Post-Traumatic Stress Disorder (PTSD) Integrated Management

Post-Traumatic Stress Disorder remains one of the leading stress-related disorders and psychological issues in society today. An understanding on to the treatment of and the management of the disorder for those with and prone to the problem is necessary. A lot of research, and shown in the literature review below, has explored the specific areas of interest and the common strategies used by psychologists, medical doctors and other professionals in the treatment of and management of Post-Traumatic Stress Disorder.

It, however, remains a challenge to find and implement an integrated approach towards Post-Traumatic Stress Disorder treatment and management. It is the labor of this research review to bring together articles and ideas from empirical reports and researches on managing and treating Post-Traumatic Stress Disorder with an aim to create an integrated approach towards the management and treatment of the disorder.

The research recognizes the diversity of possible remedies towards Post-Traumatic Stress Disorder and seeks to bring together four out of the many possible approaches for a program that offers effective remedies for Post-Traumatic Stress Disorder. It recognizes that effective management and treatment of Post-Traumatic Stress Disorder will require a practising psychologist to look beyond the symptoms he or she can see and consider the external inputs to the individual.

As a conceptual framework, therefore, effective management of and treatment for Post-Traumatic Stress Disorder is equal to successful identification of the external factors affecting, influencing and worsening Post-Traumatic Stress Disorder plus the internal factors affecting, influencing and worsening the Post-Traumatic Stress Disorder in the individual. This proposition includes several faces about Post-Traumatic Stress Disorder. First, the disorder is a non-hereditary one and the person suffers Post-Traumatic Stress Disorder in the course of their life.

This is triggered by traumatic experiences such as rape, domestic violence, war and other terrible occurrences such as terrorism and molestation. These are all external factors which often are out of control of the person will. They infiltrate the person’s peaceful course of life from outside and are often unpredictable. They can be summed up as external pressures that lead to Post-Traumatic Stress Disorder. Secondly, the disorder, once it takes its seat in the person’s life, causes several psychological and psychosocial changes in the individual that alter the general behavior of the person and especially, their perception of various stimuli.

The person starts to associate different stimuli with the trauma-related events that they witnessed a long time ago and therefore subjects the individual to a troubled life. lastly, the person being addressed and who is the Post-Traumatic Stress Disorder patient lives in a society of human beings who, from time to time, interact with the patient at different levels. Such interactions will cause various reactions by the society or the individual.

This research will identify the third class of elements part to a Post-Traumatic Stress Disorder patient effective intervention program as the secondary factors. The level or ability of such a society in handling depression and especially, Post-Traumatic Stress Disorder, will determine at a large scale, the trajectory of the individual towards or away from recovery. This is because society will be the support state of the patient.

Addressing Post-Traumatic Stress Disorder

In developing the program and with a view to a multifaceted approach to managing and treating Post-Traumatic Stress Disorder, this review adopts the framework: effective treatment of Post-Traumatic Stress Disorder = addressing external factors + internal factors + external secondary factors. To effectively address the factors, the treatment for Post-Traumatic Stress Disorder will acknowledge the need to include four domains of parties and knowledge necessary for a holistic person, where holistic means addressing all the issues party to Post-Traumatic Stress Disorder and necessary for sustained relief and recovery from the disorder.

As such, the research identifies four main domains of psychology that are important for integration in the treatment of and management of Post-Traumatic Stress Disorder. The domains include the psychological practitioners on the clinical, cognitive, social and rehabilitative. The four are chosen based on their contributions towards a holistic personal focus by psychological practitioners on the clinical, cognitive, social and rehabilitative treatment and management programs, which may take place at the hospital and the home.

There is a seamless connection between the four domains highlighted above and which will be used in the literature review. First, the patient needs drugs that are used to alleviate the deconstructive thoughts and flashbacks and often, the false sense of danger of alarm with patients with psychological practitioners on the clinical, cognitive, social and rehabilitative. The program would include a clear and accurate clinical identification of the problem through careful consultation with a doctor, more so, a psychologist or a clinician.

This is usually the first step in attending to a patient of any kind as long as they can respond to the consultant’s investigation unbiased. Upon the identification of the problem, there is a need for pharmaceuticals to identify the right drugs, if there are any, to counter the traumatic ideation and experiences or memories of the patients, toning down the symptoms of the disorder. Above that, medical science should establish science-based, theoretical and clinical knowledge perspective in relieving, preventing and understanding human psychological ill-health. on the other hand, there is the need to manage the social circles of the patents in such a way that the circles promote, rather than worsening, the recovery process of the patients. The social domain calls for the acts of those around the victim to be controlled so as to produce pro-healing efforts for the victim.

Social psychology studies how people’s acts affect those of others, in our case, the wellbeing of people with Post-Traumatic Stress Disorder. Upon understanding the clinical and social inputs necessary for the whole recovery of the Post-Traumatic Stress Disorder patient, the effective program should consider understanding and attending to primary diseases or states of well-being that promote Post-Traumatic Stress Disorder. An example is spinal and brain injury.

Such patients are more likely to suffer from Post-Traumatic Stress Disorder than any other healthy person. The connection between the chronic diseases and the disorder will be studied carefully with a view to a better management strategy for such patients. A proactive means to curbing the possibility of Post-Traumatic Stress Disorder arising from or among such parents will be reviewed with a view to using rehabilitative psychology as a domain and input to managing the disorder. To yield the best results and for an effective therapy for persons with the disorder, cognitive psychology will be applied.

This psychology includes, among other things, managing the cognitive behavior, including perception, of the Post-Traumatic Stress Disorder patient. It has been shown to be one of the most effective means to treating Post-Traumatic Stress Disorder and other research shows that cognitive behavioral therapy works very well, most effectively, when combined with injunction interventions such as eye movement desensitization and reprocessing. Ultimately, the four domains will rely on each other for the successful treatment of and management of the disorder.

While these domains have been used before, the integration of the four for a single program aimed at effective treatment of post-traumatic stress disorder has not been recorded. It is the burden of this review to show the critical need to have the disorder approached from different angles, hence the development of this literature review pending deeper research thereafter.

This literature was chosen on basis of their primacy and direct address to the various domains as well as their verifiability, coming from an authentic and official library. In so doing, the literature review hypothesizes that only an integrated approach to managing Post-Traumatic Stress Disorder would fully address the growing prevalence of Post-Traumatic Stress Disorder in America.

Discussion

Post-traumatic stress disorder is as a result of the interacting external and internal factors that are related to or associated with the first instance of the traumatic experience and sustain or repress subsequent manifestations of trauma. Specifically, it is a psychological disorder regulated by factors which the person can control and others that he can’t control. Therapy ought to, therefore, recognize the different angles and interventions necessary for Post-traumatic stress disorder treatment for holistic treatment.

Experts consider a holistic approach to health and wellness as the optimal approach, given the side effects and resultant disorders and symptoms of ill-health or anti-social behavior that can result from psycho-social disorders. To them, treating the identified disease without paying attention to the external and internal climate encouraging the disease or disorder would only offer short-term reprieve but leaving nothing for the long-term. Without the holistic approach to ill-health, therefore, treatment would be ineffective in psycho-social disorder (Auxier, Farley & Seifert, 2011).

Clinical Psychology Domain

The first step for an already exposed population ought to be an investigative approach to identify those with post-traumatic stress disorder symptoms and those who do not. Cognitive approaches can be used and this may include a simulation of the suspected event that is feared to have caused post-traumatic stress disorder as well as clinical trials or measures. Clinical psychology, as the term denotes, interests itself with the science-based theoretical and clinical evidence approaches to relieving human suffering from diseases.

In the case of post-traumatic stress disorder and in psychology, it includes the active interrogative, investigative and documentation process to identifying people with or without post-traumatic stress disorder. It seeks to understand ill-health from an evidence point of view. Integrated health management calls for thorough investigations to identify a problem before working on a solution, the reason why clinical psychology comes next to none of the four interventions and domains of psychology in this integrated literature review.

In a study carried out by Ferry, F., Bunting, B., Murphy, S., O’Neill, S., Stein, D., and Koenen, K. in 2014, the authors reported that many issues of violence precipitated post-traumatic stress disorder in Northern Ireland, a zone potential of violence and civil threats. They noted that the population sample of 4340 subjects revealed possibilities of post-traumatic stress disorder upon children and adult exposure to the death of a close friend or a loved person such as children, parents or a sibling, partner violence or threat to a partner or close friend can lead to post-traumatic stress disorder.

These are common occurrences in our societies with people getting assaulted with freehand, crude weapons or guns in every corner. The church shootings, school shootings and street racialized shootings, as well as domestic gun violence in America, expose our children and loved ones to health stressors akin to the situation in Northern Ireland. The implication of their study is that such people as having witnessed assault or violence by a close friend or a loved one need to be screened for, on a going basis, post-traumatic stress disorder among other disorders.

Those found with the slightest of symptoms for post-traumatic stress disorder should be attended to with counselling and where necessary, with cognitive behavioral therapy and eye movement desensitization and reprocessing programs among other interventions.

While programs for therapy and interventions among people with post-traumatic stress disorder would be an effective proactive means to reducing and eliminating post-traumatic stress disorder in the population, there are several internal factors that hinder the quick recovery from the disorder. Seligowski, A. V., Miron, L. R., and Orcutt, H. K. (2015) identify self-compassion as a positive factor in reducing trauma and traumatic manifestations for persons with post-traumatic stress disorder.

Those with high levels of self-compassion and self-pity are more likely to recover and cooperate than those who have reduced self-compassion. This discovery means that cognitive behavioral therapy should include enhancing the individual self-awareness of their condition and their self-compassion, which, predictably, should enhance their means to recovery. The results indicate a need to further research on the other personal emotional factors that could contribute to faster recovery.

However, clinically critical empirical results from two researches show that drug abuse and substance abuse, as well as psychological inflexibility, are two factors that lead to prolonged post-traumatic stress disorder and irresponsiveness in treatment. The first study indicates that psychological flexibility is a positive factor in the treatment of post-traumatic stress disorder while inflexibility is a negative contributor. Those who are willing to flex their opinions and views concerning themselves and concerning the encounters they went through are more likely to recover than are those who are inflexible.

Again, high inflexibility is a predictor for increased post-traumatic stress disorder manifestation (Meyers et al, 2018). Clinicians and psychologists ought to understand this and similar factors that make recover from post-traumatic stress disorder difficult among patients and develop programs that seek to increase the psychological flexibility of patients and persons likely to be or already exposed to post-traumatic stress disorder. On the other hand, Reisman (2016) associates’ drug and substance use with post-traumatic stress disorder, noting that in a study including US war veterans, the majority of them were drug abusers.

Drug abuse, he notes further, can lead to a worsening state of post-traumatic stress disorder, given that the drugs can lead to further depression and impaired judgment, which can, in turn, lead to suicidal ideation. Among the drugs most commonly abused by war veterans are alcohol and cocaine as well as cigarette, all of which have side effects and withdrawal effects as well as cause ill-health in large contents. Still, drug abuse can hinder cooperation between a therapist and the patient and the intervention program should understand the drug history of the patient as well as their current drug abuse status.

Effective intervention, therefore, would start by preventing drug abuse among persons exposed to traumatic war experiences as these are precipitates for further and worsening post-traumatic stress disorder.

As a breakthrough in post-traumatic stress disorder management and treatment, there are drugs that have been found to work best in addressing the symptoms of post-traumatic stress disorder and which ought to be used as the initial strategy for treating the disorder. In pharmacotherapy addressing post-traumatic stress disorder, drugs that act directly on the serotonergic systems are effective when used for a long period.

They actively suppress the trauma thoughts and flashbacks that cause the symptoms for the disorder and thus intervene for a change in the post-traumatic stress disorder experience of the person. The drugs include but are not limited to monoamine oxidase inhibitors and selective serotonin re-uptake inhibitors (Sauer & Bhugra, 2001).  The former includes the drugs used to inhibit monoamine oxidase A or B or both, abbreviated as MAO-A and MAO-B. the two monoamine inhibitors work against depression by functioning as strong anti-depressants and throwing the depressed out of panic and social phobia. As the person becomes less panicked and more sociable, the post-traumatic stress disorder symptoms are mitigated.

Likewise, the selective serotonin reuptake inhibitors are active and powerful antidepressants, functioning by increasing the extracellular amounts of neurotransmitter serotonin through reduced reabsorption or reuptake into the presynaptic cell. This lowers depression, thus, countering the depressive effects of post-traumatic stress disorder. This calls for, however, a patient and intelligent examination of the progress and a combination with conservative therapy strategies such as cognitive behavioral therapy and the eye movement desensitization and reprocessing as the length of time for the drug administration is not a direct predictor or factor for the speed of or level of recovery.

Therapy, therefore, should concentrate on eliminating the psycho-social instabilities through a combination of pharmacological and psychological therapies such as eye movement desensitization and reprocessing and cognitive behavioral therapy (Gutermann, Schwartzkopff & Steil, 2017).

Social Psychology Domain

Social psychology engages itself with the manner or processes and reasons why one person’s acts influence or affect the other. In this domain and in line with Post-traumatic stress disorder, there are several social environment factors that would hinder the full recovery of the Post-traumatic stress disorder patient, even when effective drugs have been provided and complete therapy or recovery has been foreseen. first, physicians and counsellors must understand that in order to design a therapy program for a person suffering from Post-traumatic stress disorder and whose impact event that led to the disorder was due to an encounter they went through, the intensity of the disorder is as often directly proportional to the period of time or intensity of exposure they had with the traumatic event.

Chou et al (2011) studied a group of 1966 children who had post-traumatic stress disorder arising from physical abuse by their relatives or a close friend at home. The authors noted that the longer the children, all of whom were from grades 4 to 8, expressed symptomatic PTDS relative to their period of exposure. They had severe peri-traumatic subjective reactions as compared to those exposed for a short time.

This is because during the time of exposure, the traumatic events continue to register in the persons conscious and subconscious mind and their somatic cells end up relating every repeating event of trauma to the former, and subsequently to the first encounter, growing a bolder association of the stimuli and the results of their experience. This implies that a patient who experienced traumatic events for a whole decade should be given more attention, subject to their resilience and response to therapy, that one who has just had a day’s experience.

The social approach is important because while the research indicates a direct relationship between the time of exposure of the patient to the traumatic event, research also finds that intimate partner abuse can lead to post-traumatic stress disorder with a sample of 128 African-American women population, the authors noticed that the strategies the women would choose would determine whether or not they will end up in post-traumatic stress disorder and if yes, to what extent.

The authors noted that both psychological non-physical and physical abuse leads to Post-Traumatic Stress Disorder. However, they noted that non-physical psycho-social abuse was more prevalent as compared to the physical abuse (Mills, Hill & Johnson, 2018). What this means is that for a woman living with an abusive woman or a man living with an abusive woman as a husband and wife, there are chances that either party, the aggrieved one, will suffer post-traumatic stress disorder. Given the home setting and husband-wife relationships and the time the two spend together, there will always be prolonged exposure to the trauma-causing abusive events to the abused party.

A wife may spend a prolonged life with an abusive husband and vice versa without opting out of the relationship. Gain, the one party can take advantage of the intimate relationship to advance their ill-aimed mistreatment or violence towards their spouses in an America where husband-wife wrangles and tensions are always a probability. This consists of Runyon, Deblinger & Steer (2014) who noted in their research that parental abuse would lead to post-traumatic stress disorder. In their case, if one parent is caring and comforting while the other one is abusive or neglecting, such a mismatch wouldn’t cancel the probability for Post-Traumatic Stress Disorder.

If the one causes the children to go through hellish experiences while the other, probably the mother, creates an encouraging and positive environment for the growing children, they will experience Post-Traumatic Stress Disorder still. The pampering of one parent cannot, therefore, reverse the damages caused by the other. In their review, the authors noted that the effects brought about by the abusive parent were independent with the love shown by another, meaning that the parent will inflict the son or daughter with trauma-causing experiences that cannot be compensated through love and care from another parent.

As such, proactive prevention of post-traumatic stress disorder includes the training for parents to actively provide the right environment for their children and for relatives of adults suffering the disorder to eliminate cases of inhumane treatment by other family members in order to provide an environment that discourages the development and persistence of post-traumatic stress disorder.

Also, Oravecz et al note in their study that post-traumatic stress disorder is not a preserve for persons working in war-torn areas or terror zones, accident occasions and other fatal experiences. They argue and research the prevalence of post-traumatic stress disorder among persons working in Slovene medical emergency units.

The authors realize that post-traumatic stress disorder is common among staff working in ICU and other critical incidence areas in the hospitals, results which can be generalized across the medical profession and the hospital environment all over the world. It is needful, in the spirit of a proactive preventive approach towards post-traumatic stress disorder, to cover such staff as are working in areas that expose them to traumatizing conditions of disease and human sufferings which cause flashbacks among clinical and medical officers. These include all people dealing with broken or missing human limbs out of accidents and other emergencies referred to hospitals and being attended by medical and support staff. One such a program for self-care and organized human resource care ought to be continuous counselling and retraining to cope with and withstand the many cases of critical illnesses and cases of accidents witnessed by the medical officers.

In their studies, Zulueta (2007 and Evans et al (2009) conclude that indeed, persons exposed to September 11, 2001, World Trade Center disaster and persons witnessing mass violence had similar outcomes; they both suffered post-traumatic stress disorder. Zulueta notes that mass violence leads to mass detachment and separation between children and their parents as well as relatives and subject the witnesses to inhumane conditions which trigger trauma symptoms.

Such witnesses may need immediate attention, a subject that delves to the preventive program of post-traumatic stress disorder intervention methods. On the other hand, 842 people who had been involved in the world trade Centre attack showed that those who had any forms of disability were more prone to post-traumatic stress disorder compared to those who didn’t. The two studies outline the need for witnesses of mass violence or terror attacks should be attended to proactively with counselling sessions and especially, those who have any forms of disability, as they are more likely to develop post-traumatic stress disorder than those who are whole and healthy.

The September 11, 2001 World Trade Center report reveals that these categories of individuals are more likely to suffer post-traumatic stress disorder because of their limitations in movement as well as their inability to flee from the scene which subjects them to more horrible conditions of susceptibility as compared to their fellow workers, friends or family members without disabilities.

Rehabilitative Psychology Domain

Understanding the social demographics prone to the likelihood of developing post-traumatic stress disorder is as important as is the understanding of cases where the disorder is likely to develop among people undergoing medical care or critical treatment. Rehabilitative psychology deals with the psychological processes among people undergoing medical treatment.

These are being rehabilitated or treatment for serious injuries such as cancer, spinal injury, brain injury among other excruciating diseases. People with such illnesses are likely to suffer post-traumatic stress disorder due to the memories and/or nightmares they experience. Their therapists ought to understand the challenges they face, the manifestations they have which are symptomatic of post-traumatic stress disorder and how to address them before they advance to a more serious case of post-traumatic stress disorder.

The likelihood that a worker who witnessed fatalities at the place of work will develop Post-Traumatic Stress Disorder is high in the US as well as any other place in the world. In the United Steelworkers research, about 26 percent reported Post-Traumatic Stress Disorder symptoms while another 21 percent reported subthreshold Post-Traumatic Stress Disorder symptoms (Blake et al, 2014). Blake also notes that such people may benefit if a program for counselling and continuous screening was availed for them and they would be in less danger of developing post-traumatic stress disorder symptoms.

Blake and company used a representative population sample of 89 individuals. It is not in industries and factories where accidents are likely to occur where workers are exposed to the development of post-traumatic stress disorder. In a separate study by Abeyasinghe and other researchers in 2012, the authors find that people who had been in the military and had lost either one or more limbs or body parts or had suffered a spinal injury in the course of their work developed a post-traumatic stress disorder. Such statistics show how often employees in the military are likely to suffer post-traumatic stress disorder, given the many chances of amputations and accidents leading to spinal injury among the men in uniforms.

During their rehabilitation programs, they are prone to flashbacks of the events leading to their injuries and loss of their limbs or the amputation, thus, suffering from post-traumatic stress disorder symptoms. This is akin to the experiences of industrial workers witnessing or being affected by industrial accidents, as studied by Blake et al (2014). Similarly, Wisco et al (2014) carried out a study that involved people who had served in the Afghanistan war as US veterans. In the study, the authors sought to establish the relationship between their experiences and traumatic brain injury, post-traumatic stress disorder and suicidal ideation.

Suicidal ideation is a subset of post-traumatic stress disorder but a symptom of other psychological and psychiatric disorders. They found that among the veteran’s study which accounted for 824 males and 825 females, there was an increased risk of post-traumatic stress disorder and suicidal ideation. These findings point to the devastating results of traumatic experiences by war veterans and their younger ones, those already in the battlefields through the army and other counter-terrorism programs. They also indicate the need for more proactive programs to attend to survivors of war, not just in the battlefield marshal’s category, but also among volunteers and good Samaritans who risk their lives to save perishing souls in war areas.

Bahraini et al (2013) studied a population of people living with and undergoing treatment for traumatic brain injury with an intention to establish the relationship between those undergoing rehabilitation for brain injury and post-traumatic stress disorder. The authors realized that all the secondary data used, with 16 different and diverse sources screened, pointed to the increased development of post-traumatic stress disorder symptoms among such patients.

Specifically, suicidal ideation was marked as prevalent ideation among patients undergoing treatment for brain injury caused by traumatic injury. Such populations require active and proactive screening for post-traumatic stress disorder, given the high chances of the development. In the same manner, people suffering from spinal cord injury were all found to have increased chances of suffering post-traumatic stress disorder (Otis, Marchand & Courtois, 2012). In a similar but separate study, Caspi and a group of researchers noted that the memory of the traumatic event is associated with increased risk for Post-Traumatic Stress Disorder.

While people suffering from critical brain and spinal injury are likely to have flashbacks of what happened, their memory of such events would lead to higher chances and prevalence of post-traumatic stress disorder during and after their rehabilitation. The study of 120 subjects showed that those who remember the events will suffer post-traumatic stress disorder while those who don’t remember them will not (Caspi et al, 2005).

These findings, combined with the study on persons who got amputated on either or all limbs, reveals the importance of proactive intervention by counselors to persons or groups of persons undergoing brain, spinal or amputation surgery and treatment. The treatment part is important but is inadequate if the environmental factors in terms of memories will not be addressed. This calls for programs such as cognitive behavioral therapy and eye movement desensitization and reprocessing which help to rebuild the narratives or memories of the events to friendlier versions.

Cognitive Psychology

Having identified the factors leading to, precipitating and contributing to persistence of traumatic flashbacks and other post-traumatic stress disorder manifestations or symptoms, an effective program ought to consider the cognitive behavior and possible approaches to reframing or refashioning the cognitive processes of the patients and people likely to suffer from post-traumatic stress disorder due to their exposure to diverse situations.

Such factors include how a person views himself once they have post-traumatic stress disorder and the value, they attach to themselves. Keshet, H., Foa, E. B., & Gilboa-Schechtman, E. (2018) shows through empirical research that indeed, women who are victims of traumatization suffer from a negative self-image. Management of post-traumatic stress disorder, therefore, should focus on reversing the negative self-perception of women and reconstructing positivity through the cognitive behavioral therapy ascertained as an effective intervention for long-term recovery. Also, women who are repeatedly teased suffer from post-traumatic stress disorder, a situation that is common among most societies where wife battering and demeaning is still active and where women suffer direct and indirect teasing from fellow women or workers.

Such an understanding should help cognitive therapists to manage post-traumatic stress disorder among such clients by counselling for teasing and similar exposures. Kishimoto, Goto and Hashimoto (2014), however, notes that such negative effects can be reversed using drugs such as gabapentin and lamotrigine. The drugs help to mitigate painful experiences as well as unpleasant experiences resulting pressure from teasers and other manipulative experiences from peers and men who tease women, as shown by Kishimoto, Goto and Hashimoto.

Prolonged exposure therapy has been recommended as an effective pro-cognitive strategy to address post-traumatic stress disorder among the worst-hit and mild patients, posing as one of the means through which psychologist can address post-traumatic stress disorder (Kumpula et al, 2017). Again, the method can be combined with other effective programs such as cognitive behavioral therapy for effectiveness and efficiency, noting that drugs help to mitigate for the short-term while cognitive behavioral therapy, eye movement desensitization and reprocessing and prolonged exposure normalizes the experiences, reduces the phobia and intervenes for a post-traumatic stress disorder.

In another research, Ogle, Siegler, Beckham and Rubin (2017) find that neuroticism increases post-traumatic stress disorder symptom severity by amplifying the emotionality, rehearsal, and centrality of trauma memories. Neurotic persons, that is, people with high scores in the personality trait measures using the big five personality traits, are more prone to post-traumatic stress disorder as the status makes one more easily depressed and subject to anxiety and depression.

The cognitive behavioral therapy, as such, ought to focus on taming neuroticism for such individuals, meaning that the psychologists need to understand the person’s character profile. This, according to Reid (2005), should include active mediation and intervention for the memory reprocessing and reconstruction of the actual experiences through flashbacks. Also, active mediation for insomnia and nightmares, which brings back the old experiences as if they were fresh (Reid, 2005), ought to be addressed to improve both sleep quality and the speed of recovery from post-traumatic stress disorder (Krakow et al, 2001).

Critique

The literature used in this review is an integration of various approaches to research on managing post-traumatic stress disorder using the four domains, that is, clinical, rehabilitative, social and cognitive psychology. The four areas are pre-selected domains, based on the need to approach therapy for post-traumatic stress disorder as a psychological problem that includes various external and internal factors either repressing or enhancing the disorder.

The data from the four domains and the literature reviewed contains results from empirical and scholarly studies by authors using sample studies, giving the results credibility and reliability as an ideal resource portfolio for post-traumatic stress disorder research. the literature fully represents the four domains in terms of both active and proactive interventions as well as internal and external factors affecting the recovery and extent of post-traumatic stress disorder. The use of empirical data and studies enhances generalizability, given that they derive their conclusions from representative samples of subjects using experimental and explorative studies.

They derive their authority from the experimental, explorative and empirical nature, relating real-life experiences of war veterans and women subjected to teasing, domestic violence, children subjected to traumatic experiences such as war and accidents among other experiences, and clinical research in drugs and other therapies for a post-traumatic stress disorder. The studies, nevertheless, do not reveal an outright or evidence-based integration and this is why the literature review aims to explain the need for integrated management of post-traumatic stress disorder.

The pieces of evidence raised from the literature matches the claims made in the introduction that post-traumatic stress disorder needs an integrated approach towards management and therapy since it is a multi-factor disorder. The APA ethical principles of psychologists and code of conduct require express permission from the subject’s party to human-subject studies and these have been followed in the majority of the literature above which required human involvement as subjects. The standards were almost uniform across the literature with individuals participating in all the studies doing so upon personal consents from a person with the capacity to give consent, that is, free from any perceptual bias.

Synthesis – Post-Traumatic Stress Disorder

The research review explains, in much detail, the integration of diverse means of treating and managing post-traumatic stress disorder. Chou, Su, Wu and Chen (2011) notes that among other things, the time exposure affects the recovery process while the drug use period doesn’t affect the effectiveness of the treatment. This is necessary for therapists given that the post-traumatic stress disorder problem calls for both pharmacological and conservative methods of therapy. In this case, an integrative approach would call for both drug and non-drug-based therapy programs personalized for the specific cases, given that different groups of individuals have different internal and external factors affecting their ability to recover and the recovery process.

Also, understanding the internal and external environmental inputs should come first in mediating for a post-traumatic stress disorder. This calls for the need to investigate further how the four domains can be effectively applied to fasten and sustain therapy. In the literature, again, cognitive behavioral therapy, eye movements desensitization and reprocessing have been noted as critical approaches towards the treatment and management of post-traumatic stress disorder with a careful drug administration to suppress depression and ignite sociability.

Notably, the literature reveals that understanding the precipitates to post-traumatic stress disorder, the factors that enhance post-traumatic stress disorder, the conditions that suppress post-traumatic stress disorder, the drugs that inhibit the disorder symptoms and the means to intervention for the disorder are all to be jointly addressed for a sustainable therapy for a post-traumatic stress disorder. I propose that a systematic management program ought to include the clinical, empirical and environmental understanding of the individual cases. This ought to include both the stressors the individual is currently facing, the events that triggered the traumatic manifestation and the symptoms party to the specific case, including the drugs most effective in the inhibitory process, in order for a holistic intervention and optimal results to be realized.

The psychologist, again, should seek to understand the social factors, the cognitive factors and therapy options, the clinical evidence and the rehabilitation experiences and voids for people with post-traumatic stress disorder in order to effectively handle the client from an empirical or informed point of view. Finally, effective post-traumatic stress disorder prevention, treatment and management ought to include different players which include pharmacologists, psychologists, and clinicians.

Conclusion

As the literature above has revealed, post-traumatic stress disorder continues to be one of the most challenging mental issues in the world today. While the problem has attracted much research and inquiry into effective combinations of conservative methods and drug-based therapy programs, there is no clear research as to how cognitive behavioral therapy, eye movement desensitization and reprocessing can be combined with drugs to ensure faster and more effective therapy.

Still, there is a need for a deeper understanding of the interacting factors leading to prolonged or sustained post-traumatic stress disorder symptoms among people who have experienced war, industrial accidents, violence and child abuse among other issues of mental torture or trauma. In so doing, the social psychologist needs to participate in developing a good and supportive external environment for the patient to recover.

This may include counselling the caretakers of the patient to avoid such events and stimuli as will remind the person of their traumatic experiences and cognitive behavioral therapy secondary care activities that include physical exercise and social activities. The cognitive psychologist will need to reframe the individual’s self-perception or help the victim to normalize their traumatic experiences through exposure therapy, cognitive behavioral therapy and eye movement desensitization and reprocessing therapy techniques, all of which aim at healing the patient from the short and long term effects of post-traumatic stress disorder as well as the clinicians to effectively identify post-traumatic stress disorder symptoms in patients and evidence-based interventions for post-traumatic stress disorder clients.

Such an approach, that is, an integrated approach to post-traumatic stress disorder management using multifaceted psychological approaches, as explained by the research from the four domains of rehabilitative, clinical, social and cognitive psychology, would make post-traumatic stress disorder treatment and management more effective and efficient. It would also make psychologists more effective and knowledgeable, alleviating the health concerns arising from post-traumatic stress disorder-prone populations such as the survivors of war and military strikes as well as the victims of Karen and Burma among other like-stricken areas.

There are however questions to be answered going forward. First, what combinations of the conservative techniques of cognitive behavioral therapy, eye movement desensitization and reprocessing and exposure therapy work best and why? The answer to this question would grant psychologist an informed database to rely on for empirical evidence in conservative non-drug-based therapy for post-traumatic stress disorder treatment.

Secondly, what would be the best approach for equipping psychologists with the knowledge necessary to implement the four domains in developing a single integrated program for post-traumatic stress disorder therapy? This answer ought to lead the research to the development of a knowledge approach, one in which the psychologist is supposed to understand various modules concerned with the post-traumatic stress disorder integrated management and therapy in order to understand the pharmacological, social and cognitive strategies for an optimal interventional program.

Lastly, the question as to the cost implications of an integrated approach to post-traumatic stress disorder management and treatment arises, seeing that the more knowledgeable the psychologist ought to be, the higher an asset he or she becomes and the more expensive he is likely to become. Also, the more attention is given to individual clients, the more expensive it is likely to be. These are some of the questions that need to be answered alongside the proposition for an integrated approach to post-traumatic stress disorder management.

References

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Post-Traumatic Stress Disorder (PTSD) Relevant Links

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