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The patient is experiencing the symptoms of posttraumatic stress disorder. Thus, appropriate modalities and interventions should be applied to manage the patient’s condition. The big behaviors observed by the girl include nightmares and lack of sleep, constant self-blame, and depression that make her stay at home. Consequently, the current goals for Marylyn’s treatment are to be able to leave the house without fears and to sleep without nightmares. The treatment plan for big behaviors, developed with the consideration of patient’s needs and strengths, is concentrated on minimizing the existing symptoms of posttraumatic stress disorder and elimination of nightmares, thus providing normal sleep and getting the patient back to normal active life.
Interventions for Nightmares and Lack of Sleep
With the problem of nightmares and the related lack of sleep, the unmet need of psychological stability results in the interruption of sleep because of traumatic thoughts and nightmares. One of the opportunities to manage this behavior is the application of trauma-focused cognitive behavioral therapy. This modality is aimed at defining the relations between the patient’s behaviors, feelings, and thought. In fact, it is a useful modality for managing posttraumatic stress because it reveals negative thoughts that cause stress and influence the patient’s behavior.
One of the interventions with proved efficiency for posttraumatic nightmares if imagery rehearsal therapy (Nappi, Drummond, & Hall, 2012). It is “a short-term treatment that integrates psychoeducation on nightmares, instruction on and experiential exercises of imagery, and a cognitive restructuring imagery technique” (Nappi et al., 2012, p. 578). The essence of the intervention is that the patient “rescripts” the nightmare in a way to avoid a distressing culmination. The rehearsal of this script during therapy at daytime reduces the negative context and gradually normalizes sleep. The efficiency of the method is proved by some studies. Thus, imagery rehearsal therapy “contributes to clinically significant reductions in nightmare frequency and psychiatric distress, including daytime PTSD symptoms, among trauma-exposed patients” (Nappi et al., 2012, p. 578). Moreover, this intervention is suitable for the patient because this young girl has an ability to concentrate on her actions even under stressful situations which can be helpful in creating the script. In addition, her love for theatre can be beneficial due to her previous experiences of creating and acting out scripts.
Another intervention applicable for managing posttraumatic nightmares can be the use of dream catchers. It is evident that this method is based on placebo effect. Still, it can be effective with this patient due to her African-American roots. The impact of cultural background is strong for this race, thus the method that implies some mystic influence can work with a young girl. Although dream catchers are more typical for the culture of Native Americans, they are used by the representatives of other minorities. However, this intervention can be only supplemental providing some additional comfort for the patient because it does not solve the problem.
Interventions for Depression and Staying In
Another big behavior experienced by the patient is depression that is characterized with staying in all days. The unmet need in this case is the feeling of the lack of safety and feeling worthless. Thus, the interventions should be directed at eliminating the symptoms of depression and getting rid of fear to leave the house. Cognitive behavioral therapy can be used to manage posttraumatic depression as well. During the initial stage of treatment, internet-based interventions can be applied. According to Kuester, Niemeyer, & Knaevelsrud (2016), these are “psychological treatments, usually based on established approaches such as CBT that are delivered exclusively via the internet” (p. 3). The evident benefit of this intervention is that the patient does not have to leave the house which can positively influence the treatment compliance of the patient with certain fears. Moreover, the efficiency of internet-based interventions for posttraumatic stress disorder is proved by the research (Kuester et al., 2016).
One more modality that provided a variety of interventions for managing a depressed patient is affective expression and modulation skills (Deblinger, Mannarino, Cohen, Runyon, & Heflin, 2015). It is particularly suitable for adolescents and children who have experienced sexual abuse. The intervention applied within this modality can be drama therapy. This intervention includes diverse activities and experiments. In fact, it is acting that has therapeutic goals. It is a popular intervention that allows the participants tell their stories, express feelings and emotions, develop their primary goals, and thus solve problems. This intervention is likely to be particularly effective for Marylyn because she loves theatre. In fact, her theatre class is the only place where the girl feels safe. Since there is no support at home, the intervention related to her hobby and associated with safety and positive emotions should be applied. The process of acting and living another life helps to distract attention from worries, and acting out the stressful situation is supposed to provide a new look at it, thus eliminating it as a stressful factor. However, drama therapy should be carefully managed to avoid any negative effects on the participants.
Deblinger, E., Mannarino, A., Cohen, J., Runyon, M., & Heflin, A. (2015). Child sexual abuse (2nd ed.). New York, NY: Oxford University Press
Kuester, A., Niemeyer, H., & Knaevelsrud, C. (2016). Internet-based interventions for posttraumatic stress: A meta-analysis of randomized controlled trials. Clinical Psychology Review, 43, 1-16. Web.
Nappi, C., Drummond, S., & Hall, J. (2012). Treating nightmares and insomnia in posttraumatic stress disorder: A review of current evidence. Neuropharmacology, 62(2), 576-585. Web.