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1 Psychotherapy Student’s Name Institutional Affiliation Professor’s Name Course Date Title

2 Psychotherapy Post-traumatic stress disorder is a mental disorder triggered by a traumatic event or enduring stressful situation. It is characterized by memories or reminders of the trauma, negative emotional reactions, hyperarousal, negatively altered thinking and behavior, and avoidance of trauma reminders. The purpose of this essay is to explore the neurobiological basis for PTSD illness, examine the DSM-5-TR diagnostic criteria for PTSD and its relation to the case study, discuss one other psychotherapy treatment option for the client, and explain how gold standard, evidence-based treatments from clinical practice guidelines are essential for psychiatric-mental health nurse practitioners. Neurobiology of PTSD The neurobiological basis for PTSD is rooted in neurochemical imbalances in the brain. These imbalances are believed to cause a wide range of symptoms that are specific to PTSD, such as intrusive thoughts, flashbacks, nightmares, memory disturbances, and avoidance ( Goodall et al., 2017 ) . Other neurobiological factors suggested to contribute to the onset and maintenance of PTSD include the involuntary formation of strong, emotion-inducing memories. This is believed to be because of enhanced hippocampus activation, a key limbic brain region involved in memory formation. Other limbic brain structures involved include the amygdala, which is thought to be hyperresponsive to stressful cues, thus resulting in hyperarousal symptoms such as increased heart rate, blood pressure, and muscle tension. In addition to these changes in the limbic system, prefrontal and cerebellar brain regions are believed to be affected, possibly leading to an overall reduction in executive functioning, problem-solving, and learning ( Levy et al., 2019) . These neurological changes are thought to be involved in developing avoidance behaviors and negatively altered thinking in people with PTSD. Furthermore,

3 neurotransmitters such as GABA, glutamate, and dopamine are believed to be also affected and may be involved in developing PTSD symptoms. DSM-5-TR Criteria Posttraumatic Stress Disorder (PTSD) is a mental disorder triggered by experiencing a traumatic event. The pattern of symptoms associated with PTSD is listed in the DSM-5-TR and includes four categories with specific criteria that must be met to make a diagnosis. These categories include intrusion, avoidance, negative mood, and arousal. Criteria A for diagnosis of PTSD includes directly experiencing a traumatic event, witnessing a traumatic event in person, or learning about violence or death involving a close family member or friend. Criteria B requires symptom clusters, including intrusion, avoidance, negative mood, and arousal, for at least one month. Case Presentation The case study of an 8-year-old motor vehicle accident survivor presented in the video provides a clear example of how PTSD can manifest in response to a traumatic event. During the therapy session, the client could describe their experience of the car accident and the feelings of fear and terror they experienced. The client also exhibited intrusion symptoms, such as vivid memories and flashbacks ( Goodall et al., 2017 ) . The client also revealed symptoms of avoidance and emotional numbing, as well as symptoms of negative mood such as guilt and anger. In addition, the client also described experiencing the physiological arousal associated with PTSD, such as hypervigilance and difficulty sleeping. When considering the client’s presentation, there is sufficient information to conclude that this 8-year-old survivor likely has PTSD. All required criteria for a PTSD diagnosis have been met, including exposure to a traumatic event, intrusive symptoms, avoidance, negative

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4 mood, and arousal. The other diagnoses discussed in the video, including attachment disorder and oppositional defiant disorder, are not as supported by the client’s presentation. It is possible that further evaluation and assessment could provide further evidence to support the diagnosis of an attachment disorder and an oppositional defiant disorder (Grande, 2019) . As a result, it is not easy to conclude these other diagnoses without more information. However, the 8-year-old survivor has PTSD, as all of the required criteria have been met and evidenced in the symptoms described by the client. Treatment One possible psychotherapy treatment option for the 8-year-old motor vehicle accident survivor in the case study is cognitive processing therapy (CPT). CPT is an evidence-based, cognitive-behavioral therapy designed specifically for working with trauma and PTSD. It combines cognitive restructuring, which is meant to help the patient challenge and change their unhelpful and potentially distorted beliefs, thoughts, and feelings about their trauma, and exposure therapy, which is meant to help the patient confront the traumatic memories, feelings, and thoughts related to the traumatic experience in a safe and supported context. CPT is considered a “gold standard” treatment from a clinical practice guideline perspective because it has been thoroughly researched and is highly effective for trauma and PTSD in clients of all ages, including very young children. Using gold standards, evidence-based treatments from clinical practice guidelines are important for psychiatric-mental health nurse practitioners to ensure they provide the best possible care to their patients ( Tran et al., 2016) . Evidence-based treatments provide practitioners with up-to-date knowledge and resources promoting safe, effective, evidence-based approaches to treating mental health issues. These

5 guidelines help ensure that practitioners follow standards of care advocated by leading experts in the field. This ultimately helps to safeguard patient safety and provide quality care. Conclusion The neurochemical imbalance associated with PTSD is believed to be due to abnormal regulation of cortisol, a hormone released during stress. Also, studies have shown that traumatic events increase noradrenaline activity in the brain and reduce the activity of serotonin, both chemicals that regulate mood. This imbalance has been linked to intrusive memories, nightmares, flashbacks, and negative mood symptoms associated with PTSD. The sources used to support the above statement are considered scholarly. The sources cited are peer-reviewed journal articles that provide evidence for the claims about the neurochemical imbalances associated with PTSD and their relation to intrusive memories, nightmares, flashbacks, and negative mood symptoms. These sources are considered reliable and trustworthy, as they have been thoroughly reviewed and checked by experts in the field.

6 References Goodall, B. B. G. cam. ac. u., Chadwick, I., McKinnon, A., Werner, S. A., Meiser, S. R., Smith, P., & Dalgleish, T. (2017). Translating the Cognitive Model of PTSD to the Treatment of Very Young Children: A Single Case Study of an 8-Year-Old Motor Vehicle Accident Survivor. Journal of Clinical Psychology, 73(5), 511–523. https://doi.org/10.1002/jclp.22449 Levy, J., Yirmiya, K., Goldstein, A., & Feldman, R. (2019). The neural basis of empathy and empathic behavior in the context of chronic trauma. Frontiers in psychiatry , 10 , 562. https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00562/full Grande, T. (2019, August 21). Presentation Example: Posttraumatic Stress Disorder (PTSD) Links To An External Site. [Video]. YouTube. https://www.youtube.com/watch? v=RkSv_zPH-M4 Tran, K., Moulton, K., Santesso, N., & Rabb, D. (2016). Cognitive processing therapy for post- traumatic stress disorder: A systematic review and meta-analysis. https://europepmc.org/article/NBK/nbk362346

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