Sep 2, 2020 in Informative

Bio/Psychosocial Spiritual Assessment

Introduction

Biopsychosocial spiritual assessment can be viewed as a concise summary of client’s information. It helps in providing a brief historical background of probable causes of problems and assists in defining strengths and resources. The current paper will provide a biopsychosocial spiritual assessment of a veteran of several tours to Iraq.

Identifying Information

John B. is 32 years old white American male, military veteran. He has been married for 12 years and has known his wife for 20 years. He has two children. The man has been diagnosed with severe PTSD. He seeks treatment to deal with emotional instability which appears unexpectedly, especially when John hears loud sounds. 

Presenting a Problem

Client reports periods when he struggles with memory problems, suffers from nightmares, sometimes repeatedly during one night, resulting in insomnia (sleeping for 4-5 hours). He goes to work, but sometimes he needs to go outside to walk around because he feels “out of control of my own emotions”. Moreover, he sometimes faces difficulties focusing on work, because of inner anxiety. He is afraid of himself and worried about his family as he might unexpectedly get very emotional, meaning that his wife and two sons “basically need to stay away from” him. The man also suffers from depression. John constantly visits a mental health professional, even when he believes that “things are getting better” or when “nothing actually works and helps”. He utilizes such helpful coping skills as breathing exercises, meditation, and yoga on a daily basis. 

John’s wife, children, friends, and coworkers are also involved in the aforementioned problems. John’s wife is his caregiver. She guides, emotionally supports, and motivates him when he is depressed. Social workers ultimately involved John in weekly (psychologist) and quarterly (psychiatrist) meetings, which has slowly helped him in recovering. These sessions and depression/sleep/mood medications helped him feel much better, “I did not feel that normal since I left the military”.

Background History

John is the oldest of three children whose parents divorced when he was 17 years old. His parents maintained a friendly relationship and lived in the same city, thus, children could spending roughly equal amounts of time with both parents. John is a veteran of several tours to Iraq. He used to be a strong man without any serious health problems before military service. PTSD presupposes that the person must have been exposed to a stressful situation or a moment of unusually menacing, dangerous, or catastrophic character. This is John’s case, as his best friend died practically in John’s hands during the last Iraq deployment. John constantly blames himself for this death, as the man saved his life barring the bullet. John reports feeling responsible and believing that he does not deserve living the life at the expense of somebody else’s death. PTSD also presupposes that there must be a tenacious reliving or remembering of the stress factor appearing as importunate flashbacks, evocative memories, or reoccurring dreams. That is why John cannot sleep and suffers from nightmares.

John was raised in a non-religious family. However, after his parents’ divorce he started attending church and found comfort in the protestant faith. He cannot attend the church as often as desired, because of some of his symptoms. Nevertheless, there is a support system at church, which tries to help John with his issues. It has actually helped in dealing with inner family issues, when John got used to heavy drinking and was on a verge of divorcing. 

Advanced Clinical Practice Theories

The current assessment demonstrates that Pavlovian conditioning and emotional conditioning theories are the most advantageous for the client. The first theory connects exposure therapy to the extinction procedure, in which associational learning cures exorbitant fear. The traumatic situation appears to be connected to unconditioned stimuli (US), which is related to numerous non-menacing conditioned stimuli, including sounds, smells, or people. Thus, when a connection between a neutral stimulus and the traumatic situation is formulated in memory, further subjection to the neutral situation will trigger the traumatic representation, stimulating a reaction of fear , encompassing symptoms re-experiencing, physiological reactance, and avoidance conduct. On the other hand, emotional processing theory suggests that fear is expressed in memory as a cognitive structure, which incorporates fear stimulus, reactions, and their purport. For instance, the client under analysis appears to have a fear structure, incorporating such stimuli representations as loud sudden noises, leading to emotive instability. The application of emotional processing theory to PTSD assists in accounting for natural recovery after trauma, as fear structure is frequently activated when the feared consequents are absent. Thus, the trauma memory revisiting, engagement with trauma-connected feelings and thoughts, sharing of reactions and experience with others will help in successfully recovering from a traumatic situation.

Cultural Competency Skills

John, being white American male, believes that emotional instability and depression are his key problems, which he cannot overcome on his own. The American culture oscillates between upraised ideas of sacrifice and hero-worship in its conception of veterans, which appears just as destructive for the veterans themselves. Analysis of the client’s trauma reveals two major issues. First, a situation which is pathologically distressful for one person might not be so traumatic for another one, resulting in substantial individual disparity in the trauma experience. Second, this disparity is stimulated by both life history and culture. Thus, embedded cultural signs, systems, and beliefs define the possibly of traumatic situations. In fact, more U.S. combat veterans are diagnosed with PTSD in the U.S. than anywhere else, turning this condition into a cultural phenomena. Therefore, conceptual models should incorporate PTSD risks, taking into account both domestic and cross-cultural research.

Client’s Strength

John has three major strengths. He is capable of acknowledging his problems and this will help in appropriately assessing existent issues. Second, he is not afraid of sharing his emotions with others. This will assist in working with specialists in organized PTSD groups. Third, he has developed individual coping strategies, which can be enhanced and broadened to develop required fear structure models and associative emotional reactions. 

Measurable Goals and Objectives

First goal stands for the fact that is important to activate the fear structure when feared consequences are absent, helping to correct the exaggerative probability harm estimates. First objective concerns the usage of exposition principle to work with constructive individuality dissociations. Second objective regards patient’s free association and impartial observation of these associations leading to activation of the circumspect ego. Third objective stands for reversible stimulation throughout trauma reliving lading to peculiar activation alerations in the central nervous system.

Second goal demonstrates that it is important to develop a safety associations plan, including repeated remittance of the trauma memory, assisting in organizing the memory narrative and consolidating the difference between trauma recollection and trauma experience. It changes connections between the meanings of traumatic and hazardous. This can be achieved through three major objectives. Firstly, it is significant to integrate the past into the complete conscience of the present. Secondly, it is important to activate internal safety sources, meaning positive internal objects. Thirdly, it is crucial to activate present secure therapeutic rapports, meaning psychotherapy in a form of a secured basis.

Third goal concerns the engagement in a self-care plan and exposure to the trauma memory will assist the client in reevaluating negative trauma-connected cognitions, which are at the core of the PTSD-connected fear structure. First objective stands for cognitive-behavioral techniques, specifically cognitive and exposition therapy. Second objective regards fear constraining/control framework, which should be utilized to conceptualize the PTSD neurobiology. Third objective stands for consolidation, trauma confrontation, and reintegration.

Application of Advanced Clinical Practice Theories Appropriate for the Client System

The defined goals will help in differentiating normal and pathological fear structures. The emotional processing theory demonstrates that the client’s normal fear structure is limited to settings which are actually hazardous, meaning an active war zone. Thus, fear structure activation will stimulate adaptive reactions, including weapons preparation and enemy dangers control. On the other hand, a pathological fear structure is activated by impartially safe stimuli, including thunderstorms and fireworks. Inaccuracy connections stimulated by pathological fear lead to overgeneralization of fear reactions. In fact, emotional processing theory can be used for successful lowering of pathological fear. Hence, treatment should primarily activate the fear structure and only then equip new data, which is inconsistent with the existent pathological fear structures. The exposure therapy can help in efficiently accomplishing both objectives.

Discussion of Research Regarding Clinical Practice Theories

Numerous researches prove that emotional conditioning theory can lead to novel therapeutic attempts, solidly influencing the attainment, attenuation, and reconsolidation of PTSD-connected fear reactions. The research reveals that 36 percent of personnel returning from Iraq who has been screened as PTSD positive enhance their fear reactions. In addition, it decreases the level of lifetime prevalence rate of war-related PTSD to 18.8 percent. Thus, the treatment will help in accounting for natural recovery of the current client’s trauma, effectively addressing PTSD. The best practices will incorporate imaginable or in vivo exposure, flooding, and systematic desensitization. These practices will require the client to revisit the traumatic memory, analyze trauma-connected feelings and thoughts, share his experience and reactions with professionals during group meetings, and approach trauma reminders in daily life. These practices will help the client in successful recovery from a traumatic event. 

Conclusion

PTSD does not own the person; it is only a diagnosis. Life changes when a person faces PTSD. The sooner the person accepts this fact, the sooner this individual can find the best treatment. Individuals suffering from PTSD frequently encounter emotional instability, depression, and unexplained fears provoked by smells, sounds, and people. Pavlovian conditioning and emotional conditioning theories together with conceptual models which take into account all domestic and cross-cultural features are the most advantageous for the client.

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