Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay

NRNP/PRAC 6645 Comprehensive Psychiatric

Evaluation Note Template

CC (chief complaint): P and S present to the setting with complaints that their home is chaotic.

HPI: Iranian mother and daughter P and S complain of relationship problems and disarray in their home when they first enter the treatment setting. The mother, P, laments that since her daughter S came forth about the sexual abuse she had received from her father in Iran prior to moving to the United States with the rest of the family, there has been anarchy in their home. S gripes that her mother is overly demanding of her time and attention, doesn’t listen to her, and likes cursing her out whenever she visits. The daughter is also disgruntled about her mother’s inability to be patient because of her pain. She believes that the mother can take care of herself given her age, and she should avoid relying on other folk for her joy and happiness as it is burdensome. The daughter believes that their mother mother expects that her children should provider her with support even when they have their own lives to live. The mother, P, in her state of hopelessness, helplessness, and depression, believes that she has been neglected by her children,which worsens her depression. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay

Past Psychiatric History:

• General Statement: These family members have been with their counsellor before with the aim of tackling their family challenges. Their challenges are largely about relating with each other, their mother’s depresson, and how she had detached from her children.
• Caregivers (if applicable): The daughters in the family are the caregivers to the mother, P.
• Hospitalizations: Mother’s foot surgery.
• Medication trials: none
• Psychotherapy or Previous Psychiatric Diagnosis: There have been previous sessions with current clinician cut short by P’s view of the therapy sessions as a waste of money. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay
  

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Substance Current Use and History: None

Family Psychiatric/Substance Use History: None

Psychosocial History: The family hails from Iran, where the mother P, was initially married to an Iranian man, that was physically and emotionally abusive. She fled to the US, with 4 of her children; leaving behind one, S. Back in Iran, S was sexually abused by her father, which is a point of bitterness towards her mother for leaving her behind. S joined the family in the US 2 years. P currently has worked before as a caregiver, and likes to shop meats for her children. 3 of the 4 children have left the home to live alone, and two sons live with P. P also has two dogs, which are uncomfortable for S during her visits home. S would like to do promotional work and is pursuing her real estate license at the moment. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay

Medical History:

• Current Medications: None
• Allergies: None

• Reproductive Hx: P, the mother has 4 children and is peri-menopausal at 40 years old.

ROS

• General: Both P and S report feeling overwhelmed and distressed due to family conflicts and interpersonal difficulties.
• Constitutional: P complains of constant pain and mobility issues, which significantly impact her daily functioning. S expresses frustration and resentment towards her mother’s behavior, leading to emotional distress.
• Cardiovascular: No specific cardiovascular-related concerns reported by either P or S.
• Respiratory: No specific respiratory-related concerns reported by either P or S.
• Gastrointestinal: No specific gastrointestinal-related concerns reported by either P or S. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay
• Genitourinary: No specific genitourinary-related concerns reported by either P or S.
• Musculoskeletal: P reports difficulty with mobility and pain, while S does not mention any specific musculoskeletal issues.
• Endocrine: No specific endocrine-related concerns reported by either P or S.
• Psychiatric: Both P and S exhibit symptoms of depression, including feelings of hopelessness, helplessness, and irritability. P also displays signs of anxiety, characterized by excessive worrying and difficulty managing stress.
• Neurological: P experiences chronic pain and mobility limitations, likely contributing to her overall distress and impaired functioning.
• Skin: No specific skin-related concerns reported by either P or S. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay

Diagnostic results: None required

Assessment

Mental Status Examination:

Appearance: S presents as a young adult woman with a neat and composed appearance, suggesting adequate self-care. She appears attentive and engaged in the conversation, displaying appropriate grooming and posture.

Behavior: S demonstrates calm and composed behavior throughout the session, maintaining good eye contact and displaying active listening skills. She appears cooperative and willing to participate in the discussion.

Speech: S’s speech is clear, coherent, and fluent, with appropriate volume and rate. She articulates her thoughts effectively and communicates her concerns with clarity. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay

Mood/Affect: S’s mood appears primarily frustrated and resentful, as indicated by her expressions of dissatisfaction with her mother’s behavior. Her affect is mostly congruent with her mood, displaying mild signs of irritability and annoyance.

Thought Process: S’s thought process appears logical and organized, with no evidence of disorganization or tangential thinking. She articulates her thoughts in a linear and coherent manner, maintaining focus on the topic at hand.

Thought Content: S expresses concerns about her mother’s excessive demands and emotional volatility, which she perceives as burdensome. She also voices frustrations about feeling obligated to fulfill her mother’s needs while seeking independence and autonomy for herself.

Insight/Judgment: S demonstrates good insight into her relationship dynamics and acknowledges the need for boundaries and healthier communication patterns within the family. Her judgment appears intact, as she expresses a desire to address the issues constructively and seek resolution. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay

For P

Appearance: P presents as a middle-aged woman. She is slightly overweight and appears to observe good personal hygiene. She has no visible stigmata of disease.

Behavior: P maintains eye contact and is generally cooperative.

Speech: P’s speech is coherent, and is marked by a Middle Eastern accent.

Mood/Affect: P’s mood appears predominantly despondent and hopeless, reflected in her expressions of sadness and resignation.

Thought Process: P’s thought process appears normal, with no tangential thoughts observed.

Thought Content: P expresses overwhelming feelings of despair and inadequacy, attributing her distress to her perceived failures as a mother and her children’s perceived rejection of her. She displays ruminative thoughts about her worthlessness and inability to cope with her current circumstances. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay

Insight/Judgment: P demonstrates limited insight into her emotional struggles and their impact on her relationships. Her judgment appears compromised, as she seems unable to identify constructive solutions or seek appropriate support for her distress, and instead, heaps it on her children to provide her with an unreasonable amount of support.

Differential Diagnoses:

• Depression: The most likely diagnostic impression for this case is depression. P exhibits symptoms consistent with major depressive disorder, including feelings of hopelessness, helplessness, and a depressed mood. She is also irritable, a major symptom of depression, as S reports that P often lashes out at them, especially after imagining scenarios of what they could be doing.These symptoms emerged following the disclosure of S’s sexual abuse, indicating a potential trigger for P’s depressive episode that explains her depressive moods. According to Wang et al. (2023), trauma-related depression can occur with people who witness their loved ones experience trauma. In this case, P, the mother, was traumatized by her daughter’s sexual assault in the hands of her abusive husband, leading to her depression. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay
• Generalised anxiety disorder (GAD): Another possible diagnosis for P is GAD. P displays symptoms suggestive of anxiety, particularly excessive worry and controlling behavior regarding her daughters’ choices in life. S describes P as restless, frustrated, and suffocating with her opinions. These are positive pertinent symptoms of GAD, as suggested by the DSM V manual that include excessive worry, hypervigilance, irritability, emotional distress (Mishra & Varma, 2023). However, P does not present with physiological symptoms typical of anxiety disorders, such as sweating, increased heart rate, or trembling, suggesting a less severe manifestation of GAD (Preti et al., 2021). The absence of these symptoms reduces its likelihood as the major diagnosis.
• Subthreshold PTSD: Another possible diagnosis for is subthreshold PTSD. She may be experiencing subthreshold PTSD, particularly secondary PTSD resulting from exposure to S’s trauma. P meets criterion A for PTSD as she was indirectly exposed to trauma through S’s experience, in accordance with the DSM V manual for PTSD (Dar et al., 2023). Criterion E of PTSD, which includes symptoms like irritability and hypervigilance, is evident in P’s behavior, such as her insistence on choosing partners for her daughters (McLaughlin et al., 2019). However, P does not exhibit other hallmark symptoms of PTSD, such as nightmares, flashbacks, or physical reactivity, which would suggest a subthreshold presentation;hence ruling it out. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay

Case Formulation and Treatment Plan:

Treatment

The treatment plan would involve a combination of individual and family therapy sessions to address the underlying trauma and improve communication within the family. For P, cognitive-behavioral therapy (CBT) techniques can help manage symptoms of depression and anxiety, while also addressing her past trauma (Öst et al., 2023). S may benefit from psychoeducation on healthy boundaries and assertiveness training to navigate her relationship with her mother. Family therapy sessions would focus on improving communication skills, fostering empathy, and establishing clear boundaries. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay

Reflections:

This case highlights the complexity of past trauma, family dynamics, and mental health issues within the context of cultural differences. P, the mother, struggles with symptoms of depression and anxiety, exacerbated by her daughter S’s disclosure of past sexual abuse. S, on the other hand, experiences frustration and resentment towards her mother’s behavior, feeling suffocated by her overbearing nature. The family’s Iranian background adds another layer of complexity, influencing their communication styles and expectations within the household. The cultural stigma surrounding mental health may also contribute to the reluctance in seeking professional help. Addressing these issues will require a culturally sensitive approach, fostering open dialogue, setting boundaries, and promoting autonomy while addressing underlying trauma and mental health concerns. Collaborative therapy involving both P and S, along with psychoeducation about mental health, may help navigate these challenges and promote healing within the family unit. Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay

 References

Dar, I. A., Iqbal, N., & Emran, A. (2023). Secondary traumatic stress, vicarious posttraumatic growth, and rumination among healthcare professionals: Examining conditional indirect effect of secondary exposure to trauma. Traumatology. https://doi.org/10.1037/trm0000443

McLaughlin, K. A., Demyttenaere, K., Koenen, K. C., Posada-Villa, J., Ruscio, A. M., & Kessler, R. C. (2019). Threshold versus Subthreshold Posttraumatic Stress Disorder. In E. J. Bromet, E. G. Karam, K. C. Koenen, & D. J. Stein (Eds.), Trauma and Posttraumatic Stress Disorder: Global Perspectives from the WHO World Mental Health Surveys (pp. 273–286). chapter, Cambridge: Cambridge University Press.

Mishra, A. K., & Varma, A. R. (2023). A Comprehensive Review of the Generalized Anxiety Disorder. Cureus, 15(9), e46115. https://doi.org/10.7759/cureus.46115

Öst, L., Enebrink, P., Finnes, A., Ghaderi, A., Havnen, A., Kvale, G., Salomonsson, S., & Wergeland, G. J. (2023). Cognitive behavior therapy for adult post-traumatic stress disorder in routine clinical care: A systematic review and meta-analysis. Behaviour Research and Therapy, 166, 104323. https://doi.org/10.1016/j.brat.2023.104323

Preti, A., Demontis, R., Cossu, G., Kalcev, G., Cabras, F., Moro, M. F., Romano, F., Balestrieri, M., Caraci, F., Dell’Osso, L., Di Sciascio, G., Drago, F., Hardoy, M. C., Roncone, R., Faravelli, C., González, C. I. A., Angermayer, M., & Carta, M. G. (2021). The lifetime prevalence and impact of generalized anxiety disorders in an epidemiologic Italian National Survey carried out by clinicians by means of semi-structured interviews. BMC Psychiatry, 21(1). https://doi.org/10.1186/s12888-021-03042-3

Wang, S. K., Feng, M., Fang, Y., Lv, L., Sun, G. L., Yang, S. L., Guo, P., Cheng, S. F., Qian, M. C., & Chen, H. X. (2023). Psychological trauma, posttraumatic stress disorder and trauma-related depression: A mini-review. World journal of psychiatry, 13(6), 331–339. https://doi.org/10.5498/wjp.v13.i6.331 Cognitive Behavior Therapy For Adult Post-Traumatic Stress Disorder Essay