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Interventions and Treatment for PTSD

Early Intervention to Prevent PTSD-Recommendations

1. For people who meet the criteria for diagnosis of Acute Stress Disorder (ASD), there is insufficient evidence to recommend for or against the use of Psychological First Aid to address symptoms beyond:

A. 10 days following trauma

B. 7 days following trauma

C. 4 days following trauma

D. 2 days following trauma


Psychotherapy

2. For ASD patients with significant early symptom levels, early brief intervention of cognitive-based therapy (CBT) should be considered.  

A. True

B. False


Psychotherapy-Psychological Debriefing

3. Psychological debriefing involves review of a traumatic event and encourages individuals to do each of the following EXCEPT:  

A. Talk about their experiences during the event

B. Recognize and verbalize their thoughts, emotions, and physical reactions during and since the event

C. Learn about coping methods

D. Improve post-trauma interactions with others


Individual Debriefing

4. Reviews and meta-analyses of studies of psychological debriefing as an early intervention to reduce or prevent PTSD symptoms in individuals have concluded that this technique is generally effective and helpful if implemented properly.

A. True

B. False


Evidence Table

5. Experts do not recommend psychological debriefing for professional work groups during the weeks or months after critical incidents.

A. True

B. False


Brief Early Cognitive-Behavioral Intervention

6.   Several controlled trials have suggested that brief cognitive-behavioral treatments, comprised of ______________, relaxation techniques, imaginal and in vivo exposure, and cognitive restructuring, delivered within weeks of the traumatic event, can often prevent PTSD in survivors of sexual and non-sexual assault.

A. Education

B. Screening and assessment

C. Group support

D. Hypnotic techniques


Early Pharmacotherapy Interventions to Prevent PTSD

7. Historically, antidepressants have been the primary agent in PTSD treatment, particularly the tricyclic antidepressants (TCIs).

A. True

B. False


Early Pain Intervention to Prevent PTSD

8. A reduction in perceived pain levels through the use of morphine or other opioids, as part of trauma care, may lower the rate of PTSD onset after major trauma.

A. True

B. False


Selection of Therapy for PTSD-Recommendations

9. Which of the following is NOT one of the recommendations for treating PTSD?

A. In general, PTSD therapy research has provided sufficient evidence to recommend medication or evidence-based psychotherapy as a first-line treatment

B. Patient preferences and the particular evidence-based treatments that the provider has the most training/expertise in will often drive the initial therapeutic approach

C. A collaborative care approach, with care management, has proven to be especially effective for PTSD

D. The level or intensity of care is guided by illness trajectory, observed outcomes, and previous therapies.


Packaging of Manualized Approaches of Therapy-Recommendations

10. Stress Inoculation Training is generally recommended for treatment of nightmares and sleep disruption for patients with PTSD.

A. True

B. False


Therapies that More Strongly Emphasize Cognitive Techniques (CT)

11. CT involves challenging and disputing dysfunctional beliefs by examining the evidence for or against them, and restructuring or replacing these beliefs with those that are more _________, logical, and reality-based.

A. Legitimate

B. Consistent

C. Functional

D. Well-organized


Summary of Studies: Conclusions

12. Although there is good evidence that individual CT is effective in reducing PTSD symptoms, evidence that treatment gains persists for up to 2 years is limited. 

A. True

B. False


Exposure Therapy

13. The most commonly used protocol for Exposure Therapy is Imaginal Exposure, although various other exposure protocols have been used.  

A. True

B. False


14. The ET technique of in vivo exposure involves asking the patient to physically confront realistically safe but still feared stimuli, such as driving a car after having been in a serious motor vehicle accident.

A. True

B. False


Stress Inoculation Training (SIT)-Discussion

15. Stress Inoculation Training studies have shown that:

A. SIT has proven to be effective with women who have survived sexual assault and for the overall treatment of PTSD

B. SIT was found to be the most effective treatment for short-term symptom improvement, and SIT was superior to PE for long term improvement

C. A study of 15 women by Kilpatrick et al. found Supportive Counseling (SC) to be superior to SIT in reducing rape-related fear and anxiety

D. Motor vehicle accident survivors had a 48 percent reduction of PTSD symptoms after involvement in a modified version of a SIT/PE combination program


Eye Movement Desensitization and Reprocessing (EMDR)

16. In EMDR, the therapist collaborates with patients to:

A. Access a disturbing image associated with the traumatic event and solicit the experience of body sensations associated with the disturbing image

B. Identify an aversive self-referring cognition (in concise words) that expresses what the patient "learned" from the trauma

C. Identify an alternative positive self-referring cognition that the patient wishes could replace the negative cognition

D. All of the above


Psychodynamic Therapy

17.   Psychodynamic psychotherapies operate on the assumption that addressing unconscious _______________ can help survivors cope with the effects of psychological trauma.

A. Anxieties and concerns

B. Mental contents and conflicts

C. Illusions and visions

D. Imagery and distress


Group Therapy-Table I - 5 Group Therapy in PTSD

18. Helping individuals develop a sense of mastery over problems via group feedback, emotional support and reinforcement of adaptive behaviors is likely to occur in Psychodynamic  Interpersonnel Process Group Therapy.

A. True

B. False


Rationale

19. Group-based treatment for individuals diagnosed with PTSD is associated with improvements in symptoms of PTSD, and there is growing belief that some unique attributes of the group treatment format provide benefits that are superior to individual treatment for trauma.

A. True

B. False


Dialectical Behavior Therapy-Discussion

20. Although no clinical trials have been reported in the literature for the use of DBT in patients with PTSD, DBT is becoming more common as a technique for treating patients with borderline personality disorder.

A. True

B. False


Hypnosis-Background

21. Historically, hypnotic treatments have played a role in the management of each of the following PTSD related conditions EXCEPT:

A. Shell shock

B. Battle fatigue

C. Avoidance symptoms

D. Traumatic neuroses


Telemedicine and Web-based Interventions

22. Several rigorous studies have determined that Cognitive Enrichment Group Therapy Techniques delivered through video conferencing are as effective as face-to-face interventions for correcting faulty cognitions.

A. True

B. False


Web-Based Interventions-Discussion

23. While there is insufficient evidence in this area thus far, in the future the use of the Internet may have relevance as adjunctive modalities in assisting distressed traumatized individuals and complementing other evidence-based treatment interventions.

A. True

B. False


Pharmacotherapy for PTSD-General Recommendations

24. If no improvement is observed at ________ of pharmacotherapy for PTSD, increasing the dose of the initial drug to maximum tolerated or discontinuing the current agent and switching to another effective medication is recommended.

A. 10 weeks

B. 8 weeks

C. 6 weeks

D. 4 weeks


Augmented Therapy for PTSD

25. Risperidone is often used effectively as an adjunctive therapy to treat PTSD.

A. True

B. False


Discussion-Antidepressants

26. Two antidepressants that have been FDA approved for the treatment of PTSD treatment are:

A. Sertraline and paroxetine

B. Citalopram and escitalopram

C. Mirtazapine and nefazodone

D. Duloxetine and desvenlafaxine


27. Venlafaxine, an SNRI, has been shown to have positive results in two trials of more than 800 participants with non-combat-related PTSD.

A. True

B. False


Benzodiazepines

28. Even though there is no evidence that benzodiazepines reduce core symptoms of PTSD, they are widely used for symptomatic control of insomnia, panic/anxiety, and:

A. Irritability

B. Avoidance

C. Dissociation

D. Hyper-alertness


Other Agents

29. Buspirone, a non-benzodiazepine anti-anxiety drug, has shown consistent efficacy in improving sleep and reducing nightmares.  

A. True

B. False


Table I - 7 Pharmacological Studies for Treatment of PTSD

30. Studies have shown that fluvoxamine appears to improve PTSD symptoms and enhance sleep quality for Vietnam veterans.

A. True

B. False


31. The atypical antipsychotic, __________, has been shown to significantly improve Clinical-Administered PTSA Scale (CAPS) score in PTSD patients.

A. Olanzapine

B. Risperidone

C. Tiagabine

D. Quetiapine


32. Novel antidepressants such as bupropion, nefazodone, and trazodone have lower rates of sexual dysfunction compared to traditional SSRIs.

A. True

B. False


Psychosocial Rehabilitation

33. Psychosocial Rehabilitation involves clinicians providing family psychoeducation, supported employment, supported education, and supported housing to assist those with chronic PTSD.

A. True

B. False


Models of Psychosocial Rehabilitation Services

34. The type of psychosocial rehabilitation that has been shown to reduce isolation in persons with severe mental disorders and may be promising for patients with PTSD is:

A. Family Skills Training

B. Social Skills Training

C. Self-Care Technique Training

D. Psychoeducation


Vocational Rehabilitation

35. Which of the following is NOT a correct statement about the use of vocational education and Supported Employment to treat mental disorders and PTSD?

A. Strong outcome data exist to support the efficacy of Supported Employment (SE) for veterans with medical and mental disorders

B. SE was found to be associated with fewer crises, less chaos, more structure, and on-going support from vocational rehabilitation specialists, because consumers now focus on developing their lives in the community and managing their illness more independently

C. The SE intervention known as "learn-by-doing" uses on-the-job training in hospitals and educational settings

D. For nonveterans and veterans, particulary those with serious mental disorders, SE was found to be superior to programs that offered pre-vocational training


Spiritual Support-Discussion

36. A study of help-seeking military veterans found significant associations between negative religious coping, lack of forgiveness, and worse PTSD and depression symptoms.

A. True

B. False


Acupuncture-Background

37. Acupuncture may be considered as a treatment for PTSD as it activates neurohumoral pathways and stimulates neural connections associated with the Central Nervous System, thalamus, and cerebrum.  

A. True

B. False


Complementary and Alternative Medicine-Recommendations

38. Complementary and Alternative Medicine (CAM) approaches that facilitate a relaxation response have been shown to more effective than standard stress inoculation techniques in treating hypersrousal symptoms of PTSD.

A. True

B. False


Natural Products (Biologically Based Practices)

39. With _________ therapy, a practitioner takes an extensive history in order to best understand which single remedy (or in some cases combinations of remedies) best accounts for the cluster of symptoms, and therefore would be most optimal for stimulating the body’s defenses against that symptom cluster.

A. Herbal

B. Homeopathic

C. Mind-Body

D. Isopathic


Manipulation and Body-Based Practices (Exercise and Movement)

40. Exercise has been advocated as an integrative approach in the prevention and treatment of PTSD and other combat-related mental health problems, while massage and skeletal manipulation has long been used for reducing the ill effects of physical and mental stress.

A. True

B. False


Animal-Assisted Therapy (AAT)

41. AAT is a goal-directed intervention in which an animal is an integral part of the treatment process designed to promote improvement in human physical, social, emotional, and/or cognitive functioning, and the most commonly used animals are dogs and cats.

A. True

B. False


Sleep Disturbances

42. Evidence suggests that since psychologically traumatized patients dread sleep because of nightmares, insomnia associated with traumatic stress reactions must be managed differently than insomnia associated with other conditions.

A. True

B. False


Use of Prazosin for Sleep Disturbance

43. Prazosin, an antiadrenergic medication commonly used for treating hypertension, has been used to treat each of the following in veterans with chronic PTSD EXCEPT:

A. Hyperarousal symptoms

B. Trauma nightmares

C. Global clinical status

D. Sleep disturbance


Pain-Background

44. Among adult survivors of physical, psychological, or sexual abuse the most common forms of chronic pain involve pain in the pelvis, lower back, face, and bladder, fibromyalgia, interstitial cystitis, and:

A. Heachache

B. Joint pain

C. Neuropathic pain

D. Non-remitting whiplash syndromes


Recommendations

45. Management of pain should be multidisciplinary, addressing the physical, psychological, and ________ components of pain in an individualized treatment plan that is tailored to the type of pain.

A. Social

B. Cognitive

C. Spiritual

D. Both A and C above


Discussion-Prevalence

46. A study by Schwartz et al.noted that between 10 percent and 50 percent of patients treated in tertiary care settings for chronic pain and related conditions have symptoms that meet criteria for PTSD.

A. True

B. False


Interdisciplinary Approach to Management

47. The focus of an integrated approach to address chronic pain and PTSD should be on education, management of symptoms, reducing pain and suffering, improving function, and enhancing quality of life.

A. True

B. False


Cognitive Behavior Therapy (CBT)

48. Which of the following is NOT a true statement about the use of CBT for chronic pain?

A. CBT for chronic pain involves teaching patients ways of safely reintroducing enjoyable activities into their lives

B. CBT for pain uses a variety of techniques that are aimed at changing maladaptive thoughts and behaviors that serve to maintain and exacerbate the experience of pain

C. One successful program developed for veterans with co-morbid pain and PTSD used components of CBT and and motivation interviewing in an eight week group treatment setting

D. Key components of CBT for chronic pain include cognitive restructuring, relaxation training, time-based activity pacing, and homework assignments designed to decrease patients’ avoidance of activity and reintroduce a healthy, more active lifestyle


Irritability, Severe Agitation, or Anger

49. While anger is an emotion that ranges from mild irritation to intense fury and rage, ________ is behavior that is intended to cause harm to another person or damage property.

A. Theat

B. Aggression

C. Assault

D. Hostility


Discussion

50. Research has identified anger as prominent in military veterans with PTSD and as having an influence on treatment outcomes.

A. True

B. False


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