Introduction
Humans grow in an environment with risk factors that may hurt their well-being and resilience factors to help them recover. Highly resilient people are surrounded by positive energy from healthy relationships, supportive families, effective communities, and healthy human brains. Social support is critical to overcoming psychosocial risks and thus attaining effective development.
This paper discusses integrating risk and resilience factors into the care delivery for people with post-traumatic stress disorder (PTSD). The discussion is about various risk factors of PTSD patients and psychosocial interventions that could ensure resilience for the patients. Thus, the best biopsychosocial interventions to promote resilience in PTSD patients are care coordination and exposure therapy.
Patient Type
PTSD is a mental health issue often triggered by an adverse event, either by witnessing or experiencing it. PTSD patients are, therefore, affected proportionately by the two terms of exposure (Coll et al., 2022). However, there is no guarantee that a person who experiences the terrifying event will be affected more than the one who witnesses it.
The most common symptoms of PTSD include nightmares, severe anxiety, flashbacks, and uncontrollable thoughts regarding the event. PTSD patients experience difficulties coping or adjusting to everyday life (Coll et al., 2022). For people with severe effects, the mental condition could last for months or years, significantly interfering with their daily functioning.
Risk and Resilience Promoting Factors
Oppression, Marginalization, and Privilege
There are a variety of risk factors that cause PTSD in the young and older populations. One of the risk factors is oppression, in which the patients might experience emotional or physical abuse, lack of social support from family and friends, or being denied basic needs and human rights (Sapiro & Ward, 2020). Some patients could also experience PTSD due to marginalization caused by racism, which leads to unstable mental health.
In some cases, marginalization could prevent access to proper healthcare after a traumatic event, thus leading to PTSD (Sapiro & Ward, 2020). Other risk factors of PTSD include having other mental health issues, such as depression and anxiety, and a family history of such or related mental health conditions. People with PTSD may be subjected to certain privileges, depending on the severity of the condition. If one is disabled because of PTSD and can no longer work, they could be entitled to supplemental security income (SSI) or social security disability insurance (SSDI) (Moss et al., 2019).
However, government employees often enjoy such benefits, especially those in military combat. In the workplace, people with PTSD are protected against harassment and discrimination based on their conditions or ability to work (Moss et al., 2019). The patients have workplace privacy and legal rights to get reasonable working plans to accommodate their mental health status.
Trauma and Adversity
People who experience long-lasting or intense trauma in childhood or adulthood may develop PTSD. Various types of traumatic events could increase the risk of PTSD. Such events are exposure to combat or dangerous law enforcement activities, physical or emotional abuse, an accident, sexual violence or harassment, physical assault, and being threatened with a weapon (Sapiro & Ward, 2020).
People may also witness adversities, such as witnessing someone being hurt or killed. For example, children from domestic violent homes may develop PTSD because they witness the abuse. The severity of these traumas and adversities determines the extent of PTSD in patients.
Strengths and Developmental Assets
Several resilience factors help PTSD patients to overcome or cope with traumatic events and their impacts. The primary resilience factor for the condition is social support (Forbes et al., 2020). PTSD patients could recover quickly by getting support from family, friends, and community members. Family and friends show love to the patient and encourage them to fight against the depressing stressors.
Another strength could be finding a support group for people with similar traumatic experiences (Forbes et al., 2020). It helps to learn that one is not alone in terrifying experiences, which could quicken recovery. Immediately after the traumatic event, the victims should find people with similar backgrounds and share their emotions. Such support helps the victims to learn how to feel good about their actions during the adverse event.
Some victims of traumatic events fall into depression because of blaming themselves (Moss et al., 2019). Therefore, learning to appreciate their actions and view them positively helps with recovery. Developmental assets that help overcome traumatic events are mindfulness, self-awareness, finding one’s purpose, and self-care. According to Masten (2015), individuals can discover resilience within themselves and their immediate environment. This is possible by believing in oneself, nurturing positive relations, and using available opportunities to cope with situations.
Cultural Components
Cultural practices and beliefs are critical in influencing the risk of developing and overcoming PTSD. A study by Koenig et al. (2019) shows that individualistic and collectivist cultures have different practices regarding seeking social support. An individualistic culture advocates for self-validation and keeping feelings to oneself. On the contrary, the collectivist culture encourages family and community functionalism, which strives to offer support (Koenig et al., 2019).
In other words, people from collectivist cultures have healthy family and community relationships that help them seek support when needed. Such people will likely seek social support upon experiencing or witnessing traumatic events. However, those from individualistic cultures will be reluctant to seek such support, thus getting PTSD more.
Resilience Promoting Interventions
Care Coordination Team
Care coordination entails the intentional organization of patient care activities and information sharing among the participating members of the team. This patient-centered intervention aims to achieve safer and more effective care for the sick (Imes et al., 2020). The essential care coordination team comprises the patient, primary care providers, mental health providers, specialists, social workers, and pharmacists. Some specialists, especially for PTSD, are health fitness coaches and nutritionists (Imes et al., 2020). Mental health providers are psychologists, licensed counselors, and psychiatrists.
The team collaborates by sharing roles and information about the patient’s changing needs, progress, and outcomes. The team is responsible for developing a coordinated care plan within which needs such as medical, fitness, and nutrition are specified according to the patient’s preferences and beliefs (Imes et al., 2020). Additionally, the team works with the patient’s family or friends to share information about the patient’s needs and progress.
Exposure Therapy
Exposure therapy is a systematic intervention that helps individuals with activities, events, or things that cause anxiety or fear. Often used to treat phobias and PTSD, psychologists and therapists create a safe environment that relates to the patient’s trauma to reduce triggered symptoms (Kothgassner et al., 2019). People with PTSD often avoid certain situations due to fear or avoid remembering them.
Exposure therapy believes that exposing these people to stimuli that cause distress in a safe environment may help them decrease avoidance and promote overcoming (Kothgassner et al., 2019). For example, a person with PTSD caused by a road accident may avoid boarding vehicles. Exposure therapy may incorporate such a setting to help the patient overcome this fear (Kothgassner et al., 2019).
Intervention Implementation at Micro and Mesosystem Levels
Care Coordination Team
Implementing care coordination intervention would require identifying patient needs, developing a care plan, sharing information, reassessing, and following up. For patients with PTSD, the coordinating team would need to identify their needs and preferences regarding the type of care to be given (Forbes et al., 2020). Using the collected information, the team would develop a holistic care plan considering resilience-promoting factors such as medication, diet, and fitness strategies (Forbes et al., 2020).
The microsystem level of ecological perspective involves individual interactions, especially conversations. At the microsystem level, the therapist would require the patient to talk with a trusted friend or family member. At the mesosystem level, two people from a microsystem level could perform the intervention, such as dancing. For example, the parent can dance with the child with PTSD to encourage them to reduce stress.
All the team members would take up their roles to deliver needed care. For example, health fitness would provide the patient with knowledge regarding exercises to maintain mental stability. The pharmacists would provide medication, while the nutritionists would advise on the best meals and beverages (Forbes et al., 2020). The care plan would be implemented in a continuous care process where information is shared across the team to inform the patient’s progress. All the coordinators should keep reassessing the patient’s needs with changes in patient progress.
Exposure Therapy
Implementing exposure therapy in healthcare would be convenient because of the systematic opportunities available. At the microsystem level, it would entail using an environment that causes patient stimulus one-on-one with the patient. In this case, the psychologist avails the stimulus environment to the patient and guides their emotions (Kothgassner et al., 2019). For example, the therapist holds the snake to trigger the patient’s emotions. Although this snake might not be alive or real, the patients can fight the negative emotions they feel upon seeing a snake.
Mesosystem levels of ecological perspective focus on the interaction of two microsystems: parents and schools. At the mesosystem level, the psychologist could expose the patients to a virtual reality experience where they watch their friends or family members do a fear-triggering activity (Kothgassner et al., 2019). For example, the virtual reality event could be designed to show the patient’s parents riding a car, where the patient cannot face moving vehicles.
Challenges in the Current Setting
The implementation process may face several challenges associated with a lack of specialists in the facility. The healthcare setting suits these interventions, but some specialists, such as psychiatrists and health fitness experts, could be problematic. Since the facility lacks these experts, the management must hire some. Hiring new workers incurs additional costs for the facility, making the treatment expensive. Another possible challenge would be the coordinators’ lack of collaboration skills (Forbes et al., 2020). If the team cannot share information adequately, the care delivery process could be slower and flawed.
Research Supporting Interventions
A study by Hall et al. (2019) discusses research on using trauma transitional care coordination intervention to protect vulnerable trauma patients from relapsing. The coordinated care program was formulated to support patients at high hospital readmission risk. The study aimed to find the effectiveness of this intervention by comparing its results to the results of readmission without its application.
The trial period was 30 days, and the coordinating teams collaborated in calling the patients, making appointments, and reconciling medication, among other things. The study results show that out of the patients incorporated in the program, 96.3% could be followed, and only 6.6% were readmitted to the hospital. Therefore, care coordination intervention was successful in reducing the level of hospital readmission for trauma patients.
A study by Kothgassner et al. (2019) tests the usefulness of virtual reality exposure therapy for PTSD patients. The research compared the outcome of PTSD symptoms treatment without VR and with VR to find the difference. The results showed better outcomes for PTSD symptoms using VR than without.
Personal Reflections
The process of doing this activity was exciting, and I had a few things to learn. Integrating the risk and resilience theory knowledge into a healthcare setting was challenging, but improved when I identified the patient type. One of the things I learned is that the care coordination team can only work if they are well-trained. I also learned that care coordination involves more than the patient and provider; it involves other people who help meet diverse patient needs.
Conclusion
In conclusion, the most effective biopsychosocial interventions for PTSD patients are coordinated care and exposure therapy. The two interventions, implemented from the micro and mesosystem levels of ecology, provide effective recovery for PTSD patients. PTSD patients could be affected by their experiences in traumatic events to the point of finding difficulties in functioning normally. Therefore, appropriate resilience-promoting interventions may help them quickly overcome these experiences and assume normal functioning.
References
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Forbes, D., Bisson, J. I., Monson, C. M., & Berliner, L. (2020). Effective treatments for PTSD. Guilford Publications.
Imes, R., Omilion-Hodges, L., & Hester, J. (2020). Communication and care coordination for the palliative care team: A handbook for building and maintaining optimal teams (1st ed.). Springer Publishing Company.
Hall, E. C., Tyrrell, R., Scalea, T. M., & Stein, D. M. (2019). Trauma Transitional Care Coordination: Protecting the most vulnerable trauma patients from hospital readmission. Trauma Surgery & Acute Care Open, 3(1), 1-4. Web.
Koenig, H. G., Youssef, N. A., & Pearce, M. (2019). Assessment of moral injury in veterans and active duty military personnel with PTSD: A review. Frontiers in Psychiatry, 10(1), 4-43. Web.
Kothgassner, O. D., Goreis, A., Kafka, J. X., Van Eickels, R. L., Plener, P. L., & Felnhofer, A. (2019). Virtual reality exposure therapy for post-traumatic stress disorder (PTSD): A meta-analysis. European Journal of Psychotraumatology, 10(1). Web.
Masten, A. S. (2015). Ordinary magic: Resilience in development. Guilford Publications.
Moss, J., Roberts, M. B., Shea, L., Jones, C. W., Kilgannon, H., Edmondson, D. E., & Roberts, B. W. (2019). Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: A prospective cohort study. Intensive Care Medicine, 45, 815-822. Web.
Sapiro, B., & Ward, A. (2020). Marginalized youth, mental health, and connection with others: A review of the literature. Child and Adolescent Social Work Journal, 37(4), 343-357. Web.