ABNORMAL PSYCHOLOGY psychological report Final assignment

psychological report

least five peer-reviewed sources that were published within the last ten years 

I will attach some of you can use them, the whole text and citation

I will attach as well the previous assignments I did on that case study psycholopathology report

I will also attach the whole book (it may be too much, please don’t forget to ask for extra material, I will send it after you won the bid)

For your Final Paper, you will demonstrate your knowledge of psychopathology and apply your skills to a realistic scenario. Throughout this course, you have developed unique knowledge and skill sets that will allow you to critically analyze depictions of psychopathology in popular media and historical case examples from an informed point of view.

As you create this report, you will be taking on the role of a clinician who is conducting an assessment and providing treatment recommendations for a patient (a character from your selected film or historical case study Chose NAPOLEON!!). Please note that a psychological report does not follow the same structure for reports you may have used in other courses. Your report must follow the format below and it must include each of the sections and their headings listed in this order:

1. Identifying Information
   Within this section, you will describe basic information on your patient, including the person’s name, sex, gender, sexual orientation, age, race, occupation, and location of residence (country, state, and region).
2. Chief Complaint/Presenting Problem
   Within this section, you will include the patient’s primary complaint verbatim to identify the main source of his or her distress and/or concerns. If there is no verbatim complaint, include observable information to create an overall picture of the presenting problem.

   Typically, this section within a psychological report seeks to address the following question (further elaboration within this section is encouraged where possible):

   • What are the patient’s complaints? (e.g., the patient might complain about “feeling on edge” or experiencing stress)
3. Symptoms
   Within this section, you will interpret specific behavioral issues and intrapsychic conflicts as they relate to abnormal behavior, behavior patterns, maladaptive thought processes, and potential unconscious conflicts. Interpret and comment on the patient’s chief complaint and/or presenting problem in the context and language of the symptoms found in the DSM-5. (e.g., the patient who complains about “feeling on edge” might actually be experiencing symptoms related to post-traumatic stress disorder or generalized anxiety disorder)
4. Personal History
   Within this section, you will analyze your patient’s personal background and history of abnormal behavior(s) that inform your diagnostic impression. You will also gather information about the patient’s cultural background and cultural norms.

   Typically, this section within a psychological report seeks to answer the following questions (further elaboration within this section is encouraged where possible):

   • Where did the patient grow up?
   • What cultures did the patient experience throughout life?
   • What was the patient’s school life like?
   • What were his or her grades? What is his or her highest level of education?
   • What is the patient’s interpersonal relationship history?
   • What was/is the patient’s romantic relationship history?
   • What was/is the patient’s friendship history?
5. Family History
   Within this section, you will analyze the patient’s familial relationship(s) and identify any abnormalities that might affect future treatment. You will also integrate information about the patient’s family and cultural background to identify any maladaptive behaviors and relational patterns.

   Typically, this section within a psychological report seeks to answer the following questions (further elaboration within this section is encouraged where possible):

   • How old were the patient’s parents when the patient was born?
   • Who were the patient’s primary caregivers?
   • What was/is family life like? (Include any information relevant to your diagnostic impression.)
   • Did the family move often?
   • What was/is the patient’s relationship with their siblings (if applicable)?
   • What culture did/does the family come from?
   • What belief systems are attached to that culture?
6. Therapy History
   Within this section, you will describe the patient’s therapy history to inform your diagnostic impression. Analyze the patient’s therapy history to identify the effectiveness of previous treatment(s). Analyze previous treatment interventions based on information and knowledge of the patient’s cultural background.

   Typically, this section within a psychological report seeks to answer the following questions (further elaboration within this section is encouraged where possible):

   • Who was the previous therapist (if applicable)?
   • How long did the previous therapy/therapies last?
   • What was the patient’s diagnosis?
   • What interventions did the therapist(s) use?
   • Were those interventions appropriate for the patient’s culture?
   • Was treatment successful?
7. Medical Conditions
   Within this section, you will analyze the patient’s medical history and comment on any possible medical conditions that could influence your diagnostic impression. Interpret specific behavioral issues as they relate to salient medical conditions. If the person has any medical conditions, indicate that in this section. Integrate information and knowledge about the patient’s cultural background as it affects treatment options for medical conditions.
8. Substance Use
   Within this section, you will analyze and comment on the patient’s substance use to identify any potential issues that could influence your diagnostic impression. Interpret specific behavioral issues as they relate to substance use. If the person misuses specific substances, indicate that in this section. Integrate information and knowledge about the patient’s cultural background to inform your interpretation of substance misuse in this patient’s case.

   Typically, this section within a psychological report seeks to answer the following questions (further elaboration within this section is encouraged where possible):

   • Which substances does the patient use? (Include any over-the-counter, herbal, and/or prescription medications.)
   • For how long has the patient used the substance?
   • What is the patient’s quantity and frequency of use?
9. Collateral
   Within this section, you will interpret specific collateral information as it relates to your patient’s abnormal behavior and behavior patterns. You will also integrate information and knowledge regarding the patient’s culture in your evaluation of the maladaptive behavior as reported by the collateral sources.

   Typically, this section within a psychological report seeks to answer the following questions (further elaboration within this section is encouraged where possible):

   • What do other people have to say about the patient’s behavior?
   • Are there any commonalities between the collateral sources’ reports?
   • Do the collateral sources have any psychological issues that might exacerbate the patient’s problems?
   • Are there any police reports?
   • Are there any personality testing or intelligence testing reports available?
10. Results of Evaluation
    Within this section, you will analyze the patient’s behavior and mental processes. There are two parts to this section. To begin your analysis, you will write a brief evaluation of each theory of personality development that you learned about in this course and determine whether or not each theoretical orientation can be used to conceptualize the patient’s current situation and treatment goals. Next, use one major theoretical orientation to write an in-depth analysis for your results of evaluation section. Within the context of this theoretical perspective, you will analyze all of the information from the previous sections. Analyze specific behaviors, cognitions, and intrapsychic processes as they relate to your diagnostic impression. Integrate knowledge of the patient’s cultural background and norms within that culture as you prepare your supporting evidence.

    Typically, this section within a psychological report seeks to answer the following question (further elaboration within this section is encouraged where possible):

    • Based on the information you gathered in the previous sections, what led to the patient’s current state?
11. Diagnostic Impression With Differential Justification
    Within this section, you will provide your diagnosis for the patient. To demonstrate your understanding of diagnostic procedure and justification, specifically address each symptom that the patient displayed and relate each symptom to a diagnostic criterion in the DSM-5. Analyze the patient’s behaviors and mental processes within your differential justification. Clearly demonstrate that the patient meets criteria to be given a diagnosis. If the patient does not meet criteria for any diagnosis based on your assessment, explain why. Also, explore any alternative diagnoses and explain why these were not chosen.
12. Recommendations
    Within this section, you will you provide treatment recommendations for the person to help them improve his or her quality of life. These recommendations must be based on the theoretical orientation you used in your Results of Evaluation. Explain why you chose your treatment intervention(s) and include peer-reviewed articles that support your choice(s). If treatment is not necessary, explain why. Pay close attention to the person’s culture since some treatment options may be insensitive to his or her culture or way of living.

psychopathology psychological report

SOURCES FOR FINAL FROM ASHFORD:

References

Reuben, A., & Schaefer, J. (2017). Mental Illness Is Far More Common Than We Knew. Scientific American Mind, 28(6), 39.

New research suggests that nearly everyone will develop a psychological disorder at some point in their life—but for most, it’s temporary

Most of us know at least one person who has struggled with a bout of debilitating mental illness. Despite their familiarity, however, these kinds of episodes are typically considered unusual and even shameful.

New research, from our laboratory and from others around the world, however, suggests mental illnesses are so common that almost everyone will develop at least one diagnosable mental disorder at some point in their life. Most of these people will never receive treatment, and their relationships, job performance and life satisfaction will likely suffer. Meanwhile the few individuals who never seem to develop a disorder may offer psychology a new avenue of study, allowing researchers to ask what it takes to be abnormally, enduringly mentally well.

Epidemiologists have long known that at any given time, roughly 20 to 25 percent of the population suffers from a mental illness, which means they experience psychological distress severe enough to impair functioning at work, at school or in their relationships. Extensive national surveys, conducted from the mid-1990s through the early 2000s, had suggested that a much higher percentage, close to half the population, would experience a mental illness at some point.

These surveys were large, involving thousands of participants representative of the U.S. in age, sex, social class and ethnicity. They were also, however, retrospective, which means they relied on survey respondents’ accurate recollection of feelings and behaviors months, years and even decades in the past. Human memory is fallible, and modern science has demonstrated that people are notoriously inconsistent reporters about their own mental health history, leaving the final accuracy of these studies up for debate. Of further concern, up to a third of individuals contacted by the national surveys failed to enroll in the studies. Other tests suggested that these “nonresponders” tended to have worse mental health.

A new study by one of us (Schaefer), published earlier this year in the Journal of Ab normal Psychology (whose very name suggests an outdated understanding of the prevalence of mental illness), took a different approach to estimating disease burden. Rather than asking people to think back many years, Schaefer and his colleagues instead closely followed one generation of New Zealanders, all born in the same town, from birth to midlife. They conducted indepth check-ins every few years to assess any evidence of mental illness having occurred during the preceding year.

They found that if you follow people over time and screen them regularly using simple, evidence-based tools, the percentage of those who develop a diagnosable mental illness jumps to well more than 80 percent. In the cohort only 17 percent of study members did not develop a disorder, at least briefly, by middle age. Because Schaefer’s team could not be certain that these individuals remained disorder-free in the years between assessments, the true proportion that never experienced a mental illness may be even smaller.

Put another way, the study shows that you are more likely to experience a bout of mental illness than you are to acquire diabetes, heart disease or any kind of cancer whatsoever. These findings have been corroborated by data from similar cohorts in New Zealand, Switzerland and the U.S.

If you ever develop a psychological disorder, many assume you will have it for life. The newest research suggests that for the most common psychological complaints, this is simply not true. “A substantial component of what we describe as disorder is often short-lived, of lesser severity or self-limiting,” says John Horwood, a psychiatric epidemiologist and director of the longitudinal Christchurch Health and Development Study in New Zealand. (Horwood has found that close to 85 percent of the Christchurch study members have a diagnosable mental illness by midlife.)

This may be a useful message to spread. According to Jason Siegel, a professor of social psychology at Claremont Graduate University, people tend to be more sympathetic and helpful when they believe that a friend or co-worker’s health problems are temporary.

And individuals with mental illness need support. Even short-lived or self-limiting disorders can wreak havoc on a person’s life. To be classified as having a disorder, “an individual typically has to meet fairly stringent symptom criteria,” Horwood says. “There needs to be substantial impairment of functioning.”

To some, though, the new statistics on mental illness rates can sound a lot like the overmedicalization of “normal” human experience. Advocates for people with mental health concerns tend to disagree with this perspective. “I’m not at all surprised by these findings,” says Paul Gionfriddo, president of Mental Health America, a national advocacy group. His organization views mental illnesses as common, “though not always enduring.” Three years ago Mental Health America launched a Web-based tool to allow individuals to discreetly screen themselves for possible psychological disorders. Since then, the tool has been used for more than 1.5 million screenings, with more than 3,000 screens a day now used to determine if people may have a condition that could benefit from treatment.

The widespread nature of mental illness, unearthed by careful longitudinal research, holds some implications for the way we study and treat disease in this country. To Gionfriddo, a former lawmaker who watched his son end up homeless and incarcerated following undiagnosed childhood schizophrenia, “one implication of these new studies is that we as a society will get tremendous benefit out of ubiquitous mental health screening.”

Although the U.S. Preventive Services Task Force currently recommends mental health screening on a regular basis for everyone older than 11 years, such screening is still far from routine. “At a time when we have recognized the importance of early intervention for cancer or for diabetes or heart disease, why would we say, ‘Okay, for mental illness, we aren’t going to screen or do early intervention’?” Gionfriddo says. “This should be as common for adults as blood pressure screening. Putting our head in the sand and waiting for a catastrophe is not a health care plan.”

Another implication stems from the fact that individuals who never develop a mental illness—those who experience what we call “enduring mental health”—are actually quite remarkable. These people may be the mental health equivalents of healthy centenarians: individuals who somehow manage to beat the odds and enjoy good health for much longer than we would expect. It is possible that studying the mentally robust more closely could provide insight into how we can help more people to enjoy lives like theirs.

Who are these extraordinary people? In Schaefer’s New Zealand cohort, his team found that those with enduring mental health tended to have two things going for them: First, they had little to no family history of mental illness. Second, they tended to have what the researchers call “advantageous” personalities. As early as age five, individuals who would make it to midlife without an episode of mental disorder tended to display fewer negative emotions, get along better with their peers and have greater self-control. Perhaps just as striking, the team found that these individuals were not any richer, smarter or physically healthier than their peers, at least in childhood.

Ultimately the most important suggestion from the newest research is that mental health concerns may be nearly universal. As a result, society should begin to view mental illnesses like bone breaks, kidney stones or common colds—as part of the normal wear and tear of life. Acknowledging this universality may allow us to finally devote adequate resources to screening, treating and preventing mental illnesses. It may also help us go easier on ourselves and our loved ones when we inevitably hit our own rough patches in the road. M

Nishith, P., Mueser, K. T., & Morse, G. A. (2015). A brief intervention for posttraumatic stress disorder in persons with a serious mental illness. Psychiatric Rehabilitation Journal, 38(4), 314-319. doi:10.1037/prj0000158

A brief intervention for posttraumatic stress disorder in persons with a serious mental illness.

The lifetime prevalence of trauma exposure among people with a serious mental illness is extremely high, both before the onset of mental illness and after. For example, a recent review of trauma in persons with serious mental illness reported a median exposure rate of 34% to childhood sexual abuse, 53% to childhood physical abuse, 38% to adult sexual assault, and 77% to adult physical assault (Grubaugh et al., 2011). Trauma exposure in this population is associated with worse outcomes, including more severe symptoms and substance abuse, poorer psychosocial functioning, and more frequent hospitalizations (Briere, Woo, McRae, Foltz, & Sitzman, 1997; Hodgins, Lincoln, & Mak, 2009). Trauma in persons with a serious mental illness is also associated with increased rates of posttraumatic stress disorder (PTSD), with most estimates of current PTSD in the range of 25%–50% (Grubaugh et al., 2011; Mueser, Rosenberg, Goodman, & Trumbetta, 2002), compared to 3.5% in the general population (Kessler, Chiu, Demler, & Walters, 2005). PTSD has been hypothesized to mediate the negative effects of trauma on poorer outcomes in persons with a serious mental illness (Cusack, Herring, & Steadman, 2013; Mueser et al., 2002; Subica, Claypoole, & Wylie, 2011).

Although trauma exposure is common in this population, many individuals are not assessed for PTSD, and many with PTSD do not receive evidence-based trauma-focused treatment for PTSD (Cusack, Frueh, & Brady, 2004; Rosenberg et al., 2001). Recognition of the high prevalence of PTSD and the associated worse clinical outcomes has stimulated interest in treating PTSD in persons with a serious mental illness (Mueser, Rosenberg, Jankowski, Hamblen, & Descamps, 2004). Controlled research on the treatment of PTSD in the general population indicates that cognitive–behavioral therapy (CBT) approaches that usually include anxiety management training (e.g., breathing retraining), education about PTSD, and either exposure therapy or cognitive restructuring are more effective than supportive counseling (Mendes, Mello, Ventura, Passarela, & Mari, 2008). Less research has been conducted on the treatment of PTSD in persons with a serious mental illness, but the feasibility and beneficial impact of several approaches have recently been demonstrated, including cognitive restructuring (Lu et al., 2009; Mueser et al., 2007; Rosenberg, Mueser, Jankowski, Salyers, & Acker, 2004), exposure therapy (Frueh et al., 2009; van den Berg et al., 2015), and eye movement desensitization and reprocessing therapy (van den Berg et al., 2015; van den Berg & van der Gaag, 2012).

The only controlled research on the treatment of PTSD in persons with a serious mental illness is based on an individual CBT program provided to clients who are receiving other services for their primary psychiatric disorder (Mueser, Rosenberg, & Rosenberg, 2009). This program involves 12–16 weekly 1-hr sessions, with the primary treatment components including teaching breathing retraining and education about PTSD (3 sessions) and cognitive restructuring (9–13 sessions). One randomized controlled trial conducted in rural New Hampshire and Vermont compared the CBT program to usual services for persons with a serious mental illness and PTSD and demonstrated high retention in CBT (82%), as well as greater improvements in PTSD symptoms, diagnosis, knowledge of PTSD, trauma-related thoughts, depression, and other symptoms, with treatment gains at posttreatment maintained 6 months later (Mueser, Rosenberg, et al., 2008).

A second randomized controlled trial conducted in urban New Jersey evaluated the incremental benefit of cognitive restructuring in the CBT program by comparing the full CBT program with a three-session Brief program that included only the breathing retraining and educational components but no cognitive restructuring (Mueser et al., 2015). Similar to the first study, the CBT program had good rates of retention (75%) and comparable improvements in PTSD and other symptoms, which were maintained at 1 year posttreatment. However, the Brief program had even higher rates of retention (95%), and participants improved almost as much in PTSD as those in the CBT program and showed comparable levels of improvement in depression and other symptoms. The results of this second study suggest that the Brief PTSD program had beneficial effects on PTSD and related outcomes, warranting further study.

The present pilot study sought to explore several questions related to the Brief program. In the New Jersey study (Mueser et al., 2015), clients in the Brief program were “yoked” to clients in the longer CBT program for their posttreatment assessment (i.e., it was conducted 4–6 months after baseline for both groups to coincide with the end of the CBT program) in order to avoid confounding treatment (CBT or Brief) with duration of between-baseline and posttreatment (and follow-up) assessments. Thus, it is unclear whether the benefits of the Brief program would be apparent sooner after completing the program, rather than several months later. In addition, we sought to evaluate the feasibility of implementing the Brief program, as well as retention in treatment, in an urban mental health treatment setting serving an ethnically diverse and economically disadvantaged population of persons with a serious mental illness.

Method

The study was an open clinical trial that examined changes in PTSD and related outcomes from baseline to posttreatment and 3 months later in persons with a serious mental illness and PTSD. All study procedures were approved by the local institutional review board.

The research took place at Places for People, a large behavioral health care provider in St. Louis, Missouri, that specializes in providing services to people with a serious mental illness who are either unserved or underserved by the mainstream public-sector behavioral health system. Places for People serves a predominantly low-income population, 63.4% of whom are African American, and provides a full range of services, including outreach, assessment, pharmacological treatment, case management, assertive community treatment, supported employment, supported housing, and other rehabilitative services to approximately 2,300 clients per year, with over 1,500 admissions and more than 700 discharges in the past year. Trauma history and PTSD are routinely screened at intake for all clients receiving services but not using standardized instruments.

Study Participants

Inclusion criteria for participation in the study were (a) a serious mental illness according to the state of Missouri, (b) PTSD diagnosis based on the Clinician Administered PTSD Scale (CAPS) and interest in treatment for PTSD, and (c) able and willing to provide informed consent to participate in the study. Exclusion criteria were (a) current suicidal or homicidal ideation, or a suicide attempt within the past 3 months; (b) organic brain condition; or (c) participation in another trauma-specific treatment, including either evidence-based treatments for PTSD such as prolonged exposure or cognitive restructuring, or treatments that address possible trauma-related schemas or provide related skill building, at any time between the baseline assessment and the 3-month follow-up assessment. Other trauma-focused interventions available at the time of the study at Places for People were Seeking Safety (Najavits, 2002) and Trauma Recovery and Empowerment (Harris & The Community Connections Trauma Work Group, 1998).

For recruitment into the study, the Brief treatment program and eligibility criteria were described to case managers. On the basis of either a chart diagnosis of PTSD or known history of significant trauma and suspected PTSD symptom, case managers introduced and explained the nature of the Brief program and study to potentially eligible participants. Clients who were interested in participating in the program and study were referred to a member of the research team, who met with them, reviewed the project, obtained informed consent, and completed the CAPS to confirm eligibility. If the client was eligible, the rest of the baseline assessment was completed and the first treatment session was scheduled. All 18 clients who were referred to the study met the CAPS and other eligibility criteria and were thus enrolled in the study. Data on the number of clients who were approached by case managers but who were not interested in the study were not tracked.

A total of 18 clients met eligibility criteria and completed the baseline assessment. The mean age of the sample was 45.8 (SD = 9.74) years. Two participants (11%) were men, 11 (61%) were African American, and 7 (39%) were white. Eight (44%) participants had less than a high school diploma, 3 (17%) had graduated high school, and 7 (39%) had some college. Monthly income was $500 or less for 6 participants (33%), between $501 and $1,000 for 11 (61%), and over $1,000 for 1 (6%) participant. Psychiatric diagnoses, based on chart review, indicated that 10 clients (59%) had PTSD, of whom 3 (17%) had PTSD as their only diagnosis. A total of 7 clients (39%) had schizoaffective disorder (2 with PTSD), 5 (28%) had major depression (3 with PTSD), and 4 (22%) had bipolar disorder (2 with PTSD). Additional comorbid diagnoses included eating disorder for 2 clients and (for 1 client each) panic disorder, anxiety disorder NOS (Not Otherwise Specified), polysubstance dependence, cocaine dependence in early full remission, and alcohol dependence in full remission. Two clients (11%) had moderate PTSD symptom severity (total score < 65) on the CAPS (see below), and the remaining 16 clients (89%) had severe PTSD (total score ≥ 65) (Weathers, Ruscio, & Keane, 1999).

Measures

Assessments were conducted at baseline, 1 month posttreatment, and 3 months later. We elected to conduct the posttreatment assessment 1 month after completing treatment, rather than immediately after, to evaluate PTSD symptom severity and diagnosis on the CAPS for 1 full month without overlapping with the treatment period. The CAPS (Blake et al., 1995) is a semistructured interview considered the “gold-standard” measure of PTSD, which evaluates the frequency and severity of PTSD symptoms over the past month and has shown to be reliable and valid in persons with a serious mental illness (Mueser et al., 2001). The broad range of symptoms over the past 2 weeks was evaluated with the Brief Psychiatric Rating Scale–Expanded version (BPRS; Lukoff, Nuechterlein, & Ventura, 1986), a widely used interview-based measure of symptoms that includes 24 items, each rated on a 7-point scale ranging from not present to extremely severe.

Self-reported PTSD symptom severity over the past month was rated with the PTSD Checklist (PCL; Blanchard, Jones-Alexander, Buckley, & Forneris, 1996), a widely used measure related to interview-based assessments of PTSD that is reliable and valid persons with a serious mental illness population (Mueser et al., 2001). Self-reported depression over the past week was evaluated with the Beck Depression Inventory-2 (BDI-2; Beck, Steer, & Brown, 1996), and self-reported anxiety was evaluated with the Beck Anxiety Inventory (BAI; Beck & Steer, 1990).

Brief Treatment Program

The Brief treatment program is a standardized three-session intervention for PTSD (Mueser, Fite, Rosenberg, & Gottlieb, 2008) that includes education about trauma and PTSD, as well as instruction in breathing retraining, a self-management strategy for reducing anxiety and arousal that is widely employed in CBT programs for PTSD and other anxiety disorders (e.g., Foa & Rothbaum, 1998). Education and breathing retraining are conducted using an interactive teaching style that employs handouts and worksheets designed to facilitate applying information to clients’ personal experiences, as well as home assignments to practice skills and review materials, drawn from curriculum and methods in Mueser et al. (2009). A video that contains interviews with clients with serious mental illness who have recovered from PTSD and a therapist who specializes in the treatment of PTSD is used to supplement the educational material provided by the clinician. Mueser et al. (2015) defined “exposure” to the Brief program as completion of at least two of the three sessions. Following training in the Brief program by the second author, the program was delivered to study participants by the first author, a licensed counseling psychologist with extensive experience in CBT for PTSD. Assessments of treatment fidelity to the Brief program were not conducted.

Treatment sessions are scheduled weekly. The first session begins with an overview of the program, followed by a discussion about the nature of psychological trauma and its consequences in the context of the index traumatic event (or events) reported by the client as leading to PTSD. Breathing retraining is then taught, using a combination of modeling and practice in the session. A home assignment is collaboratively developed with the client to practice the skill daily until the next session, with an emphasis on building familiarity and expertise with the skill by initially practicing it in situations in which the person feels calm and safe.

The second session begins with a review of the previous session and the home assignment to practice breathing retraining, with additional training or tailoring to the individual as required. Education is then provided about the nature of PTSD, including the fact that it is a common disorder resulting from trauma, and the characteristic symptoms of PTSD, with attention to discussing the client’s specific PTSD symptoms. A home assignment is developed for the client to continue practicing the breathing retraining, which may also include completing worksheets related to information about PTSD.

The third session begins like the second session and includes review of any worksheets completed as a home assignment. Education is then provided about common problems associated with PTSD, such as negative emotions (e.g., depression, guilt), difficulties with interpersonal relationships, and substance use problems, with discussion focusing on specific consequences experienced by the client related to the index traumatic event and PTSD symptoms. The last 15 minutes are spent wrapping up, discussing progress made in the program, and considering any supports the client may need after completing the program.

Data Analysis

Within-group t tests were conducted to compare baseline PTSD and other symptom measures to posttreatment assessments and to compare posttreatment assessments to the 3-month follow-up. Effect sizes for changes from baseline to the posttreatment and follow-up assessments were computed for the eta statistic.The treatment gains were maintained from the 1-month posttreatment assessment to the 3-month follow-up, with no significant changes in any of the measures (all ps > .1), including CAPS frequency, t(14) = 1.25; CAPS intensity, t(14) = 1.39; CAPS severity, t(14) = 1.36; PCL, t(14) = 1.49; BDI-2, t(14) = 1.04; BAI, t(14) = 2.05; and BPRS, t(14) = 0.41. The number of participants with a PTSD diagnosis on the CAPS decreased from 15 (100%) at pretreatment to 5 (33.3%) at posttreatment and 5 at the 3-month follow-up.

Discussion

Among the 18 clients in the study, 17 (94%) were exposed to the program by completing at least two of the three sessions, and 15 (83%) completed all three sessions. This rate of exposure to the Brief program is comparable to that reported by Mueser et al. (2015) in a sample of persons with a serious mental illness and severe PTSD, and it is higher than rates of exposure to the lengthier (12- to 16-week) CBT program (defined as completion of at least six sessions), ranging from 74%–86% (Lu et al., 2009; Mueser et al., 2015; Mueser, Rosenberg, et al., 2008; Rosenberg et al., 2004). These high rates of exposure and completion of the Brief program indicate the program is both acceptable and tolerated well in the low-income and ethnically diverse sample of persons with severe mental illness and PTSD.

Participants in the Brief program showed statistically and clinically significant reductions in PTSD symptoms from baseline to the posttreatment assessment, assessed through both interviews on the CAPS and self-reports on the PCL, with gains maintained at the 3-month follow-up. Furthermore, 10 of the 15 (66%) participants no longer met criteria for PTSD at the end of treatment and follow-up. Similar reductions were reported on the interview-based measure of psychiatric symptoms (BPRS) and self-reported depression (BDI-2) and anxiety (BAI). These clinical improvements are significantly greater than the changes observed over similar time periods in people with a serious mental illness and PTSD who continue to receive their usual psychiatric services (Mueser, Rosenberg, et al., 2008). The results suggest the Brief PTSD program for persons with a serious mental illness is acceptable and well tolerated by the target population and may also provide a therapeutic benefit. It is noteworthy that the study sample included two participants with moderate PTSD symptom severity (i.e., CAPS scores < 65), in contrast to the previous study in which all participants had severe PTSD (i.e., CAPS scores ≥ 65; Mueser et al., 2015), suggesting that clients with mild or moderate levels of PTSD severity might benefit from the Brief PTSD program.

Prolonged exposure and cognitive restructuring have the strongest evidence for the psychotherapeutic treatment of PTSD (Foa, Keane, Friedman, & Cohen, 2009), raising the following question: if the Brief program is clinically beneficial, why? One possibility suggested by the polyvagal theory is that breathing retraining may normalize maladaptive autonomic responses that characterize the overarousal symptoms of PTSD, leading to improvements in other symptoms as well. According to this theory, three distinct neural circuits involving the autonomic nervous system evolved in mammals to regulate adaptive behaviors (Porges, 2011). The oldest circuit, the unmyelinated vagus, is involved in fear-immobilization behaviors in extreme danger through rapid and dramatic reductions in cardiac output, whereas the next oldest circuit, which depends on the sympathetic nervous system, controls fight-or-flight behaviors in response to threat through increased metabolic and cardiac output. The newest circuit to evolve is the myelinated or “smart” vagus, which inhibits the influence of the sympathetic nervous system on the heart when no danger signals are perceived and contributes to calm behavioral and emotional states necessary for communication and social engagement (Park & Thayer, 2014; Porges, 2011). Early or chronic trauma can result in prolonged overactivation of sympathetic defensive responses, including a persistently elevated state of arousal characterized by reduced engagement with the environment and others, difficulty accurately perceiving threat, poor emotion regulation, and reduced heart rate variability (Dennis et al., 2014; McCraty & Zayas, 2014; Park & Thayer, 2014; Shah et al., 2013). We speculate that teaching breathing retraining in the Brief program, which involves inhaling normal breaths and exhaling slowly, minimizes inadvertent hyperventilation and stimulates vagal tone in the new, “smart” vagal circuit. This in turn leads to increased engagement with the world, calmness, more accurate threat detection, and improved emotion regulation and is associated with increased heart rate variability (Williamson, Porges, Lamb, & Porges, 2015). Consistent with this, yoga and other breathing or meditation-based practices have been found to increase heart rate variability (Bernardi et al., 2001; Krygier et al., 2013), and research suggests that yoga may have therapeutic benefits in the treatment of PTSD (Seppälä et al., 2014; van der Kolk et al., 2014).

Several limitations of this study should be noted. The study was an open clinical trial with a small sample size. Clinical assessments were conducted by interviewers who were not blind to the treatment provided, although client self-reported improvements in PTSD and other symptoms paralleled those of the interviewer-based ratings. In addition, clients with active suicidal ideation were excluded from the study, and thus the generalizability of the findings to the broader population of persons with a serious mental illness and PTSD is unknown. There is clearly a need for controlled research comparing the Brief program to either services as usual or other control groups aimed at evaluating the mechanisms underlying its effects (e.g., supportive therapy to control for nonspecific therapist effects, education only to determine the impact of the breathing retraining component).

The demonstration of beneficial effects of the Brief program in more rigorously controlled research could have important implications for the treatment of PTSD in persons with a serious mental illness. Although the CBT for PTSD program has been shown to be effective at reducing PTSD and related symptoms in the population of people with serious mental illness, the 12- to 16-week duration of the program can be an obstacle to its implementation. The high rates of treatment engagement, exposure, and completion of the Brief program suggest it may be a practical alternative to the CBT for PTSD program; in particular, the Brief program may increase the penetration rate for treatment for persons with a serious mental illness while providing a cost-effective, initial treatment for these prevalent comorbid disorders. Furthermore, because the Brief program is based on the first three sessions of the CBT for PTSD program, it is possible that a stepped-care approach to the treatment of PTSD would be optimal, with brief treatment provided first, followed by cognitive restructuring only if needed. Stepped-care approaches have been previously implemented successfully with mood and anxiety disorders (Katon et al., 1999; Richards & Borglin, 2011; Zatzick et al., 2011) but have not been evaluated in the treatment of persons with a serious mental illness. The high prevalence of PTSD among people with a serious mental illness and the relative lack of treatment alternatives suggest that the Brief program has potential for cost-effective treatment of the distressing and disabling effects of PTSD in this population.

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