Danell Pugh Exposure Therapy Treatment for PTSD
1. By: Danell Pugh Argosy University PSY 250 (Microsoft ClipArt, 2009) 2. Introduction Post traumatic stress disorder (PTSD) affects several people every year, including our military members who are returning from their tours over in Iraq and Afghanistan. According to Frueh, Grubbaugh, Elhai, & Buckley (2007), the number of veterans receiving compensation from VA for PTSD has increase 79.5% from 1999 to 2004. Exposure therapy has been shown to be an effective treatment in reducing the symptoms associated with this disorder. 3. Focal Question: How has exposure therapy proven as an effective treatment for Veterans who are suffering from PTSD? (Microsoft ClipArt, 2009) 4. Development of PTSD PTSD affects people who have been exposed to traumatic experiences, such as: military combat being kidnapped or taken hostage personal assault, terrorist attack confinement as a prisoner of war ((Rizzo, Pair, Graap, Manson, McNerney, Wiederhold, et al, n.d.). (Ruach, 2003) 5. Factors associated with PTSD According to the Department of Veterans Affairs (n.d.), there are several factors involved that can determine if one will exhibit the symptoms associated with PTSD, such as: Intensity of the trauma Length of the event Loss of a close family member or friend Proximity to the incident Amount of support after the event (Photographer unknown, n.d.) 6. Possible causes of increased PTSD Diagnosis The military members opposition does not wear a specific uniform; instead, they choose to dress like the regular civilians (Salvatore, 2009). This makes it more difficult in determining who the ally is versus the adversary. (Riley, 2008) 7. Another possible cause The tours have increased from a standard 12 month tour in Vietnam to tours in Iraq and Afghanistan that can last up to 18 months (Salvatore, 2009). In Vietnam, the Soldiers were deployed once and that was considered the end of their tour. With the current conflicts, Soldiers are deployed numerous times. The constant deployments increase their exposure to tragic events, thus increasing their risk of obtaining PTSD. 8. Diagnostic Measures for PTSD The Diagnostic and Statistical Manual of Mental Disorders , 4 th edition, composed by the American Psychiatric Association (1994) identifies six diagnostic measures for PTSD. Traumatic stressors: tragic experience Intrusive symptoms: flashbacks and nightmares Avoidant symptoms: avoiding painful triggers Hyper arousal: constant alertness, insomnia, irritability, extreme startle response Symptoms length: at least one month of symptoms Significance: suffers significant social, interpersonal, or work-related problems (Microsoft ClipArt, 2009) 9. Stigmas attached to Soldiers with PTSD The Soldier is afraid that their mental health appointment may negatively affect their career or they think that their leadership will treat them differently. These Soldiers do not want to be seen as weak and they are fearful that will happen if they seek assistance for their issues. 10. Stigma Study A study conducted by Wright, Cabrera, Bliese, Adler, Hoge, & Castro (2009) determined that the lowest stigmas and barriers to care scores were associated with a combination of high leadership ratings and high unit cohesion (p. 113). The results of this research were similar to others that had been performed. The stigma was related to the views that the Soldiers had of their leadership. Military member assigned to a unit with a positive environment, they were more likely to seek treatment; however, if they are in a unit with a negative climate, stigmas are more likely present. (Photographer Unknown, 2009) 11. Exposure Therapy: PTSD Treatment Exposure Therapy is one treatment that has been shown to effectively reduce the symptoms for veterans and military personnel who have been diagnosed with PTSD as a result of their deployments. Exposure therapy is a technique that is used to confront feared memories and thoughts. 12. Virtual reality Virtual reality(VR) is an exposure therapy technique that integrates real-time computer graphics, body-tracking devices, visual displays, and other sensory input devices (Ready, Pollack, Rothbaum, & Alarcon, 2006, p. 202). Main benefit of virtual reality exposure (VRE) therapy is that it desensitizes the Soldiers painful memories by allowing them to relive the situations in a safe environment (Ready, et al, 2006). (Jardin, 2009) 13. Exposure therapy study #1 A study conducted by Wood, Murphy, Center, McLay, Reeves, Pyne, et al, (2007), located a Veteran volunteer to undergo virtual reality graded exposure therapy (VRGET) in ten, 90-minute sessions in order to decrease his PTSD symptoms. The overall conclusion for this study was that VRGET was shown to decrease PTSD patients skin conductance and heart rate, as well as increase temperature. These factors mean that the patient was less aroused by the original stressors (Wood, et al, 2007). (Liewer, 2008) 14. Exposure Therapy Study #2 A study conducted by Reger and Gahm (2008) placed a PTSD diagnosed Veteran in six, 90-minute sessions of virtual reality treatment. As a result of the exposure therapy, the patient reported a meaningful decrease in problematic symptoms, increased socialization, and improved functioning. He returned to previously enjoyed hobbies and improvements in functioning were also reported by family members (Reger & Gahm, 2008, p. 944). 15. Exposure Therapy Study #3 A study conducted by Ready, Pollack, Rothbaum, and Alarcon (2006), examined 16 patients and placed them in 8 to 20 virtual reality exposure sessions as determined by standardized tests. The results of this study showed that fourteen of the sixteen patients revealed a decrease in symptoms after their treatments had ended. 16. Conclusion It is apparent that exposure therapy is an effective procedure in reducing the symptoms of PTSD. Our countries heroes no longer have to suffer with this mental illness. There are helpful treatments available. Frey (2003) suggests that patients who receive treatment directly after the trauma occurs, has the best possibility of making a full recovery. (Jardin, 2005) 17. References: American Psychiatric Association. 309.81 Posttraumatic Stress Disorder. In: Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition. American Psychiatric Association, Washington 1994:424-429. Retreived on 4 June 2009, from http://www.cirp.org/library/psych/ptsd2/ . Department of Veterans Affairs, (n.d). National center for PTSD factsheet. Retrieved on 4 June 2009, http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_what_is_ptsd.html . Frey, R. (2003). Post-traumatic stress disorder. In M. Harris & E. Thackerey (Eds.) The Gale Encyclopedia of Mental Disorders , 2 (pp. 776-781) Detroit: Gale Retrieved May 27, 2009, from Gale Virtual Reference Library via Gale: http://go.galegroup.com/ps/start.do?p=GVRL&u=lirn_main . Frueh, B.C.,Grubaugh, A.L., Elhai, J.D., & Buckley, T.C.(2007). US Department of Veterans Affairs Disability Policies for Posttraumatic Stress Disorder: Administrative Trends and Implications for Treatment, Rehabilitation, and Research. American Journal of Public Health, 97 (12),2143-5. Retrieved May 27, 2009, from ProQuest Psychology Journalsdatabase. (Document ID:1392878281). Jardin, X., (2009). Virtual Reality Therapy for Combat Stress. Retrieved on 25 June 2009, from http://www.npr.org/templates/story/story.php?storyId=4806921 . Jardin, X., (2005). VR goggles heal scars of war.. Retrieved on 25 June 2009, from http://www.wired.com/science/discoveries/news/2005/08/68575. 18. References: Liewer, S., (2008). Virtual reality goes to war vs. stress disorder. Retrieved on 23 February 2010, from http://www.signonsandiego.com/uniontrib/20080909/news_1n9virtual.htm. Microsoft ClipArt, (2009). Retrieved on 23 February 2010, from http://office.microsoft.com/enus/clipart/results.aspx?CategoryID=CM790019601033#1188 . Photographer unknown, (n.d.). Retrieved on 23 February 2010, from an email. Salvatore, R., (2009, May). Posttraumatic Stress Disorder: A Treatable Public Health Problem. Health & Social Work , Retrieved 5 February 2010, from Psychology and Behavioral Sciences Collection database. Rauch, Laura, (2003). First Day of the Ground War. Retrieved on 23 February 2010, from http://www.laurarauch.com/ . Ready, D., Pollack, S., Rothbaum, B., & Alarcon, R. (2006). Virtual reality exposure for veterans with posttraumatic stress disorder. Journal of Aggression, Maltreatment & Trauma , 12 (1), 199-220. Retrieved 5 February 2010, from PsycINFO database. 19. References: Reger, G., & Gahm, G. (2008, August). Virtual reality exposure therapy for active duty soldiers. Journal of Clinical Psychology , 64 (8), 940-946. Retrieved 5 February 2010 , doi:10.1002/jclp.20512. Riley, S., (2008). Iraq Pictures. Retrieved on 23 February 2010 , from http://iraqpictures.blogspot.com/. Rizzo, A., Pair, J., Graap, K., Manson, B., McNerney, P., Wiederhold, B., (n.d.). In M. Roy (Ed.) Nato Advanced Research Workshop on Novel Appraoches to the Diagnosis and Treatment of Posttraumatic Stress Disorder. (pp. 235-250). Washington D.C: IOS Press. Wood, D., Murphy, J., Center, K., McLay, R., Reeves, D., Pyne, J., et al. (2007, April). Combat-Related Post-Traumatic Stress Disorder: A Case Report Using Virtual Reality Exposure Therapy with Physiological Monitoring. CyberPsychology & Behavior , 10 (2), 309-315. Retrieved 5 February 2010 , doi:10.1089/cpb.2006.9951. Wright, K., Cabrera, O., Bliese, P., Adler, A., Hoge, C., & Castro, C. (2009, May). Stigma and barriers to care in soldiers postcombat. Psychological Services , 6 (2), 108-116. Retrieved 5 February 2010 , doi:10.1037/a0012620.