TRMA830 LUO Post Traumatic Stress Disorder Discussion

DISCUSSION ASSIGNMENTINSTRUCTIONS
In addition to carrying on the discussion in the thread you created, you will reply to 3 of your classmates threads. Each reply should have 200 words. All posts must be written in a substantive manner, without spelling and grammar errors, and must adhere to Student Expectations.

• Three discussion replies that directly address related discussion threads;

• Each discussion reply is a unique contribution that reflects thoughtful analysis of topic and discussion thread

• Spelling and grammar are correct. Sentences are complete, clear, and concise.

• Paragraphs contain appropriately varied sentence structures. Where applicable, references are cited in current APA format.

• Minimum word count of 200 words is met or exceeded

Please Respond to the following 3 discussions posts.

1. POSTED BY Ap C

F43.10 Post-Traumatic Stress Disorder (Renee)

A – 1 “She described her mother as unavailable, but when she did pay attention to her, she was mean and sometimes physically abusive.”

B – 1 Renee“recalled when she was 6 and wanted a kiss from her mother, she looked at Renee with disgust and screamed ‘what’s wrong with you!’”

B-2 Renee also experiences the intrusion symptom of prolonged psychological distress of fear, anger, and shame when she is exposed to normal childhood behavior from her young daughters and confronted with family relationships. These are triggering for her.

C – 1 “She has started to have fantasies of running away from her family.”

D-1 Renee has negative alternation of cognitions and mood as evidenced by exaggerated negative beliefs about herself. She hates herself for her trauma-related behaviors.

D-2 Renee has a persistent negative state of shame. She was initially embarrassed to talk about her trauma with her therapist and she believes something is wrong with her.

E-1 Renee has marked alteration in arousal and reactivity associated with parenting. She has angry outbursts and yells at her children when they are exhibiting normal developmental behavior.

E-2 Renee engages in self-destructive behavior by eating junk food all day and drinking at night. She does this to “deaden the pain”.

The interventions that are helping Renee heal from PTSD are journaling, self-compassion, self-acceptance, mindfulness, cognitive restructuring, a non-judgmental therapeutic relationship, and parts work.

Since Renee is connecting well with differentiating the part of her that defaults to the flight response to stay safe from the part of her that believes she needs to embrace vulnerability to heal, I would invite Renee to consider if her abusive mother assigned her a dysfunctional family role. Young children who are trying to get legitimate needs met may be assigned the role of “Black Sheep”, even though they have done nothing wrong (Applebury, 2020). Renee can break agreement with roles that do not accurately reflect her identity. Renee can give voice to the part of her that feels like a Black Sheep and the part of her that is realizing children have appropriate needs for nurturing from their parents.

Anger toward self and others who contributed to trauma is a common symptom of complex PTSD (Chu, 2011). To process the anger Renee feels toward herself, her mother (and perhaps her father, too), I would suggest a daily anger time of about 15 minutes to connect with and release her anger in healthy ways. I would provide Renee with a chart of different anger emotions ranging from frustration to seething. Renee can identify what anger emotion she is having on a daily basis, then release anger through somatic interventions like talking, writing, crying, praying, yelling (alone), exercise, hitting a pillow, breaking something not valuable, etc.

Renee can learn to recognize stress in her body when she is triggered by closeness to her husband and children. Once aware of the desire to run away, the rising tone of her voice, tension in stomach or shoulders, etc., she can thank her body for delivering the message of threat and then evaluate if actual threat exists. Assuming not, Renee can employ relaxation strategies to down-regulate sympathetic nervous system arousal (Sanderson, 2013) like grounding, diaphragmatic breathing, asking for hugs, listening to peaceful music, squeezing distressing emotions into a stress ball, or engaging in spiritual activity to calm the body and the mind.

If Renee is a Christian and wants her faith integrated into her therapy, she can study scripture to learn what healthy relationships look like. Romans 13:10 teaches, “Love does no harm” (New International Bible, 1978/2011). Renee can label her mother’s abusive behavior as abuse, and not love, to validate her experience. Wisdom from 1 Corinthians 13 and Proverbs 31 can illustrate characteristics of loving behavior.

References

Applebury, G. (2020). 6 Dysfunctional family roles and their characteristics. Webpage. https://family.lovetoknow.com/about-family-values/6-dysfunctional-family-roles-their-characteristic Links to an external site.

Chu, J. A. (2011). Rebuilding shattered lives: Treating complex PTSD and dissociative disorders. (2nd ed.). John Wiley & Sons.

New International Bible. (2011). Zondervan. (Original work published 1978)

Sanderson, C. (2013). Counseling skills for working with trauma: Healing from child sexual abuse, sexual violence, and domestic abuse. Jessica Kingsley Publishers.

2. Brit S Posted

Discussion Thread: Post-Traumatic Stress Disorder (Renee)

F43.10 Post-Traumatic Stress Disorder (Renee) – Bri

A – 4 (one required): Renee described her mother as “unavailable, but when she did pay attention to her, she was mean and sometimes physically abusive” (Schwartz, 2017, p. 130).

B – 1 (one required): Renee shared a memory of when “she was six and wanted a kiss from her mother, she looked at Renee with disgust and screamed ‘what’s wrong with you’” (Schwartz, 2017, p. 157).

B – 5 (two of one required): Renee shared that “she found herself shouting the very same words ‘what is wrong with you’ at her own children” (Schwartz, 2017, p. 157).

C – 1 (one required): Renee stated that she is“starting to have fantasies of running away from her family.” As a child “she would also fantasy about running away from her mother when she was abusive” (Schwartz, 2017, p. 130).

C – 2 (one required): She shared that “she is pushing her husband and children away” (Schwartz, 2017, p. 130). She has withdrawn from her husband who says, “he feels like he does not know her anymore” (Schwartz, 2017, p. 122).

D – 2 (one of two required): Renee stated that “she sometimes believes her children and husband would be better off without her” (Schwartz, 2017, p. 122). That she is “afraid I’m ruining my kids” (Schwartz, 2017, p. 122).

D – 3 (two of two required): Renee shared that“deep down I have always believed that there was something wrong with me” (Schwartz, 2017, p. 157).

D – 4 (three of two required): She expressed feelings of disgust and anger with her behavior and appearance “Why should I deserve love, look how fat and ugly I’ve become” (Schwartz, 2017, p. 134).

D–6 (four of two required): Renee shared that she is “afraid I’m pushing my husband so far away that he will leave” (Schwartz, 2017, p. 122).

D–7 (four of two required: Renee shared she does not feel deserving of love “How could she love herself for yelling at her kids” (Schwartz, 2017, p. 134).

E –1 (one of two required): Renee shared that “parenting her two young children was triggering her childhood memories” (Schwartz, 2017, p. 122).Her outburst of anger at her own children “screaming what is wrong with you” (Schwartz, 2017, p. 157).

E – 2 (two of two required): Renee started “using avoidance strategies of emotional eating and drinking alcohol to ‘hold herself’ together” (Schwartz, 2017, p. 122).

F – Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.

G –The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H –The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Current Interventions

Renee’s current interventions are addressing her symptoms of avoidance which stems from her childhood trauma. Her symptoms were described as denying her past, diminishing her distress, repressing her feelings, and numbing the pain with overeating and alcohol (Schwartz, 2017). The focus of her current interventions is on identifying her avoidance defenses, teaching her self-acceptance, and teaching her that a change is necessary so she can process the traumatic events without becoming overwhelmed by her emotions (Schwartz, 2017). The use of journaling allowed her to see some of her self-protection defenses that she had developed from her childhood trauma. By using these protective defenses she was pushing her husband and children away and journaling allowed her to recognize her critical thought patterns and feelings. Additionally, through the use of journaling, she started to accept herself and explore new positive ways of thinking about herself. This was difficult for Renee, and she employed grounding techniques and learned how to ask for help through therapy.

Recommendations

This author believes that Renee could benefit from Cognitive Behavioral Therapy (CBT) to address the negative beliefs that she has about herself. Using CBT with Renee would help her to address the relationship between her thoughts, feelings, and emotions” (Schwartz, 2017). Although this author is not trained in Eye Movement Desensitization and Reprocessing (EMDR) therapy it has been found very effective in treating PTSD. EMDR is a cognitive-focused based therapy where Renee would be asked to think about memories she has from her childhood while attuning to bodily sensations (finger tapping) and eye movement (Shapiro, 1990). Renee could additionally benefit from group therapy. Working in a group setting provides a safe environment where Renee will not feel so isolated, she can build trust, and connect with others who understand what she has been through (Sloan et al., 2012). Using additional mindfulness practices to bring her awareness to the present. Techniques such as body scanning, yoga, and deep breathing practices teach Renee some relaxation techniques to use when she is starting to become overwhelmed. Teaching these replacement behaviors allows Renee to work in the present breathing through and processing her emotions. Given the anxiety that Renee is experiencing, she may also benefit from pharmacological treatment in addition to therapy through the use of antidepressants such as particularly the SSRIs and SNRIs (Friedman & Bernardy, 2017). Additionally, if she is a Christian then speaking with her about her faith, and incorporating scripture in therapy may benefit her. Psalm 34:18 “The Lord is near to the brokenhearted and saves the crushed in spirit” (NIV Bible, 2001).

References

Friedman, M. J., & Bernardy, N. C. (2017). Considering future pharmacotherapy for PTSD. Neuroscience Letters, 649, 181–185. https://doi.org/10.1016/j.neulet.2016.11.048

New International Version Bible. (2001). NIV Online. https://www.biblegateway.com/

Schwartz, A. (2017). The complex PTSD workbook: A mind-body approach to regaining emotional control and becoming whole. Althea Press.

Shapiro, F. (1990). Eye movement desensitization and reprocessing procedure: From EMD to EMDR a new treatment model for anxiety and related trauma. Behavior Therapist, 14, 133–135.

Sloan, D. M., Bovin, M. J., & Schnurr, P. P. (2012). Review of group treatment for PTSD. Journal of Rehabilitation Research & Development, 49(5).

3. St S Posted

F43.10 Post-Traumatic Stress Disorder (Renee)

“Renee is a stay-at-home mother of two children who seems to have frustration, anger, and anxiety. She is struggling with disgust and anger at herself, memories of her father leaving when she was 2-years-old, and how her mother became emotionally unavailable and abusive to her. She is afraid that she is now pushing her husband and children away.”

A – 1: “she told me her father had left her mother when Renee was only two years old. She described her mother as unavailable, but when she did pay attention to Renee, she was mean and sometimes physically abusive” (Schwartz, 2016, p. 76).

B – 5: “I promised myself I would parent differently than I was raised, but I find myself saying the exact things my mother said to me” (Schwartz, 2016, p. 71).

C – 2: “Renee recognized she was pushing her husband and children away so that she did not have to feel her own pain” (Schwartz, 2016, p. 76).

D – 2: “Renee had a hard time accepting herself she was filled with judgment and shame About her behavior” (Schwartz, 2016, p. 78).

D – 3: “Renee shared she felt bad inside. Like she had done something wrong but could never figure out what it was” (Schwartz, 2016, p. 91).

E – 1: “At first she only felt disgust and anger, with statements like, “How could I love myself for yelling at my kids? Why should I deserve love? Look how fat and ugly I’ve become” (Schwartz, 2016, p. 78).

E – 2: “She copes with food; eating junk food during the day and having a drink or two in the evenings deadens the pain” (Schwartz, 2016, p. 72).

Journaling is one intervention working with Renee as it is helping her to be aware of her intrusive and automatic negative and abusive thoughts about herself and her ability to cope. It helps her to be aware of the negative thoughts and beliefs that need to be changed to positive self-accepting and positive nurturing thoughts to build herself up instead of putting herself down (Schwartz, 2016).

I believe Renee could benefit significantly if she developed the spiritual side of her life. There was no mention that she had any spiritual beliefs at any time. I would encourage her to change her automatic negative thoughts into thoughts of truths in the Bible of what God says about His creation and how we are fearfully and wonderfully made. Schwartz (2016) discusses healing allies you associate with nurturance, protection, and wisdom. Having a relationship with Jesus Christ has helped me in these areas. God’s Word nurtures, strengthens, protects, and I find wisdom in his truth. He is all I needed to be delivered from my addictions and learn to love myself and others. “At the heart of Christian spirituality is a healing relationship with God… Brokenness is a prerequisite to understanding God’s grace, but the Christian gospel does not leave us in a state of broken despair” (McMinn, 2011, pp. 41-42).

Another benefit for Renee would be Psychoeducation in the form of a “separate, clinician-led support group, wherein a small number of people with similar trauma histories compare stories, give each other advice, and discuss interpersonal violence and its effects” (Briere, 2015, pp. 125-126).

I would use Cognitive Processing Therapy (CPT) because it would help Renee immensely. CPT is an evidence-based therapy developed explicitly for trauma-related victims and deals with the distorted beliefs victims maintain about themselves and others (Resick, 2017).

Emotional processing would also benefit Renee because the emotions that develop while talking about traumatic events or by environmental triggers activate conditioned emotional responses (CERs). These emotional reactions may exceed Renee’s ability to deal with them positively (Briere, 2015).

Briere, J. &. (2015). DSM-5 Update Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment. Thousand Oaks: SAGE.

McMinn, M. (2011). Psychology, Theology, and Spirituality in Christian Counseling. Carol Stream: Tyndale.

Resick, P. M. (2017). Cognitive processing Therapy for PTSD : A Comprehensive Manual. New York: Thw Guilford Press.

Schwartz, A. (2016). The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control & Becoming Whole . Berkeley: Althea Press.