POST1GINA.docx

Posted: July 2nd, 2021

POST # 1 GINA

The purpose of this discussion is to look at the clinical parameters for identifying and assessing trauma, and what psychotherapeutic strategies are useful for people who have experienced trauma. Traumatic events can happen to anyone, at any age during a person’s lifetime. While some people think that trauma is only physical violence, it can also be due to emotional or verbal events, severe weather events, and anything that is significant or overwhelming for someone. According to Kleber (2019) the psychiatric classification from the World Health Organization and the DSM-5 defines a traumatic event as “the exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.” The identification of trauma can be done when a person seeks treatment and states they have experienced trauma or a traumatic event. Many people do not know they are victims of trauma, especially children. When patients exhibit the physical or emotional signs or symptoms of trauma is when a practitioner should make an assessment. For children the most common trauma is from violence in or out of their home, this can be from abuse or neglect (Yearwood et al., 2021). Both children and adults can be identified as victims of violent crimes or disaster experiences as well (Sadock et al., 2014). Some many people experience posttraumatic stress disorder (PTSD) or Acute Stress Disorder, or even a personality disorder with dissociation as a result of repeated trauma (Kleber, 2019; Sadock et al., 2014). However, it is important to point out that not every person has lifelong effects from trauma or traumatic experiences. Comorbid mental health issues, supports, and cognitive abilities affect each person’s individual responses to trauma. 

The assessment of trauma can take place in a variety of ways. Through a thorough interview, an APRN can get a sense of trauma in a client through self-reported symptoms. The “empathy, knowledge, and communication” of the APRN are essential tools during the interview (Wheeler, 2014). Wheeler (2014) discusses the importance of every client being screened for trauma but recognizes for different reasons this doesn’t always happen. There are many scales to help in the assessment of trauma as well such as the Dissociative Experiences Scale and the Adverse Childhood Experience Scale (Wheel, 2014). If trauma is suspected, utilizing scales or additional scales and information are necessary. According to Yearwood et al. (2021) when children are involved gathering information from other sources is helpful in assessing trauma. I believe this is helpful for adults as well. I had a patient recently that we had a family meeting because of her trauma history and treatment-resistant depression. 

There are many evidence-based psychotherapeutic strategies that are helpful for individuals that have experienced trauma. For children, psychotherapy is an important treatment modality to assist them with their “emotional, behavioral, and social issues” that can manifest as a result of trauma (Yearwood et al., 2021). According to Yearwood et al. (2021), both trauma-focused cognitive behavioral therapy and play therapy are effective for children. For adults, selective serotonin reuptake inhibitors such as Zoloft and Paxil have been successful in relieving PTSD symptoms (Sadock et al., 2014). There are other pharmaceutical agents that have known validity to be helpful for PTSD as well. Psychotherapy such as individual and group cognitive behavioral therapy (CBT) and stress inoculation therapy (SIT) which is a type of CBT that helps patients work and skill-building through education are helpful for trauma (Wheeler, 2014). Mindfulness strategies that teach living in the present moment and staying grounded are wonderful adjunctive skills to add to therapy (Wheeler, 2014). Mindfulness has made an explosion over the past few decades and there are many apps, podcasts, and classes that individuals may find helpful. These modalities both assist individuals in stabilizing and dissociating them from the trauma. Dialectical behavior therapy (DBT) is evidence-based for individuals with complex trauma, personality disorders, and chronic suicidality (Wheeler, 2014). 

References

Kleber R. J. (2019). Trauma and Public Mental Health: A Focused Review. Frontiers in psychiatry, 10, 451. https://doi.org/10.3389/fpsyt.2019.00451

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Synopsis of Psychiatry (11th ed.). London, England: Lippincott, Williams, and Wilkins.

Wheeler, K. (2014). Psychotherapy for the Advanced Practice Nurse Psychiatric Nurse: A How-to Guide for Evidence-Based Practice (2nd ed.). Mosby.

Yearwood, E. L., Pearson, G. S., & Newland, J. A. (2021). Child and adolescent behavioral health: a resource for advanced practice psychiatric and primary care practitioners in nursing. John Wiley & Sons, Inc.

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