1. Post Traumatic Stress Disorder
Virtual Reality Treatments
Yahira Lugo-Lugo & Melissa Hennion
Virtual Reality Process
for the clients
Pharmacological Treatments for ages 10 +
Alternative Treatment for ages 4-9
Antecedent
Abstract Bullets
References
Conclusion
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders.
Arlington, VA : American Psychiatric Association.
Cooper, J., Carty, J., & Creamer, M. (2005). Pharmacotherapy for posttraumatic stress disorder: empirical review
and clinical recommendations. Australian & New Zealand Journal of Psychiatry, 39(8), 674-682.
doi:10.1111/j.1440-1614.2005.01651.x
Massad, P., & Husley, T. (2006). Exposure Therapy Renewed. Journal of Psychotherapy Integration , 417-428.
doi 10.1037/1053-0479.16.4.417
Preston, J., O'Neal, J., & Talaga, C. (2010). Handbook of clinical psychopharmacology for therapist sixth
edition. Oakland, CA: New Harbinger Publications.
The DSM–IV-TR assumes that Acute Stress
Disorder was present in any person who
meets the diagnostic criteria for Post
Traumatic Stress Disorder.
•Conduct Disorder is currently the “most common psychiatric
disorder in youth and is one of the most frequent reasons for clinical
referral to child and adolescent treatment services, encompassing
one-third to one half of all referrals (Tcheremissine & Lieving,
2006).
• 70 % of Children age 4-9 are more likely to be diagnosed with
Conduct Disorder (Short & Shapiro, 1993)
•Among the most well-demonstrated antecedent and covariates of
conduct disorders are parent and family characteristics, behaviors and
an important factor in the recovery of clients with conduct disorder is
the parent-child interactions (Short & Shapiro, 1993).
•Rates of diagnosed conduct disorder are lower in females than
males. However females with this disorder are more likely to attempt
suicide (Tcheremissine & Lieving, 2006).
•Parent Management Training (PMT) aims to effect change in
children’s behavior and adjustment by modifying aspects of the
family environment that maintain and reinforce a child’s problem
behaviors (Sanders, 1992).
•Behavioral family interventions (BFI) also known as Behaviorism is
one of the most effective Non- Pharmacological treatments available
for children under the age of ten.(Tcheremissine & Lieving, 2006).
•In spite of progress in the field of pediatric psychopharmacology
there are still no medications licensed for the treatment of conduct
disorder (Tcheremissine & Lieving, 2006)
•Children ages ten to eighteen have shown positive changes in
behavior from continued pharmacological interventions, even though
there is not a preferred medication (Tcheremissine & Lieving, 2006).
•It might be equally important to develop a parent training with
Behavior Modification principles with a curriculum that teaches the
skills of clear and appropriate discipline for parents and teachers of
conduct disordered youth (Jewell & Beyers, 2008).
Conduct Disorder is currently the “most common psychiatric
disorder in youth and is one of the most frequent reasons for
clinical referral to child and adolescent treatment services,
encompassing one-third to one half of all referrals (Tcheremissine
& Lieving, 2006)”. The DSM–IV-TR assumes that Operant
Defiant Diagnosis is always present in youth who meet diagnostic
criteria for Conduct Disorder (2000). The differences between the
two diagnosis are just a few symptoms which makes treating the
disorder in many instances more difficult. 70.0% of children who
met criteria for Conduct Disorder during ages one to thirteen, did
so for the “first time during ages four to nine” (Short & Shapiro,
1993).Once parents are told about the onset of conduct disorder,
they generally “avoid psychopharmacological interventions in
children ten years of age or younger (Tcheremissine & Lieving,
2006)”. There is very little research on the validity and
effectiveness of pharmacological interventions on children under
the age of ten. Leaving clinicians ‘and parents to try alternative
methods, which require further participation from other members
of the client’s daily life for treatment to be successful in the
client. This participation must be all inclusive from all avenues
of the clients’ life. If the client is attending school outside of the
home, a teacher will need to be given the tools to better
understand the child’s conduct disorder and the techniques being
utilized by the parents and other people in the clients’ life. The
teacher should utilize Behavior Modification Principles for
children with Conduct Disorder. These Children exhibit
“antisocial behaviors in sufficient frequency and intensity
significantly affecting their educational performance and
interpersonal interactions (Short & Shapiro, 1993)”. One
approach to preventing or treating conduct problems has been to
provide interpersonal skills training to the affected youth and
their families. This approach is also known as Behavioral family
interventions (BFI) which aim to effect change in “children’s
behavior and adjustment by modifying aspects of the family
environment that maintain and reinforce a child’s problem
behaviors (Sanders, 1992).The theoretical rationale for the skills
training approach is the belief that a lack of interpersonal and
problem solving skills is the primary cause of behavior problems
(Tcheremissine & Lieving, 2006) in some conduct disorder
diagnosed children under age ten. Modifying these behavioral
patterns early with parental training could be essential in
decreasing the onset of future behavioral problems in children
under the age of ten.
Failure to recognize and deal with Conduct Disorder
and its associated problems may have serious and
extensive consequences for schools, communities,
and society. Studies have shown that children with
Conduct disorder are more likely to be suspended,
drop out of school, or are remanded to the juvenile
justice system (Sanders, 1992; Short & Shapiro,
1993; Tcheremissine & Lieving, 2006),others
receive community-based mental health and social
services. In many cases, these children grow to
adulthood to become liabilities. The DSM-IV-TR also
states that if untreated conduct disorder in childhood
and adolescence will turn into adult Antisocial
Personality Disorder (2000). Because the behaviors
of these children are significant, changing a clients
and their families behaviors at a young age is
essential in changing the way the families behaviors
are developing. Children with Conduct Disorder
often have “recurrent bad behaviors and are
frequently resistant to classroom interventions
(Tcheremissine & Lieving, 2006).Teachers and
parents constitute an important dimension of
treatment for children under the age of ten with
Conduct Disorder.
The purpose of behavior modification is to reshape behavior (i.e., to change
pupils' undesirable classroom behavior to desirable) and is effected through
four "simple" steps.
The first step is identification of the behavior problem itself. Teachers
must identify the behavior they find undesirable. The key is to be specific. It
is insufficient, for example, for teachers to say that Sarah misbehaves. Rather,
pinpoint the specific way(s) she misbehaves (i.e. does she come to class late;
does she talk out of turn; does she sleep in class?).The more specific the
behavior is identified, the better.
The second step is identification of the appropriate behavior. Teachers
must identify the specific way(s) they want the pupil to act. In almost every
case, such identification is the reverse of step one (i.e. she is prompt and on-
task.)
The third step is the use of reward. When the pupil behaves in the way
that was spelled out in the second step, teachers must reward him/her.
The quickest and surest way of eliminating misbehavior is rewarding its
opposite. So when Sarah comes to class on time and is rewarded for arriving
on time, she is more likely to repeat the behavior again in the future. Teachers
also need to reinforce other good behaviors that are occurring during the class
time as well for this process and the behaviors to change the client. Omitting
rewards for positive behaviors in class can lead to new problem behaviors.
The fourth and final step is the use of extinction procedures to help
eliminate the inappropriate behavior identified in the first step. The key
words are to help eliminate.
Pupils can be conditioned to act in desirable ways if teachers reward them for
acting in these ways. Then, as pupils begin to be conditioned, their need for
reward lessens. At first, Sarah needs immediate and frequent payoffs for
arriving on time. Later, as she gradually becomes conditioned to arriving on
time, the payoffs can and should become less frequent. Finally, it is hoped,
the conditioning process will work so well that payoffs will no longer be
necessary.
The key to behavior modification is not the use of punishment, but the use of
reward
Researchers have utilized a form of therapy when treating a youth
clients with trauma’s called exposure therapy. The idea of exposure therapy is
to extinguish the anxiety associated with the trauma. Functioning with severe
anxiety can make life nearly impossible for some clients. “The assumption is
that by exposing patients to feared stimuli in a safe context, their fear
responding will diminish (Massad & Husley, 2006). Also eliminating the
anxiety in relation to the trauma. One method of exposure therapy utilized for
youth is similar to the VR Treatment is systematic desensitization .
The clients anxiety should be overcome with “presentation of the
stimulus (Massad & Husley, 2006).” A counselor could begin with having the
client imagine the traumatic event. Teaching them breathing techniques to
help work through some of the initial anxiety. Once a client can remain calm
while having visualizations of the traumatic event, the counselor could present
a black and white photo that is similar to the traumatic event,. Once the client
can see the image in black and white a counselor should show the client a
colored photo. Followed by, a synthetic presentation of the trauma such as toys
in the room set up to look like the details of the trauma, that have been
released by the youth at this point. If the trauma is sexual, toys able to mimic
the positions the client has described, dressed with similar clothing to the event
of the clients memory, should trigger even further progress. Then a
presentation of a the real trauma. If the anxiety of the trauma is in relation to a
place, take the client to the place. Finally having the client touch a the building
safely can help to eliminate the anxiety associated with the location.
PTSD SYPTOMS THAT CAN ALSO RESPOND TO MEDICATION
TARGET SYMPTOMS
Intrusive experiences
such as “flashbacks”a,
avoidance and numbing
Hyperarousalc
Transient psychosis,
marked derealization d
Nightmares
Treatment Resistant
PTSD e
Depression a
Panic Attacks
CLASS OF MEDICATION
SSRI antidepressants, buspirone
augmentation of SSRI, second
generation antipsychotics
Antidepressants,
benzodiazepines, adrenergic
agonists, anticonvulsants
Low- dose antipsychotics
Prazosin(Minipress)
Second generation antipsychotics
anticonvulsants
Antidepressants
Antidepressants, MAO inhibitors
High potency benzodiazepines