & Najavits, 2013; Schnyder et al., 2015). In particular, van der Kolk and Najavits (2013) clarify that memory plays a crucial role in the condition because unprocessed memories result in the symptoms. The application of EMDR “facilitates connections to integrated semantic memory networks that provide corrective information, resulting in the internal generation of insights, changes to appropriate emotions, and the emergence of a coherent narrative” (Schnyder et al., 2015, p. 28186). Consequently, it would be reasonable to rely on this intervention while working with Kai.
Since the client showed symptoms of additional conditions, it would be required to address his diverse needs. It has been noted that Kai also suffers from Generalized Anxiety Disorder and Alcohol Use Disorder. That is why an appropriate treatment option is necessary to address these illnesses. According to McHugh et al. (2017), it would be reasonable to draw sufficient attention to addressing anxiety sensitivity. The rationale behind this statement is that this sensitivity can intensify deviant behaviors among people with substance abuse who were also exposed to a traumatic event (McHugh et al., 2017). This approach would result in a more comprehensive service for Kai.
Since EMDR was chosen as a primary intervention, it is necessary to comment on how its implementation. According to Schnyder et al. (2015), a treatment plan should include ensuring a client’s stabilization through clinical experiences, addressing memories, and promoting recommendations on how to involve in social interactions. This strategy would demonstrate that Kai would control his memories, mitigate symptoms, and could be a fully-fledged member of society and his family.
In conclusion, it is reasonable to comment on how I would evaluate treatment outcomes. For that purpose, it is necessary to rely on specific measurement tools. For General Anxiety Disorder, Hamilton’s anxiety rating scale is appropriate since this measurement tool is typically used to diagnose anxiety spectrum illnesses (Sudhir et al., 2017). For PTSD, the Davidson Trauma Scale is suitable because this 17-item self-report instrument allows for assessing the severity and frequency of trauma symptoms (Santarnecchi et al., 2019). It is necessary to use these measures both pre- and post-intervention to determine whether treatment options have led to any improvement.
References
McHugh, R. K., Gratz, K. L., & Tull, M. T. (2017). The role of anxiety sensitivity in reactivity to trauma cues in treatment-seeking adults with substance use disorders. Comprehensive Psychiatry, 78, 107-114. Web.
Santarnecchi, E., Bossini, L., Vatti, G., Fagiolini, A., La Porta, P., Di Lorenzo, G., Siracusano, A., Rossi, S., & Rossi, A. (2019). Psychological and brain connectivity changes following trauma-focused CBT and EMDR treatment in single-episode PTSD patients. Frontiers in Psychology, 10, 129. Web.
Schnyder, U., Ehlers, A., Elbert, T., Foa, E. B., Gersons, B. P. R., Resick, P. A., Shapiro, F., & Cloitre, M. (2015). Psychotherapies for PTSD: What do they have in common? European Journal of Psychotraumatology, 6(1), 28186. Web.
Sudhir, P. M., Rukmini, S., & Sharma, M. P. (2017). Combining metacognitive strategies with traditional cognitive behavior therapy in generalized anxiety disorder: A case illustration. Indian Journal of Psychological Medicine, 39(2), 152-156. Web.
Van der Kolk, B., & Najavits, L. M. (2013). Interview: What is PTSD really? Surprises, twists of history, and the politics of diagnosis and treatment. Journal of Clinical Psychology, 69(5), 516-522. Web.