Post Traumatic Stress DisorderVirtual Reality Treatments

Yahira Lugo-Lugo & Melissa Hennion

Virtual Reality Process for the clients

Pharmacological Treatments for ages 10 +

Alternative Treatment for ages 4-9

Antecedent

Abstract Bullets

References

Conclusion

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders.

Arlington, VA : American Psychiatric Association.

Cooper, J., Carty, J., & Creamer, M. (2005). Pharmacotherapy for posttraumatic stress disorder: empirical review

and clinical recommendations. Australian & New Zealand Journal of Psychiatry, 39(8), 674-682.

doi:10.1111/j.1440-1614.2005.01651.x

Massad, P., & Husley, T. (2006). Exposure Therapy Renewed. Journal of Psychotherapy Integration , 417-428.

doi 10.1037/1053-0479.16.4.417

Preston, J., O'Neal, J., & Talaga, C. (2010). Handbook of clinical psychopharmacology for therapist sixth

edition. Oakland, CA: New Harbinger Publications.

The DSM–IV-TR assumes that Acute Stress

Disorder was present in any person who

meets the diagnostic criteria for Post

Traumatic Stress Disorder.

•Conduct Disorder is currently the “most common psychiatric

disorder in youth and is one of the most frequent reasons for clinical

referral to child and adolescent treatment services, encompassing

one-third to one half of all referrals (Tcheremissine & Lieving,

2006).

• 70 % of Children age 4-9 are more likely to be diagnosed with

Conduct Disorder (Short & Shapiro, 1993)

•Among the most well-demonstrated antecedent and covariates of

conduct disorders are parent and family characteristics, behaviors and

an important factor in the recovery of clients with conduct disorder is

the parent-child interactions (Short & Shapiro, 1993).

•Rates of diagnosed conduct disorder are lower in females than

males. However females with this disorder are more likely to attempt

suicide (Tcheremissine & Lieving, 2006).

•Parent Management Training (PMT) aims to effect change in

children’s behavior and adjustment by modifying aspects of the

family environment that maintain and reinforce a child’s problem

behaviors (Sanders, 1992).

•Behavioral family interventions (BFI) also known as Behaviorism is

one of the most effective Non- Pharmacological treatments available

for children under the age of ten.(Tcheremissine & Lieving, 2006).

•In spite of progress in the field of pediatric psychopharmacology

there are still no medications licensed for the treatment of conduct

disorder (Tcheremissine & Lieving, 2006)

•Children ages ten to eighteen have shown positive changes in

behavior from continued pharmacological interventions, even though

there is not a preferred medication (Tcheremissine & Lieving, 2006).

•It might be equally important to develop a parent training with

Behavior Modification principles with a curriculum that teaches the

skills of clear and appropriate discipline for parents and teachers of

conduct disordered youth (Jewell & Beyers, 2008).

Conduct Disorder is currently the “most common psychiatric

disorder in youth and is one of the most frequent reasons for

clinical referral to child and adolescent treatment services,

encompassing one-third to one half of all referrals (Tcheremissine

& Lieving, 2006)”. The DSM–IV-TR assumes that Operant

Defiant Diagnosis is always present in youth who meet diagnostic

criteria for Conduct Disorder (2000). The differences between the

two diagnosis are just a few symptoms which makes treating the

disorder in many instances more difficult. 70.0% of children who

met criteria for Conduct Disorder during ages one to thirteen, did

so for the “first time during ages four to nine” (Short & Shapiro,

1993).Once parents are told about the onset of conduct disorder,

they generally “avoid psychopharmacological interventions in

children ten years of age or younger (Tcheremissine & Lieving,

2006)”. There is very little research on the validity and

effectiveness of pharmacological interventions on children under

the age of ten. Leaving clinicians ‘and parents to try alternative

methods, which require further participation from other members

of the client’s daily life for treatment to be successful in the

client. This participation must be all inclusive from all avenues

of the clients’ life. If the client is attending school outside of the

home, a teacher will need to be given the tools to better

understand the child’s conduct disorder and the techniques being

utilized by the parents and other people in the clients’ life. The

teacher should utilize Behavior Modification Principles for

children with Conduct Disorder. These Children exhibit

“antisocial behaviors in sufficient frequency and intensity

significantly affecting their educational performance and

interpersonal interactions (Short & Shapiro, 1993)”. One

approach to preventing or treating conduct problems has been to

provide interpersonal skills training to the affected youth and

their families. This approach is also known as Behavioral family

interventions (BFI) which aim to effect change in “children’s

behavior and adjustment by modifying aspects of the family

environment that maintain and reinforce a child’s problem

behaviors (Sanders, 1992).The theoretical rationale for the skills

training approach is the belief that a lack of interpersonal and

problem solving skills is the primary cause of behavior problems

(Tcheremissine & Lieving, 2006) in some conduct disorder

diagnosed children under age ten. Modifying these behavioral

patterns early with parental training could be essential in

decreasing the onset of future behavioral problems in children

under the age of ten.

Failure to recognize and deal with Conduct Disorder

and its associated problems may have serious and

extensive consequences for schools, communities,

and society. Studies have shown that children with

Conduct disorder are more likely to be suspended,

drop out of school, or are remanded to the juvenile

justice system (Sanders, 1992; Short & Shapiro,

1993; Tcheremissine & Lieving, 2006),others

receive community-based mental health and social

services. In many cases, these children grow to

adulthood to become liabilities. The DSM-IV-TR also

states that if untreated conduct disorder in childhood

and adolescence will turn into adult Antisocial

Personality Disorder (2000). Because the behaviors

of these children are significant, changing a clients

and their families behaviors at a young age is

essential in changing the way the families behaviors

are developing. Children with Conduct Disorder

often have “recurrent bad behaviors and are

frequently resistant to classroom interventions

(Tcheremissine & Lieving, 2006).Teachers and

parents constitute an important dimension of

treatment for children under the age of ten with

Conduct Disorder.

The purpose of behavior modification is to reshape behavior (i.e., to change

pupils' undesirable classroom behavior to desirable) and is effected through

four "simple" steps.

The first step is identification of the behavior problem itself. Teachers

must identify the behavior they find undesirable. The key is to be specific. It

is insufficient, for example, for teachers to say that Sarah misbehaves. Rather,

pinpoint the specific way(s) she misbehaves (i.e. does she come to class late;

does she talk out of turn; does she sleep in class?).The more specific the

behavior is identified, the better.

The second step is identification of the appropriate behavior. Teachers

must identify the specific way(s) they want the pupil to act. In almost every

case, such identification is the reverse of step one (i.e. she is prompt and on-

task.)

The third step is the use of reward. When the pupil behaves in the way

that was spelled out in the second step, teachers must reward him/her.

The quickest and surest way of eliminating misbehavior is rewarding its

opposite. So when Sarah comes to class on time and is rewarded for arriving

on time, she is more likely to repeat the behavior again in the future. Teachers

also need to reinforce other good behaviors that are occurring during the class

time as well for this process and the behaviors to change the client. Omitting

rewards for positive behaviors in class can lead to new problem behaviors.

The fourth and final step is the use of extinction procedures to help

eliminate the inappropriate behavior identified in the first step. The key

words are to help eliminate.

Pupils can be conditioned to act in desirable ways if teachers reward them for

acting in these ways. Then, as pupils begin to be conditioned, their need for

reward lessens. At first, Sarah needs immediate and frequent payoffs for

arriving on time. Later, as she gradually becomes conditioned to arriving on

time, the payoffs can and should become less frequent. Finally, it is hoped,

the conditioning process will work so well that payoffs will no longer be

necessary.

The key to behavior modification is not the use of punishment, but the use of

reward

Researchers have utilized a form of therapy when treating a youth

clients with trauma’s called exposure therapy. The idea of exposure therapy is

to extinguish the anxiety associated with the trauma. Functioning with severe

anxiety can make life nearly impossible for some clients. “The assumption is

that by exposing patients to feared stimuli in a safe context, their fear

responding will diminish (Massad & Husley, 2006). Also eliminating the

anxiety in relation to the trauma. One method of exposure therapy utilized for

youth is similar to the VR Treatment is systematic desensitization .

The clients anxiety should be overcome with “presentation of the

stimulus (Massad & Husley, 2006).” A counselor could begin with having the

client imagine the traumatic event. Teaching them breathing techniques to

help work through some of the initial anxiety. Once a client can remain calm

while having visualizations of the traumatic event, the counselor could present

a black and white photo that is similar to the traumatic event,. Once the client

can see the image in black and white a counselor should show the client a

colored photo. Followed by, a synthetic presentation of the trauma such as toys

in the room set up to look like the details of the trauma, that have been

released by the youth at this point. If the trauma is sexual, toys able to mimic

the positions the client has described, dressed with similar clothing to the event

of the clients memory, should trigger even further progress. Then a

presentation of a the real trauma. If the anxiety of the trauma is in relation to a

place, take the client to the place. Finally having the client touch a the building

safely can help to eliminate the anxiety associated with the location.

PTSD SYPTOMS THAT CAN ALSO RESPOND TO MEDICATION

TARGET SYMPTOMS

Intrusive experiences such as “flashbacks”a, avoidance and numbing

Hyperarousal c

Transient psychosis, marked derealization d

Nightmares

Treatment Resistant PTSD e

Depression a

Panic Attacks

CLASS OF MEDICATION

SSRI antidepressants, buspironeaugmentation of SSRI, second generation antipsychotics

Antidepressants, benzodiazepines, adrenergic agonists, anticonvulsants

Low- dose antipsychotics

Prazosin(Minipress)

Second generation antipsychotics anticonvulsants

Antidepressants

Antidepressants, MAO inhibitors

High potency benzodiazepines