Comprehensive Treatment

This clinical case describes the assessment and treatment of Roger, a 31-year-old veteran who served in Operation Iraqi Freedom. In addition to combat-related post-traumatic stress disorder (PTSD), Roger presented with a conversion disorder (globus pharyngeus) and avoidance of consuming solid food without also consuming alcohol. A multicomponent treatment program for PTSD, trauma management therapy (TMT), was provided 5 times per week over a 3-week period. TMT included daily-exposure therapy (EXP) as well as daily social and emotion regulation (SER) group therapy to target anger, social withdrawal, and depression. In addition to TMT, exposure to food consumption in the absence of alcohol was provided in the final week. PTSD symptoms were assessed via semi-structured interview and self-report measures, while food intake was assessed via behavioral observation. PTSD symptoms as measured by the Clinician-Administered PTSD Scale (CAPS) decreased from 63 at pre-treatment to 17 at post-treatment, indicating that Roger no longer met criteria for PTSD. Exposure to food intake was equally successful with Roger consuming full meals (e.g., hamburger and french fries) without consuming alcohol. This case study exemplifies the successful use of intensive exposure therapy to target comorbid anxiety-based disorders in a short period.

[1]  Erica K. Yuen,et al.  Randomized Controlled Trial of Home-Based Telehealth Versus In-Person Prolonged Exposure for Combat-Related PTSD in Veterans: Preliminary Results. , 2015, Journal of clinical psychology.

[2]  S. Southwick,et al.  Posttraumatic stress disorder in the US veteran population: results from the National Health and Resilience in Veterans Study. , 2014, The Journal of clinical psychiatry.

[3]  R. Hanwella,et al.  Phagophobia: a case report , 2014, BMC Research Notes.

[4]  A. Roberts,et al.  Individual differences in behavioral and cardiovascular reactivity to emotive stimuli and their relationship to cognitive flexibility in a primate model of trait anxiety , 2014, Front. Behav. Neurosci..

[5]  M. Rinck,et al.  Implicit and explicit avoidance in sexual trauma victims suffering from posttraumatic stress disorder: a pilot study , 2014, European journal of psychotraumatology.

[6]  P. Anderson,et al.  Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. , 2013, Journal of consulting and clinical psychology.

[7]  C. Marmar,et al.  PATTERNS OF LIFETIME PTSD COMORBIDITY: A LATENT CLASS ANALYSIS , 2013, Depression and anxiety.

[8]  Deleene S. Menefee,et al.  Treating PTSD and Disordered Eating in the Wake of Military Sexual Trauma , 2012 .

[9]  C. Botella,et al.  Virtual reality exposure therapy in anxiety disorders: a quantitative meta‐analysis , 2012, Depression and anxiety.

[10]  S. Southwick,et al.  Cognitive-behavioral coping strategies associated with combat-related PTSD in treatment-seeking OEF–OIF Veterans , 2011, Psychiatry Research.

[11]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[12]  Rosalie Liccardo Pacula,et al.  Invisible wounds, visible savings? Using microsimulation to estimate the costs and savings associated with providing evidence-based treatment for PTSD and depression to veterans of Operation Enduring Freedom and Operation Iraqi Freedom. , 2011 .

[13]  D. Beidel,et al.  Multicomponent behavioral treatment for chronic combat-related posttraumatic stress disorder: a randomized controlled trial. , 2011, Journal of anxiety disorders.

[14]  JoAnn Difede,et al.  Development and early evaluation of the Virtual Iraq/Afghanistan exposure therapy system for combat‐related PTSD , 2010, Annals of the New York Academy of Sciences.

[15]  Mark B. Powers,et al.  A meta-analytic review of prolonged exposure for posttraumatic stress disorder. , 2010, Clinical psychology review.

[16]  E. Teng,et al.  Treating Panic in a Veteran With Comorbid Combat-Related Posttraumatic Stress Disorder , 2010 .

[17]  Tyler C Smith,et al.  New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study , 2008, BMJ : British Medical Journal.

[18]  M. Davis,et al.  Mechanisms of fear extinction , 2007, Molecular Psychiatry.

[19]  Olga V. Demler,et al.  Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[20]  Olga V. Demler,et al.  Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[21]  D. Clark,et al.  A cognitive model of posttraumatic stress disorder. , 2000, Behaviour research and therapy.

[22]  B. Litz,et al.  Posttraumatic stress disorder associated with peacekeeping duty in Somalia for U.S. military personnel. , 1997, The American journal of psychiatry.

[23]  D. Beidel,et al.  Trauma management therapy: a preliminary evaluation of a multicomponent behavioral treatment for chronic combat-related PTSD. , 1996, Behaviour research and therapy.

[24]  J. A. Wilson,et al.  Globus pharyngis: development of a symptom assessment scale. , 1995, Journal of psychosomatic research.

[25]  M. Donner,et al.  Psychogenic dysphagia and globus: Reevaluation of 23 patients , 1989, Dysphagia.

[26]  G. Stacher.  [Differential diagnosis of psychosomatic deglutition disorders]. , 1986, Wiener Klinische Wochenschrift.

[27]  G. Stacher.  [Swallowing the psyche]. , 1983, Wiener Klinische Wochenschrift.

[28]  J. Wolpe,et al.  Psychotherapy by reciprocal inhibition , 1958, Conditional reflex.

[29]  J. Watson,et al.  Conditioned emotional reactions , 1920 .

[30]  I. Pavlov,et al.  The Work of the Digestive Glands , 1903, Bristol Medico-Chirurgical Journal (1883).

[31]  P. Henningsen,et al.  [Somatoform disorders]. , 2010, Psychotherapie, Psychosomatik, medizinische Psychologie.

[32]  Arif Demirdaş,et al.  Kaplan Sadock Comprehensive Textbook of Psychiatry , 2007 .

[33]  E. Foa,et al.  Emotional Processing Theory: An Update. , 2006 .

[34]  V. Miele,et al.  Globus hystericus: a brief review. , 2004, General hospital psychiatry.

[35]  D. Charney,et al.  The development of a Clinician-Administered PTSD Scale , 1995, Journal of traumatic stress.

[36]  M. Kozak,et al.  Emotional processing of fear: exposure to corrective information. , 1986, Psychological bulletin.