6 hours ago Devan Marfil
RE: Discussion – Week 2
COLLAPSE
An evidence-based practice intervention that can be used in the Levy case is Cognitive Processing Therapy (CPT). CPT can be offered in as few as 4 sessions up to 48 sessions total and includes in session work as well as work between sessions (Holder et al., 2020). CPT is also one of two manualized evidence-based psychotherapies for post-traumatic stress disorder distributed by the Veterans Health Administration (Holder et al., 2020). This intervention may be appropriate for Jake due to the flexibility offered in treatment sessions (Holder et al., 2020). As a young veteran coming home offers many challenges with adjusting back to home life with his wife and children as well as his substance abuse. Offering flexibility in treatment can offer clients like Jake to receive effective treatment within shorter time spans. In discussing this intervention with a supervisor issues regarding to implementation can include managing group, emotional, and non-completion of out of session work (Holder et al., 2020). Benefits of group therapy can be increased social support, cost effectiveness and the ability to treat larger number of veterans at one time (Holder et al., 2020).
Two factors that can be necessary to successful implementation of this intervention is the utilization of scales such as Patient Health Questionnaire (PHQ-9) and the Externalizing Disinhibition Subscale (DIS-20) to measure the initial and end of state of a client’s progress from the treatment provided (Resick et al., 2021). A second factor to consider before implementation is whether group CPT or individual CPT would most benefit Jake in this case. This practice requires the individual to learn skills to recognize and challenge their dysfunctional cognitions in relation to their PTSD and other traumas (Resick et al., 2021). The clinician must first decide which route is best for Jake before implementing this evidence-based practice.
The intervention can be hindered by the lack of consistency of how many sessions are beneficial for everyone in the group receiving Cognitive Processing Therapy (CPT). The client’s severity of PTSD, the client’s ability to attend sessions, and client’s willingness to attend a follow-up session are all factors to consider before implementing this intervention with Jake. One may be able to mitigate these factors by ensuring Jake is aware of the guidelines of CPT as well as being aware of how stigma, acculturation, and discrimination all impact the individuals in the program (Resick et al., 2021).
References
Holder, N., Shiner, B., Li, Y., Madden, E., Neylan, T. C., Seal, K. H., Lujan, C., Patterson, O. V., DuVall, S. L., & Maguen, S. (2020). Cognitive processing therapy for veterans with posttraumatic stress disorder: What is the median effective dose? Journal of Affective Disorders, 273, 425–433. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2020.04.030
Resick, P. A., Wachen, J. S., Dondanville, K. A., LoSavio, S. T., Young-McCaughan, S., Yarvis, J. S., Pruiksma, K. E., Blankenship, A., Jacoby, V., Peterson, A. L., & Mintz, J. (2021). Variable-length cognitive processing therapy for posttraumatic stress disorder in active duty military: Outcomes and predictors. Behaviour Research and Therapy, 141. https://doi-org.ezp.waldenulibrary.org/10.1016/j.brat.2021.103846
REPLY QUOTE EMAIL AUTHOR
3 hours ago anna pantoja mendez
RE: Discussion – Week 2
COLLAPSE
Treatment of Post -Traumatic Stress Disorder
In the video, Jake’s social worker expresses an intertest in mindfulness interventions such as meditation for Post-Traumatic Stress Disorder (PTSD). The supervisor questions why the social worker wants to implement newer interventions that might not be appropriate for Jake’s presenting problems. The supervisor also mentions to the social worker that she should focused on treatments that have research evidence to their effectiveness. In order to proceed with treatment a measurement scale should be given to Jake to determine a PTSD diagnosis. Once the social worker has a score that indicates that Jake is experiencing PTSD then an intervention plan can be chosen to fit his personal goals. Social workers met clients where they are at in life by using a client-centered approach.
The evidence-based intervention that I selected for Jake’s symptoms of PTSD is Cognitive Processing Therapy. This practice is short-term and directs to clients’ presenting problem during therapy (Doran et al., 2018). During CPT social workers assist clients in recognizing their negative thinking, which is known as “stuck points” (Doran et a., 2019, & Resick et al., 2021). These negative thoughts stop clients from participating in everyday activities that might trigger clients. The negative thoughts are dysfunctional because they are influenced by traumatic experiences. CPT has shown to reduce PTSD symptoms in veterans (Sloan et al., 2021). This intervention is appropriate for Jake because he is experiencing intense PTSD episodes which has led to substance use of alcoholic drinks. Jake is also experiencing interfamily conflict with his wife and children that has affected his marriage.
Implementation of Cognitive Processing Therapy
Using a 12-week program approach with Jake can facilitate the implementation of the intervention because it is not considered too long of an approach. A short-term program would reduce any drop out of the treatment plan. Solan et al. (2012) mentioned that approximately 50 percent of veterans do not complete their treatments due to time intensive and distressing interventions. A second factor to consider during implementation is appropriate resources for clients to obtain during treatment. In the case of Jake, he should agree to the intervention before implementing it. The social worker can start with educating client about PTSD and how it is addressed in therapy. The social worker could also provide information about CPT and how it is an evidence-based practice. Part of the resources is worksheets for Jake to complete during treatment or at home that targets negative thoughts. Once Jake is in session those worksheets can be used to create alternative thoughts that reduce dysfunctionality. Factors that can inhibit the implementation for this intervention is if the social worker has a high caseload (Sloan et al., 2021). Having a high caseload can affect the preparedness of the social worker when meeting with Jake for treatment. When social workers are overworked it can have an impact on their work performance and get burned out. Supervisors need to be aware of burn out and need to provide appropriate training to their staff regarding self-care. Another problem with implementation is that Jake might not be ready to talk about his past trauma and connect how it has affected his current state of mind. Using scales to determine if Jake is motivated to change certain thoughts and behaviors can provide information to the social worker. Using other modalities to increase participation such as Motivational Interviewing can be useful for the overall treatment goal.
References
Doran, J. M., O’Shea, M., & Harpaz-Rotem, I. (2019). In Their Own Words: Clinician Experiences and Challenges in Administering Evidence-Based Treatments for PTSD in the Veterans Health Administration. The Psychiatric quarterly, 90(1), 11–27. https://doi.org/10.1007/s11126-018-9604-5
Laureate Education (Producer). (2013c). Levy family episode 2 [Video file]. Retrieved from https://class.waldenu.edu
Resick, P. A., Wachen, J. S., Dondanville, K. A., LoSavio, S. T., Young-McCaughan, S., Yarvis, J. S., Pruiksma, K. E., Blankenship, A., Jacoby, V., Peterson, A. L., & Mintz, J. (2021). Variable-length cognitive processing therapy for posttraumatic stress disorder in active duty military: Outcomes and predictors. Behaviour Research and Therapy, 141. https://doi-org.ezp.waldenulibrary.org/10.1016/j.brat.2021.103846
Sloan, D. M., Marx, B. P., Acierno, R., Messina, M., & Cole, T. A. (2021). Comparing written exposure therapy to Prolonged Exposure for the treatment of PTSD in a veteran sample: A non-inferiority randomized design. Contemporary Clinical Trials Communications, 22. https://doi-org.ezp.waldenulibrary.org/10.1016/j.conctc.2021.100764
Respond to at least two colleagues by doing all of the following:
Identify strengths of your colleagues’ analyses and areas in which the analyses could be improved. Address his or her evaluation of the efficacy and applicability of the evidence-based practice, his or her identification of factors that could support or hinder the implementation of the evidence-based practice, and his or her solution for mitigating those factors.
Offer additional insight to your colleagues by either identifying additional factors that may support or limit implementation of the evidence-based practice or an alternative solution for mitigating one of the limitations that your colleagues identified.
