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Hypervigilance

Goal

Client will utilize therapeutic interventions to reduce hyperarousal resulting in an increased ability to engage in community activities.

Objective 1

Client will meet with a counselor at the VA to complete a Davidson Scale or other appropriate assessment to determine current anxiety/hypervigilance level

Krishnamacharya Healing and Yoga foundation

Cognitive Behavioral Therapy (CBT) and prolonged exposure therapy are the two first-line treatments supported by the Veteran’s Health administration. Both have shown reduction in overall symptoms of PTSD in veterans, however, improvements for hyperarousal have not been consistently observed (Staples, Hamilton, Uddo 2013)

Treatment Plan Goal and Objectives

Objective 2

Intervention

Client will pick a trigger location in the community, visit 3x a week for 30 minutes with a coach CHANGE TO: Pick 3 activities the client enjoys doing all 3 in one week

  • Yoga Programs
  • Emotional Freedom Techniques
  • Exposure Therapy
  • CBT –ABC work
  • Behavioral Activation
  • Dialectical Behavior Therapy
  • Functional Analytic Psychotherapy
  • Mindfullness –visualization/work around closing eyes

Objective 3

Client will meet with his primary care giver to link mental health concerns to determine if pharmacological interventions are appropriate

Exposure Therapy

  • a therapist guides the client to recall traumatic memories in a controlled fashion so that clients eventually regain mastery of their thoughts and feelings around the incident
  • the APA-initiated Center for Deployment Psychology includes exposure therapy for professionals who are or will be treating returning Iraq and Afghanistan service personnel (http://www.apa.org/monitor/jan08/ptsd.aspx)

Adaptive Response

Hyperarousal may lead to varied health problems including:

1) neuroimmunoendocrine system alter-ations (changes in cortisol, insulin, and glucose levels; elevations in cytokines and enzymes) resulting in inflamation and compromised immune functioning

2) correlation with thyroid level

3) impairment of health due to risk behaviors

(Pérez, Abrams, López-Martínez, & Asmundson 2012)

Emotional Freedom Therapy

  • Mentally "tune in" to specific issues, while stimulating certain meridian points on the body by tapping on them with our fingertips.
  • Imaging studies showed that the stimulation of certain points with needles reliably produced prominent decreases of activity in the amygdala, hippocampus, and other brain areas associated with fear (Feinstein 2012)

Description of Symptom Cluster

References

DSM V section E. of PTSD

Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 (or more) of the following:

(American Psychiatric Association, 2013)

American Psychiatric Association. (2013). Diagnostic and statistical

manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Pérez, L., Abrams, M. P., López-Martínez, A. E., & Asmundson, G. G.

(2012). Trauma Exposure and Health: The Role of Depressive and Hyperarousal Symptoms. Journal Of Traumatic Stress, 25(6), 641-648. doi:10.1002/jts.21762

Staples, J. K., Hamilton, M. F., & Uddo, M. (2013). A Yoga Program for the

Symptoms of Post-Traumatic Stress Disorder in Veterans. Military Medicine, 178(8), 854-860. doi:10.7205/MILMED-D-12-00536

Feinstein, D. (2012). Acupoint stimulation in treating psychological

disorders: Evidence of efficacy. Review Of General Psychology, 16(4), 364-380. doi:10.1037/a0028602

  • Irritable behavior and angry outbursts typically as verbal or physical aggression toward people or objects
  • Reckless or self-destructive behavior
  • Hypervigilance
  • Exaggerated startle response
  • Problems with concentration
  • Sleep disturbance

Neurological Roots

http://www.nature.com/nrn/journal/v14/n7/box/nrn3524_BX5.html

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