Tackling Trauma and Anxiety with Exposure-Based Therapy: Case Study

Picking the right therapy models is a crucial step conducting a successful treatment procedure. Treatment models can aid or worsen the situation depending on their application. As a result, therapists should be careful when adopting a particular treatment procedure for their patients. Based on the information provided in the vignette, Jacki's situation seems suitable for exposure therapy. The discussion's objective is to evaluate and assess Jacki and come up with a treatment plan based on the exposure-based therapy.

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An assessment of Jacki's situation from the exposure-based therapy models reveals the risk of aggravating the situation. This mainly because Jacki has Post-Traumatic Stress Disorder (PTSD). Her traumatic history involving her uncle and her recent narrow escape from date rape may leave her with a permanent trauma despite the fact that most PTSD patients recover within a year, there is still the chance of she falling among the 40 percent who develop chronic PTSD (Davidson, Stein, Shalev & Yehuda, 2004). On the positive side, Jacki does not have any form of ideation or substance abuse, which may need to be rectified. Dialect behavioral therapy (DBT) is suitable for rectifying behaviors by eliminating negative thinking and pushing for positive behavioral changes. As a result, DBT is useful in addressing situations that include self-harm, mood disorders, suicidal ideation, or substance abuse (Dimeff, & Linehan, 2001). Therefore, Jacki will be evaluated and assessed on three fronts. Historical background; cultures and ethical issues, and anxiety and trauma.

Jacki has a very tragic historical background. Based on the vignette, she was sexually abused by her uncle when she was a young girl. That alone is enough to traumatize a normal human being, but that did not stop her. She continued to live her life in the best way that she knew and even opened herself up to other people. Her going on a date proves that she was still willing to entrust her safety to another person. It also shows that she had not developed a negative attitude towards the entire gender of men. Unfortunately, her trust was bettered once again and as her date tried to rape her. Now she is a person who has lost all trust she had on the world and feels like the same world will not hesitate to attack her. She has retreated from the world because she feels that is the best way to protect herself.

According to Jacki, she is having horrible dreams, which is something that may have been triggered by her recent ordeal. On the other hand, her trauma may be something that she had managed to keep hidden for a long time after the incident with her uncle. The date rape incident may have brought these old memories from the past or unleashed the fear that she had kept bottled down for all those years. On the other hand, Jacki may be feeling like she is losing control over her life. The two rape incidents that happened were out of her control, and there is almost nothing she could do to avert the situations. She is feeling vulnerable and trying to counter her vulnerability by locking her self in the dorm which she has control over. The regards the dorm as her safe space. Based on the analysis of her historical background, Jacki's treatment plan needs to make her feel like she in charge of her life. She should not feel like she is giving up control every time she steps out of the dorm.

A good part of Jacki's situation is influenced by her culture and ethics. According to the case study, she kept the rape incident a secret because she did not want to bring shame into her family. Asian culture places great emphasis on family ties and honor. Being of Asian descent, Jacki has been brought up to put family above self. When she was deciding to conceal her uncle's misdeed, she thought she was doing the right thing. Jacki does not just follow these principles, she believes in them. That is who she, and to go against these principles would be to go against herself. Also, her decision to not anyone about her uncle's actions may have stemmed from the fear of stigmatization. Rape victims always run the risk of facing stigma if they come out to report the act. For a young girl, the stigma can be even worse because she is more concerned about what her friends will think of her.

On the other hand, her ethical standards may have protected her from a darker fate that may have complicated her situation. According to the vignette, Jacki denies any suicidal ideation or substance abuse. Suicidal ideation may have the same effect as reporting the uncle. Both events are likely to bring shame to the family, and that maybe one of the reasons that Jacki has not considered suicide. The same applies to substance abuse, which is against her culture and ethical standard. Substance abuse may lead her to addiction, which will require a different kind of treatment. The treatment has to factor is her cultural background as well as her ethics.

Finally, it difficult for Jacki to undergo such a kind of ordeal without suffering any trauma or anxiety disorder. Post Traumatic Stress Disorder (PTSD) is a common occurrence among rape victims. Furthermore, she has a higher chance of developing PTSD due to her previous experience that involved her uncle. According to research conducted by Davidson et al., (2004), rape victims who had suffered previous assault showed higher levels of cortisol compared to those who had no previous incident. The results showed that people such as Jacki, who had had previous incidents involving rape, are more likely to develop PTSD compared to their counterparts who had no prior incidents of rape. Jacki runs of common risks such as exposure to trauma, familial and genetic factors, cognitive factors such as low IQ, and avoidant personality (Davidson et al., 2004).

Exposure-based therapy can be combined with solution focused therapy to increase the chances of success. Based on the cause of Jacki's problem, it is hard to replicate the condition or situation that led her to that place. However, the therapy can begin by getting her to confront the situations that make her uncomfortable or increase her anxiety. Solution-based therapy can then be brought in to observe her responses to the therapy sessions and the treatment plans before proceeding to the next stage of the treatment process.

Based on exposure-based therapy, Jacki needs to be subjected to the situations that she tends to be most uncomfortable. The main objective is to get her to start interacting with the world again. According to Olatunji, Deacon & Abramowitz (2009), the use of exposure-based theory to treat patients with pathological anxiety and fear is one of the biggest stories in the field of mental health. This treatment technique is supposed to help Jacki confront the stimuli that provoked her obsession and fear. It also meant to encourage her to refrain from the behaviors that provided her with an escape from the fear. Behaviors such as hiding or locking herself up in the dorm the whole day. It is expected that when Jacki is exposed to that same stimuli, she will have an initial increase in fear and distress, but after some time, the anxiety will diminish due to repeated exposure.

There are ethical concerns that have been raised concerning the tolerability, safety, and even humanness of exposure-based therapy (Olatunji et al., 2009). It is essential to consider these concerns because the condemnation against harming patients is one of the items that appears twice in the American Psychological Association (APA) codes. Some people think that exposure-based therapy assumes such guidelines and principles. As a result, four domains are considered when examining the outcomes associated with exposure-based therapy (Olatunji et al., 2009). There are attrition rates, patient preferences, litigation, and ethical complain and symptom exacerbation. This discussion will not be able to go into the details of these domains because of the required length of the paper.

In this treatment plan, the therapist can either use the graded or the flooded approach. However, due to a personal comfort level, and the risk associated with the flooded treatment plan, the graded treatment plan will be used. The first step of the treatment plan is to target the mildly feared stimuli before proceeding to the strongly feared stimuli. That warrants the construction of the exposure hierarchy that ranks stimuli according to their anticipated reaction (Katerelos, Hawley, Antony, & McCabe, 2008). In the hierarchy, the fear stimuli are ranked according to their anticipated reaction (Katerelos et al., 2008). The therapist will not attempt to conduct the exposure to higher levels fears until Jacki's fear for lower-level exposures subsides. There are two options available for the therapist.

In the second step, the therapist also has to decide on whether to use the vivo or imaginal treatment plan. Vivo treatment plan involves exposing the patient to the real-world stimuli. As a result, the vivo technique is not always practice or applicable. In Jacki's situation, it will be difficult to expose her to real world confrontation of the feared stimuli without violating some ethical obligations as well as cultural. As a result, the appropriate treatment plan should use imaginal exposure where the therapists will try to recreate the stimuli in Jacki's head to get her to confront it. In the modern world, technology has allowed psychologists to employ technological innovations such as virtual reality to enable them recreate realistic exposure that is almost similar to the real world and with minimal risk involved.

The techniques have a high probability of treating Jacki's trauma and anxiety. However, she also needs a good support structure that will prevent her from relapsing back into her former fears. The exposure-based therapy technique has a good chance of helping her.

References

Davidson, J. R., Stein, D. J., Shalev, A. Y., & Yehuda, R. (2004). Posttraumatic stress disorder: acquisition, recognition, course, and treatment. The Journal of neuropsychiatry and clinical neurosciences, 16(2), 135-147.

Dimeff, L., & Linehan, M. M. (2001). Dialectical behavior therapy in a nutshell. The California Psychologist, 34(3), 10-13.

Katerelos, M., Hawley, L. L., Antony, M. M., & McCabe, R. E. (2008). The exposure hierarchy as a measure of progress and efficacy in the treatment of social anxiety disorder. Behavior Modification, 32(4), 504-518.

Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009). The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cognitive and Behavioral Practice, 16(2), 172-180.