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A systematic review of cognitive behavioural therapy and psychodynamic approaches

A systematic review of cognitive behavioural therapy and psychodynamic approaches.

 Respond to  your  colleagues by providing one alternative therapeutic approach. Explain  why you suggest this alternative and support your suggestion with  evidence-based literature and/or your own experiences with clients.

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PTSD  is a debilitating disorder and should always be taken very seriously  when a client presents with this disorder. Normally, it develops after  experiencing or getting exposed to a traumatic event and it is always  managed through both psychotherapies and pharmacotherapies (Lancaster,  Teeters, Grs & Back, 2016). About 6.8 to 7.3 percent of Americans  are affected by PTSD in their lifetime. Studies however show that  African Americans have a higher rate of 8.7% in lifetime prevalence  (Nguyen, Chatters, Taylor, Levine & Himle, 2016). This is a very  significant statistics for the purpose of this discussion because  William the client is an African American with high risk factor of  having PTSD because he served in the army and was deployed to Iraq  during the war.

In his narration, William seems not to concentrate especially in regard  to his surroundings. He also points out that his family, that is him  and his wife have been going through a lot. Just recently, he lost his  job and he was not able to effectively meet the deadlines for his  mortgage. Because of this, he became homeless. He was then taken in by  his brother who lives with his wife and children. William denies the  fact that his brother is concerned about his condition. It is known that  he has a problem with alcohol, and this could be a way of coping with  his PTSD from the war. In fact, through an exploratory analysis, it was  concluded that drinking with a view of coping with PTSD was common in  war veterans. This coupled with the perception that they were  stigmatized led to increased severity of PTSD and alcohol abuse as well  as associated consequences (Miller, Pedersen & Marshall, 2017).  William was directly experiencing traumatic occurrences in the war.  There is a very high possibility therefore that he has PTSD leading to  his drinking problem as a way of coping. This has affected his life in  very different ways including losing his job, house and becoming  homeless. William has been having flashbacks about the events in the  war. He avoids things that may remind him of such events, and he does  not have interest in doing different activities including his hobbies.  He has a sense of self-blame and he is reckless as well as experiencing  sleep disturbance. All these have been going on for a while. Long enough  to cost him his job and house. The DSM-5 requires that these  disturbances should not be due to drugs, alcohol or a different medical  issue (American Psychiatric Association, 2013). William is going through  all these issues because of the traumatic events at war and the alcohol  use is just because he thinks this is a way of coping.

In the treatment and management of PTSD for William, psychodynamic  therapy shall be implemented. Through a systematic review, psychodynamic  therapy showed efficacy in reducing all measures that were associated  with PTSD and at the end of the studies reviewed, more than half of  participants did not present with requirements or symptoms that could  meet the PTSD DSM criteria (Paintain & Cassidy, 2018). As such, for  William, psychodynamic theory shall be used. SSRIs that are first line  treatment for PTSD can be used as an additional therapy. If such fails  to work, Trazodone shall be used as it has been effective in cases where  SSRIs fail in this patient population (Shin &Saadabadi, 2019).  Psychodynamic theory can be used alone in this case. However, a combined  therapy will be more effective in helping to improve symptoms and  allowing William to start functioning effectively. If drugs shall be  used, he is supposed to be told that they may have some side effects.  This will allow him to choose whether he want psychotherapy alone or a  combination.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub

Lancaster,  C. L., Teeters, J. B., Gros, D. F., & Back, S. E. (2016).  Posttraumatic stress disorder: Overview of evidence-based assessment and  treatment. Journal of clinical medicine5(11), 105

Miller,  S. M., Pedersen, E. R., & Marshall, G. N. (2017). Combat experience  and problem drinking in veterans: Exploring the roles of PTSD, coping  motives, and perceived stigma. Addictive behaviors66, 90-95

Nguyen,  A. W., Chatters, L. M., Taylor, R. J., Levine, D. S., & Himle, J.  A. (2016). Family, friends, and 12-month PTSD among African Americans. Social psychiatry and psychiatric epidemiology51(8), 1149-1157.

Paintain, E., & Cassidy, S. (2018). First‐line therapy for post‐traumatic stress disorder: A systematic review of cognitive behavioural therapy and psychodynamic approaches. Counselling and psychotherapy research18(3), 237-250.

Shin, J. J., & Saadabadi, A. (2019). Trazodone, Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470560/

A systematic review of cognitive behavioural therapy and psychodynamic approaches

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