Posttraumatic Stress Disorder Although originally considered an anxiety disorder, the DSM-5 removed PTSD from the classification of anxiety disorders and included it in a new chapter, Trauma- and Stressor-Related Disorders. PTSD was once considered a psychological condition of combat veterans who were “shell shocked” by and unable to face their experience on the battlefield. Individuals with PTSD were labeled as weak, faced rejection from their military peers and society in general, and were removed from combat zones or discharged from the military. Today we know that PTSD is a psychobiological mental disorder associated with changes in brain function and structure and can affect survivors of combat experience but also survivors of terrorist attacks, natural disasters, serious accidents, assault or abuse, and even sudden and major emotional losses (National Institute of Mental Health, 2014a). Scientists are focusing on genes that play a role in creating fear memories as well as studying parts of the brain that deal with fear and stress (Clapp, 2016). The DSM-5 criterion for PTSD has been expanded to include both direct and indirect exposure to potentially traumatic experiences (Uher et al., 2014). Prevalence Most of the research on PTSD has been conducted with male veterans of military combat. In the cohort of Vietnam veterans (now in the “baby boomer” cohort), 3 out of 10 experience PTSD. Among Afghanistan and Iraq veterans, 11% to 20% experience PTSD (United States Department of Veterans Affairs, 2014). Only recently realized is the fact that many World War II veterans have lived most of their lives under the shadow of PTSD without realization of their disorder. PTSD occurs increasingly in women, although research is scarce. Rape, child abuse, and domestic violence are the most likely traumas that will result in PTSD in women. With more women serving in the military, combat-induced PTSD among women is expected to increase (Kaiser et al., 2014a). Prevalence rates of PTSD among older adults have not been adequately studied, but estimates are that between 3% and 5% of individuals older than age 60 experience PTSD. Many older individuals may not meet the full criteria for a PTSD diagnosis but may still exhibit symptoms (partial or subsyndromal PTSD) (Chopra et al., 2014). The percentage of older individuals with subclinical levels of PTSD symptoms ranges from 7% to 15% (Kaiser et al., 2014a). Current estimates may underrepresent the prevalence of PTSD in older adults (Clapp, 2016). In addition to military combat, seniors in our care now have also experienced the Great Depression, the Holocaust, and racism events that also may precipitate PTSD. Although they may have managed to keep symptoms under control, a person who becomes cognitively impaired may no longer be able to control thoughts, flashbacks, or images. This can be the cause of great distress that may be exhibited by aggressive or hostile behavior. Older individuals who are Holoca ...

1. Posttraumatic Stress Disorder
Although originally considered an anxiety disorder, the DSM-5
removed PTSD from the classification of anxiety disorders and
included it in a new chapter, Trauma- and Stressor-Related
Disorders. PTSD was once considered a psychological condition
of combat veterans who were “shell shocked” by and unable to
face their experience on the battlefield. Individuals with PTSD
were labeled as weak, faced rejection from their military peers
and society in general, and were removed from combat zones or
discharged from the military. Today we know that PTSD is a
psychobiological mental disorder associated with changes in
brain function and structure and can affect survivors of combat
experience but also survivors of terrorist attacks, natural
disasters, serious accidents, assault or abuse, and even sudden
and major emotional losses (National Institute of Mental Health,
2014a). Scientists are focusing on genes that play a role in
creating fear memories as well as studying parts of the brain
that deal with fear and stress (Clapp, 2016). The DSM-5
criterion for PTSD has been expanded to include both direct and
indirect exposure to potentially traumatic experiences (Uher
et al., 2014).
Prevalence
Most of the research on PTSD has been conducted with male
veterans of military combat. In the cohort of Vietnam veterans
(now in the “baby boomer” cohort), 3 out of 10 experience
PTSD. Among Afghanistan and Iraq veterans, 11% to 20%
experience PTSD (United States Department of Veterans
Affairs, 2014). Only recently realized is the fact that many
World War II veterans have lived most of their lives under the
shadow of PTSD without realization of their disorder. PTSD
occurs increasingly in women, although research is scarce.

2. Rape, child abuse, and domestic violence are the most likely
traumas that will result in PTSD in women. With more women
serving in the military, combat-induced PTSD among women is
expected to increase (Kaiser et al., 2014a). Prevalence rates of
PTSD among older adults have not been adequately studied, but
estimates are that between 3% and 5% of individuals older than
age 60 experience PTSD. Many older individuals may not meet
the full criteria for a PTSD diagnosis but may still exhibit
symptoms (partial or subsyndromal PTSD) (Chopra et al.,
2014). The percentage of older individuals with subclinical
levels of PTSD symptoms ranges from 7% to 15% (Kaiser et al.,
2014a). Current estimates may underrepresent the prevalence of
PTSD in older adults (Clapp, 2016). In addition to military
combat, seniors in our care now have also experienced the Great
Depression, the Holocaust, and racism events that also may
precipitate PTSD. Although they may have managed to keep
symptoms under control, a person who becomes cognitively
impaired may no longer be able to control thoughts, flashbacks,
or images. This can be the cause of great distress that may be
exhibited by aggressive or hostile behavior. Older individuals
who are Holocaust survivors may experience PTSD symptoms
when they are placed in group settings in institutions. Bludau
(2002) described this as the concept of second
institutionalization. Older women with a history of rape or
abuse as a child may also experience symptoms of PTSD when
institutionalized, particularly during the provision of intimate
bodily care activities, such as bathing. Box 24.6 provides some
clinical examples of PTSD.
Symptoms
The DSM-5 includes four major symptom clusters for diagnosis
of PTSD:

3. (1) reexperiencing;
(2) avoidance;
(3) persistent negative alterations in cognition and mood;
(4) alterations in arousal and receptivity (including irritable or
aggressive behavior and reckless or self-destructive behavior)
(American Psychiatric Association, 2013).
Individuals often reexperience and relive the traumatic event in
episodes of fear and experience symptoms such as helplessness,
flashbacks, intrusive thoughts, dreams, images, avoidance of
thoughts or situations that remind them of the traumatic event,
poor concentration, irritability, increased startle reactions, and
numbing of emotional responsiveness (detachment, flattened, or
absent affect) (Clapp & Beck, 2012; Khouzam, 2013).
Implications for Gerontological Nursing and Healthy Aging
Assessment
PTSD prevention and treatment are only now getting the
research attention that other illnesses have received 317over the
years. The care of the individual with PTSD involves awareness
that certain events may trigger inappropriate reactions, and the
pattern of these reactions should be identified when possible.
Knowing the person's history and life experiences is essential in
understanding behavior and implementing appropriate
interventions. Research on resiliency may lead to ways to
predict who is most likely to develop PTSD following highly
stressful events (National Institute of Mental Health, 2014a).
Assessment of trauma and related symptoms should be routine
in older patients because they may not report traumatic
experiences or may minimize their importance. The Hartford
Institute for Geriatric Nursing recommends the Impact of Event
Scale–Revised (IES-R) (Christianson & Marren, 2013) (Box
24.7). Similar to other mental health concerns, elders may be
more likely to report physical concerns, pain, sleep difficulties,

4. or cognitive problems rather than emotional problems. Asking
about issues or concerns may prompt a description of emotional
reactions. Reports of physical issues should be followed with
questions about changes in mood and activities. Cognitive
screening for delirium/dementia is important, as well as
assessment for depression and suicide (Kaiser et al., 2014b).
Box 24.7
Interventions
The understanding of how to treat PTSD among older adults is
still developing (Clapp & Beck, 2012) but recommendations are
that older patients can benefit from CBT and prolonged
exposure (PE) therapy (Kaiser et al., 2014b). Other therapies
shown to improve PTSD symptoms include cognitive processing
therapy, eye movement desensitization and reprocessing, and
narrative exposure therapy (Agency for Healthcare Research
and Quality [AHRQ], 2013). Pharmacological therapy is also
used, and sertraline and paroxetine have received approval by
the U.S. Food and Drug Administration (FDA) to treat PTSD.
Careful monitoring of these medications is necessary in older
patients (see Chapter 9). Cognitive therapy aims to isolate
dysfunctional thoughts and assumptions about the trauma that
seem to cause distress. Individuals are encouraged to challenge
the truth of the beliefs and to substitute them with more
balanced thoughts. Exposure therapy involves recalling
distressing memories of the trauma/event via controlled
exposure to reminders of the event. Exposure can be done by
imagining the trauma, reading descriptions of the event, or
visiting the site of the trauma until distress associated with the
memory lessens and your body and mind are retrained to view
the situation less dangerous than it was perceived to be.
Therapies should be individualized to meet the specific
concerns and needs of each unique patient and may include
individual, group, and family therapy (Khouzam, 2013). Further
research is necessary to understand the various presentations of

5. PTSD in late life and validate and improve the effectiveness of
available treatment approaches (Bottche et al., 2012; Thorp
et al., 2009).
Thread 1
Promise keeping is directly connected to the study of ethics and
is morally important in the day to day lives of individuals.
People are constantly making promises to other individuals,
groups of citizens, and to God as well. Whether it be something
as small swearing to bring coffee for someone, or as big as
standing before a congregation and God to pledge vows in a
marriage ceremony, promises are found all throughout one’s
life. Therefore, understanding their significance is crucial in
living a moral life as a believer in Christ. Jesus constantly made
promises to people and His Father in heaven during His time on
earth. Throughout Scripture one thing is very clear, Jesus was
always faithful. He never committed to doing something that he
would then later go back on.
Because Scripture has clearly shown the importance of keeping
promises made, I believe that breaking one is morally wrong.
Matthew 5:37 states, “Let what you say be simply ‘Yes’ or
‘No’; anything more than this comes from evil.” Therefore, if a
person claims that he is going to do or not do something, then
Scripturally he is bound to his word. Anything less would be
breaking this spoken promise, making him a liar by default. God
has clearly told believers that what they say should either be
“Yes or No,” meaning they should stick with what they say.
However, imagine that a person commits to do something for
someone without all of the information. After discovering what
the promise is in detail, he realizes that what he has vowed to
do is actually immoral and goes against Scripture. Now which
option is the moral one? Should he carry out the task that he
already gave his word on or should he tell the person that he
cannot fulfill his promise anymore due to the circumstances?
As a result of both of these arguments, I believe

6. Scripture has made it clear that keeping a promise is morally
correct. One should strive to live truthfully by his word just as
Jesus demonstrated in every area of His life. However, if a
promise is in direct contradiction with Scripture, then that
person may have to break that specific promise. Thankfully,
with whatever decision is made, Jesus has already shown grace.
He did that when he died on the cross for sinners. Because of
this, believers can pursue holiness while living under the power
of grace. With that being said, each individual should be smart
when making promises. They should understand exactly the
weight of what they are agreeing to before saying yes, realizing
that they do not know the outcome.
Going off this last point, I believe sometimes it is
morally obligatory to break a promise. Imagine a woman is on
her way to an overdue promised dinner with a friend that she
had not seen in a while. However, after leaving her house she
witnesses a fatal car accident right in front of her car. Does she
stop to call an ambulance and help, or keep driving in order to
keep her promise? Most people would agree that morally
speaking, it would be correct to stop and see who is hurt rather
than continue on to dinner. Because of this, it appears there are
times when it is necessary to break a promise. However, this
still does not lay aside the textbook words that “It is unethical
to promise and fail to deliver.”[1] This is a true statement still.
Despite it all, one thing is certain: God’s grace triumphs over
anything. This is never an excuse, but rather a beautiful
blessing.
[1] Stivers, Laura A., Christine E. Gudorf, and James B. Martin-
Schramm. n.d. “Christian Ethics: A Case Method Approach”
4th Edition.
Thread 2 –
A promise is sacred and is defined as “a declaration that

7. something will or will not be done, given, etc.”[1] When a
promise is made, one is verbally assuring someone that he or
she will do a certain task or fulfill a certain request. So, why is
it morally important to keep a promise? In order to answer this
question, one must first understand what makes any principle
moral. In order for something to be morally correct it must be
objective with generalized validity and rational intelligibility.
Therefore, it is reflected that being truthful is moral, as it is a
general and rationally accepted standard.[2] Since promise
keeping is equated to being truthful, keeping a promise is a
moral obligation. From a Christian perspective one is morally
obligated to keep his or her word because it is a commandment
of God: “This is the thing which the Lord has commanded: if a
man makes a vow to the Lord, or swears an oath to bind himself
by some agreement, he shall not break his word; he shall do
according to all that proceeds from his mouth.”[3] Thus, it is
evident that it is not only a moral obligation between
individuals to be true to one’s word, but a person is also under
the command of God.
Considering promise keeping is a deeply important principle of
moral conduct, it is necessary to beg the question of whether it
is morally permissible to break a promise? As mentioned
above, a promise is a morally binding word that has been given
to someone regarding a specific task. To fail to keep a promise
is essentially telling a lie and invites distrust into the
relationship. From a Christian perspective, distrust enters the
earthly relationship but disobedience becomes a part of the
relationship with God. In Exodus 20:2-17, the Ten
Commandments clearly states that it is a sin to lie. Therefore,
when a promise is broken it is more than just not following
through on one’s word, it is a sin against God.[4]
Nevertheless, there are extraordinary circumstances when there
exists a moral obligation to break a promise. One such example
is if keeping a promise places one’s own or someone else’s life
in danger. One cannot, in good conscience, keep a promise that
knowingly places someone’s life in harm’s way. Another

8. example of a moral obligation to break a promise is if it causes
us to disobey God. A common occurrence of such a moral
obligation throughout history has been noted when leaders
require people to follow acts that are in rebellion to the Word of
God. The Bible calls for honor and obedience to leaders and one
may promise to follow a certain leader, however, if that leader
is killing Jews in the Holocaust or condoning the murder of
unborn children, their actions are breaking commandments set
by God. As God’s commandments supersede all other earthly
leaders, it becomes a moral obligation to break the oath to
follow that person. It is important to remember that, when
making a promise, one is asserting that he or she knows how the
future is going to play out. On account that there is only one
person who truly knows the future, one has to be truly careful
what promises he or she makes and to whom the promise is
made. As a result, promise making and keeping becomes
difficult and weighty situation.[5]
[1]Dictionary.com, “promise,” Accessed November 4, 2019,
https://www.dictionary.com/browse/promise
[2] Schramm, James Martin, B., Stivers, Laura A., Gudorf,
Christine E., Christian Ethics: A Case Method
Approach, (Maryknoll, NY, Orbis Books).
[3] Num. 30:1-5
[4] Ibid., part I
[5] Ibid., part I
ETHC 101
Discussion Board Reply Grading Rubric
Criteria
Levels of Achievement
Content 70%
Advanced
Proficient

9. Developing
Not Present
Points Earned
Word Count
14 or 15 points
Word count is between 500 and 600 words.
11 to 13 points
Word count exceeds 600 words.
1 to 10 points
Word count is less than 500 words.
0 points
Not present
Style
9 or 10 points
Reply offers constructive feedback to a classmate in a manner
that is polite, rationally argued, and not overly emotional.
7 or 8 points
Reply offers constructive feedback to a classmate but with some
deficiency of politeness, reasonableness, and/or dispassion.
1 to 6 points
Reply offers little to no constructive feedback, and/or is
strongly impolite, and/or is very emotional.
0 points
The post is not a reply (it is off-topic).
Understanding
9 or 10 points
Reply utilizes many of the concepts and technical vocabulary
taught in the class in a manner that demonstrates accurate
understanding.
6 to 8 points
Reply utilizes some of the concepts and technical vocabulary
taught in the class in a manner that demonstrates accurate
understanding.
1 to 5 points

10. Reply utilizes some of the concepts and technical vocabulary
taught in the class but sometimes in ways that suggest that they
are not correctly understood.
0 points
Reply does not utilize the concepts and technical vocabulary
taught in the class.
Structure 30%
Advanced
Proficient
Developing
Not Present
Points Earned
Spelling, Punctuation, and Grammar
9 or 10 points
Reply is written in paragraph form and is devoid of spelling,
punctuation, and grammar errors.
7 or 8 points
Reply is not written in paragraph form and/or has occasional
spelling, punctuation, and grammar errors.
1 to 6 points
Reply is not written in paragraph form and has numerous
spelling, punctuation, and grammar problems.
0 points
Not present
Turabian formatting
5 points
Direct references and/or allusions to outside resources (such as
the textbooks) are present and are cited using footnotes in
current Turabian format.
4 points
Direct references and/or allusions to outside resources (such as
the textbooks) are present but are cited otherwise than using
footnotes in current Turabian format.
1 to 3 points

11. Direct references and/or allusions to outside resources (such as
the textbooks) are present but the sources are not cited. (Note:
if plagiarism is present, that requires additional corrective
action.)
0 points
No direct references and/or allusions to outside resources are
present.
Total
/50
Instructor's Comments:
Page 1 of 1
Running Head: PTSD 1
PTSD 2
What is PTSD?
Abstract
Post-traumatic Stress Disorder (PTSD) is the mental health
disorder that triggers a horrifying experience either
experiencing. The trauma experienced by the victim is leading
to the tearing of their mental anchors. According to
approximation, PTSD affects 3.5 percent of the United States
population every year. Studies have shown that in the past
years, PTSD has affected about 3.6 percent of the America
adults of ages 18 years. The management of the PTSD is
focused on the management of the symptoms and improvement
in the behaviors. The behavioral changed is addressed using
trauma-focused cognitive behavioral therapy. Evidence-based
approaches such as clinical practice guidelines (CPGs) are used
to inform healthcare personnel with the framework needed for
the assessment, treatment, and management of the individual
needs and the preferences.
What is PTSD?
Post-traumatic Stress Disorder (PTSD) is the mental health

12. disorder that triggers a horrifying experience either
experiencing. It is a psychiatric trauma that is being instigated
by an event associated with an acute and devastating threat. As
the events take place, the inner agency of the mind of the
affected individual leads to the loss capability of controlling the
disorganization of the effects caused by the experience thus
leading to the disequilibrium. The trauma experienced by the
victim is leading to the tearing of their mental anchors. Some of
the symptoms associated with PTSD include severe severity,
nightmares, and flashbacks, and the uncontrollable thoughts
about the event. The common traumas leading to PTSD can
include sexual abuse and battering among many others.
Individuals with PTSD also face other problems such as drug
addiction since the majority of them are using substances to
cope with the symptoms of PTSD. PTSD is turning into a gang
war with a host of other comorbid issues which makes it harder
for the victims of patients to deal with them (James &
Gilliland).
A person may experience or may witness any horrible event,
and he/she can be the victim of PTSD.
The causes of this syndrome may vary from person to
person. It may occur after a single traumatic event or maybe a
result of many sudden and horrifying events. Even though PTSD
is linked to the experience of wartime trauma, it can also occur
due to exposure to traumatic events. PTSD is developing in
response to exposure to natural disasters and violent
experiences
Statistics
The statistics of the PTSD in the United States tend to
differ depending on a particular group of the population under
study. It estimated that PTSD is affecting 3.5 percent of the
United States population yearly and this is about 8 million
Americans. Studies have shown that in the past years, PTSD has
affected about 3.6 percent of the America adults of ages 18
years. Studies also show that 36.6, 33.1, and 30.2 percent of
adults have experienced severe, moderate, and mild impairment

13. respectively. It is also estimated that around 5 percent of
adolescents are experiencing PTSD while 1.5 percent are
experiencing severe PTSD. Recent statistics show that the
number of people suffering from post-traumatic stress disorder
is increasing day by day. It has been as almost every 6 out of 10
men, and every 5 out of 10 women face any sudden and
terrifying situation at least once in their lives. These traumatic
events may appear in the form of any physical violence or
sexual assaults when talking about women and children. While,
in men this event can be any severe accident, witnessing any
death of a loved one, serious injury, or any physical violence.
The situation for PTSD is quite alarming. Almost 7 to 8% of the
total population has the possibility to have PTSD (Tang et al.,
2018). This mental disorder may appear in any phase of your
life, mostly noticed among the people of 30-40 years. The
previous studies showed that 1.8 percent of men had
experienced PTSD as compared to 5.2 percent recorded by
women.
Diagnosis of Post-traumatic Stress Disorder
The symptoms of PTDS may vary from person to person,
depending upon the actual cause of this syndrome (Jonas et al.,
2019). If someone notices a serious change in behavior,
attitude, and level of interest after any trauma. He/she must
consult immediately to a medical expert to determine the causes
and intensity of this disorder. A delay and negligence may
increase the severity of disorder and cam led the victim to the
suicidal attempts. That is why an early diagnosis is very
important. To diagnose PTSD, DSM-5 criteria are used by most
of the psychologists.
DSM-5 stands for Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition (2013). The version of DMS got revised
in 2013 and introduced the criteria for the diagnosis of
disorders caused by any trauma or stress. This criterion is valid
for victims of more than 6 years old. For under 6 years, another
DMS version is used and designed for children only (Ibrahim et
al., 2018). DMS-5 criterion covers the following aspects.

14. A. Stressor
A stressor is a person who was victimized through any sexual
assault or threatened to death. He may be witness any murder or
death of any loved one, and he may get seriously injured in an
accident. Such injury may result in losing any body part etc. in
the following ways.
· Directly exposed to death or any accident.
· Witnessing any horrifying situation or trauma.
· Watching any friend who has witnessed any trauma.
· Interacting with a loved one who has gone through any major
disease or horrible event (Ibrahim et al., 2018).
B: intrusion symptoms
The appearance of traumatic events may be any one of the
following.
· Any upsetting event or memory related to the past.
· Nightmares
· Flashbacks
· Emotionally disturbed after any trauma
· Extreme psychological distress for a longer time span (Ibrahim
et al., 2018).
C: avoidance
Avoiding the trauma-related stimuli after observing any
stressful event in any way are given below.
· Making an effort to avoid the reoccurring thoughts about the
trauma
· Avoidance for the external reminders related to the trauma
(Tyler et al., 2019).
· Neglecting the events or situations that can be similar to any
stressful event.
D: negative alterations in cognitions and mood

15. This section covers all the thoughts and unnatural emotions that
start appearing after that trauma in the following ways.
· Trouble encountering positive effect
· Blaming own self or others (who were directly or indirectly
involved or present during that trauma) for causing the injury
(Tyler et al., 2019)
· Decreasing enthusiasm for doing any sort of work
· Excessively negative thoughts and presumptions about oneself
or the world.
· Negative effect
E: alterations in arousal and reactivity
Trauma-related arousal and reactivity can make the situation
worse. This can cause serious depression and stress in a victim.
It may appear in the following ways.
· Irritation for trauma-related stuff
· Difficulty concentrating and focus on anything (in terms of
social and personal life as well) (Tyler et al., 2019).
· Difficulty in sleeping. A changed sleep cycle.
· Rude and hard behavior
· Frustrated attitude towards everything.
F: Time period of stress
In DSM-5 criteria, the time span for the symptoms matters a lot.

16. These symptoms may appear or reappear for a minimum of 2
weeks to 1 month.
This DSM-5 method is used by the experts to diagnose the
nature, extent, and causes of post-traumatic stress disorder
(Tyler et al., 2019). This syndrome is mostly associated with
stress and depression caused as the end result of any trauma.
Physiological response to PTSD
Post-traumatic stress disorder affects both the mind and body of
a patient. The physiological responses to PTSD may vary from
person to person. It depends on the immunity of the person, the
intensity of the stress, and the nature of the trauma that caused
the stress (Tang et al., 2018). Any sort of Injury and stress for a
longer time period directly or indirectly has negative effects, by
and large, a person’s physical and mental health. PTSD has been
connected to more doctor visits in veteran populaces that means
you need regular consultation if this issue has been diagnosed
once. It can highly influence a person’s personal, social and
even economic position of a patient.
The impacts of PTSD may entirely change the way of lifestyle.
It actually influences human health and can disturb him/her.
Sentiments of loneliness, sadness, stress, and consistent tension
may lead the PTSD sufferers towards any illegal act or smoking.
They will in general, smoke more than non-PTSD sufferers just
to make others realize that they are fine. Moreover, some
cardiovascular diseases can be a result of PTSD (Jonas et al.,
2019).
Maladaptive patterns
PTSD likewise appears to have suggestions for the safe
framework of analysis. The patients of this stress regularly
include a more aggressive mindset and a higher white platelet,
which, thus, can prompt a blood issue or genuine disease. At the

17. point when the body is in a steady condition of battle or has to
fight against a continuous stressful condition, likewise with
PTSD, the invulnerable framework needs to make a little more
effort (Jonas et al., 2019). It pursues that PTSD sufferers may
skip more working days than the individuals who do not endure
with PTSD. They may likewise observe a higher danger of
malignant growth and problems related to their immune system,
just as early as mentioned (Tang et al., 2018). In the last few
years, in the area of traumatic stress, some admirable works
have published by luminaries. They are highlighting the inter-
dependent relationship between body and mind, the process of
recovery and wounding.
Pharmacological and Non-pharmacological treatments of PTSD.
Post-traumatic stress disorder can be a result of different sudden
and traumatic events. In 2017, an updated Clinical Practice
Guideline was released by the Department of Defense and the
Department of Veterans Affairs. This published guideline is all
about the treatment of PTSD. This report is actually based on
all the information which was available since 2016. It involves
non-Pharmacological and pharmacological treatments of PTSD.
The pharmacological treatment of PTSD actually begins by
targeting the discovery (Jonas et al., 2019). It is quite a difficult
and challenging process for the treatment as compare too
pharmacological treatments of PTSD. If a patient goes for the
pharmacological treatment of PTSD, that totally depends upon
the nature of stress and the medical history of the patient.Non-
pharmacological treatments may involve proper counseling
sessions through which the actual reason can be found. Some
psychotherapies are also used as a non-pharmacological
treatment of PTSD (Furukawa, 2016). For example, exposure
therapy, EMDR (Eye movement desensitization and
reprocessing), and Cognitive therapy. The details of these
therapies are given below.

18. Cognitive therapy
This is a therapy used during counseling sessions to determine
the cognitive patterns of the patients of PTSD. It actually helps
to recognize the thinking pattern of any person. Through the
responses of the patients, experts analyze and determine the
change in cognitive patterns of a patient as compared to a
normal person (Furukawa, 2016). For example, the
psychologists may ask the patient to tell them about himself and
his feelings for his own self. By asking some questions, they try
to analyze his speech and the actual reason, intensity of trauma,
and patient’s emotions regarding the trauma.
Exposure therapy
This therapy assists the patients to face the situation and all the
associated memories related to that trauma. It may teach the
patients what to do when to do and how to do in a particular
situation that makes him/her frightened (Furukawa, 2016). It is
all about giving the patient a certain level of confidence and
courage to cope with his/her fear that he/she has linked with
that trauma and increasing the level of stress.
Eye movement desensitization and reprocessing
This therapy consists of exposure therapy, along with some
guidance regarding eye movement. It helps the patient to change
their perspective about the trauma and their contemporary
reaction towards that ((Furukawa, 2016).
Pharmacological treatments of PTSD
Non-pharmacological treatments are considered as the best ways
for the treatment of Post-traumatic disorders. Hence, the failure

19. of non-pharmacological treatments may lead to the medication
to control the intensity of stress, to prevent the stability of
stress for a longer period of time, and to treat the stress at the
end (Hering et al., 2015). Mostly, these medicines are used to
reduce the intensity of stress to make non-pharmacological
treatment possible. Using medicines to treat Post-traumatic
disorders is not supposed to be an effective way.
Some Antidepressant drugs are mentioned by the writers that
are being used most and may be any one of these, dual serotonin
and noradrenaline reuptake inhibitors, like the 5-
HT2A/2C antagonist/5-HT reuptake inhibitor nefazodone,
tricyclic antidepressants such as amitriptyline and imipramine,
reversible monoamine oxidase A inhibitors (RIMAs) such as
moclobemide, monoamine oxidase inhibitors (MAOIs) like
phenelzine, such as venlafaxine as well as drugs with other
mechanism of action (Furukawa, 2016).
Nursing management of the PTSD
One of the focuses of the nursing management of the PTSD
is on the behavior. The behaviors of patients with PTSD are
managed through trauma-focused cognitive behavioral therapy.
This approach involves long term exposure and cognitive
processing therapy, reprocessing, and eye movement
desensitization. Families and caregivers have a key role in
giving support to individuals with PTSD. Therefore, while
recommending family care to patients with PTSD, the nurse
needs to consider the impacts of PTSD on the whole family due
to the trauma associated impacts. The families are therefore
notified about the general reactions of the traumatic
experiences. Families are also made aware of the self-help
groups and the support groups available (Rose, 2017).
Evidence-based practice guidelines for adults with PTSD

20. One of the evidence-based practices was the one which
was developed by the Department of the Veteran Affairs (VA)
and the Department of Defense (DOD) is the clinical practice
guidelines (CPGs). This guideline is used in providing
healthcare personnel with the framework that is required to help
in the assessment, treatment, and management of the individual
needs and the preferences of the patient with PTSD and acute
stress disorder (ASD).
Other considerations in the management of PTSDManaging a
patient of PTSD is not as easy as it seems to be. Sometimes, the
patient can be aggressive and can harm him/herself or anyone
around him/her. It is very important for the doctor to indicate
the actual reasons for stress/trauma, symptoms, and preventions
to the patients and his family members as well (Jonas et al.,
2019). If post-traumatic stress disorder remained neglected, it
might urge the patient to even commit suicide. That is why this
must be managed with extra care and attention. Do not let the
patient think that he/she is useless. Give some time to him/her
and try to involve the patient in some creative activities.
References
James, R. K., & Gilliland, B. E. (n.d.). Introduction to
posttraumatic stress disorder (PTSD). Retrieved from Book
Crisis Intervention Strategies. References
Furukawa, A, Toshi. (2016). Which Psychotherapy for PTSD?.
Evidence-Based Mental Health, 19(4), 118-119.Hering, D.,
Lachowska, K., & Schlaish, M. (2017). Role of the Sympathetic
Nervous System in stress-mediated Cardiovascular Disease.
Current Hypertension Reports, 17(6).Ibrahim, H., Ertl, V.,
Catani, C., Ismail, A, A., & Neuner, F. (2018). The validity of
the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5)
as screening instrument with Kurdish and Arab displaced
populations living in the Kurdistan region of Iraq. BMC
Psychiatry, 18(259).Jonas, D., Cusack, K., Forneris, C.,

21. Wilkins, T., Sonis, J., & Middleton, J. et al. (2019).
Psychological and Pharmacological Treatments for Adults with
Posttraumatic Stress Disorder (PTSD). Retrieved 30 October
2019, from https://europepmc.org/abstract/med/23658937Tang,
W., Lu, Y., & Xu, J. (2018). Post-traumatic stress disorder,
anxiety, and depression symptoms among adolescent earthquake
victims: comorbidity and associated sleep-disturbing factors.
Social Psychiatry and Psychiatric Epidemiology, 53(11), 1241-
1251.Tyler, M, P., Mason, A, W., Chmelka, B, M., Patwardan,
I., Dobbertin, M., Pope, K., Shah, N., Rahim, A, H., Johnson,
K., & Blair, J, R. (2019). Psychometrics of a Brief Trauma
Symptom Screen for Youth in Residential Care. Journal of
Traumatic Stress, 32(5), 753-763.
1-Review the follow research paper about Topic: Posttraumatic
Stress Disorder
2-Write a CONCLUSION must have a minimum of 500 words
The group project research paper must have:
· a minimum of 2500 words
· Main body (does not include the title page, abstract, or
reference pages).
· Times New Roman, Size 12, and 6 references about that topic
(4 of them most be research articles). The criteria exposed in
your paperwork must be exclusively based on peer reviewed
article, and I will be very fussy in confirming the reliability of
your statements.
· A formal paper using APA format according to Publication
Manual American Psychological Association (APA) (6th
ed.).2009 ISBN: 978-1-4338-0561-5 will be submitted via
Exercise Submission.

22. · This paperwork must be submitted by Wednesday November
20.
Question Guide:
The paper should include the following:
1. Abstract
2. What is PTSD ?
3. Statistics
4. Diagnostic criteria / Categorization
5. Physiological Responses
6. Maladaptive Patterns
7. Interventions / Treatments (pharmacological and non-
pharmacological)
8. Other considerations in the management of PSTD (including
but not limited to management of behaviors, family
considerations, challenges in the care of patients with this
disorder.
9. Examine evidence-based practice guidelines / research,
nursing theories that support the identification of clinical
problems, implementation of nursing skills in the care of adults
with this disorder.
10. Conclusion