Indiana University Week 11 Somatic Symptom Disorder Discussion please follow the directions below. Peer reviewed articles within 5 years of publication in

Indiana University Week 11 Somatic Symptom Disorder Discussion please follow the directions below. Peer reviewed articles within 5 years of publication in USA. Attachment below. It’s a Db reply. Apaformat. DB1: : 300 words without references page include. 2-3 references APA format. Peer review articles
within 5 years of publication only in U.S.A.
List the symptoms of all Somatic Disorders and which medication you would use to treat.
Somatic symptom disorder—unexplained physical symptoms (Morrison, 2014, p. 249).
Somatic symptom disorder with predominant pain—pain with no apparent physical or physiological
basis (Morrison, 2014, p. 249).
Conversion disorder—isolated symptoms with no physical cause (Morrison, 2014, p. 249).
Illness anxiety disorder—healthy people have an unfounded fear of a life-threatening illness, but no
somatic symptoms (Morrison, 2014, p. 249).
Psychological factors affecting other medical conditions—client’s mental or emotional issues influence
the course or care of a medical condition (Morrison, 2014, p. 249).
Factitious disorder imposed on self—patient who want to occupy the sick role, enjoy the attention of
being in a hospital. They fabricate symptoms for attention from health care workers (Morrison, 2014, p.
250).
Somatic disorder generalized is characterized by the client’s sensations. They may be sensations of pain,
fatigue, or very specific like shortness of breath. The symptoms may be one, many, or variable.
The pharmacotherapy for somatic disorder includes amitriptyline for pain and fatigue (Kurlansik, 2016).
The medication specifically for well-being, stiffness, pain, sleep, and tender points is fluoxetine.
Kurlansik (2016) also states herbal medication, St. John’s Wort improved symptoms in self-reported
studies. Keltner and Steele (2019) states SSRIs, SNRIs, and TCAs are helpful because of the high
comorbidity of anxiety and depression that goes along with somatic disorders. Antipsychotics may be
used as well. The somatic disorder patients are especially sensitive to side effects of these medications,
as they may believe their illness is getting worse (Keltner and Steele, 2019).
Cognitive behavior therapy and psychodynamic therapy are effective, with the focus being on identifying
and expressing emotional issues and then connecting them to the patient’s physical symptoms (Keltner
and Steele, 2019, p. 323). Other considerations include physical therapy to prevent muscle atrophy,
goal setting, skill building, and social skill groups.
References
Keltner, N.L. (2019). Psychiatric nursing. (8th ed.). St. Louis, MO: Elsevier
Kurlansik, S.L. (2016). Somatic symptom disorder. American Family Physician. (93)1 49-54
Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY: Guilford Press
DB2: : 300 words without references page include. 2-3 references APA format. Peer review articles
within 5 years of publication only in U.S.A.
List the symptoms of all Somatic Disorder and what medications you would use to treat.
The criteria for diagnosis of somatic symptom disorder (SSD) as defined in DSM-5 are: (A) The person
has one or more symptoms, for example pain or fatigue, that are distressing or cause problems to the
person’s daily life. (B) The person has excessive and persistent thoughts about the seriousness of the
person’s symptoms. The person has a persistently high level of anxiety about their health or symptoms,
or the person devotes too much time and energy to his/her symptoms or health concerns. (C) The
person continues to have symptoms that concern him/her, typically for more than six months, even
though the symptoms may vary (American Psychiatric Association, 2013). These conditions range from
mild to severe and general to very specific. People with somatic disorder exhibit symptoms that aren’t
related to any known medical condition; symptoms that are related to a known medical condition, but
are much more extreme than they should be; constant or intense anxiety about a possible illness;
thinking that normal physical sensations are signs of illness; worrying about the severity of mild
symptoms, such as a runny nose; believing the doctor hasn’t given a proper examination or treatment;
worrying that physical activity will harm the body; repeatedly examining the body for any physical signs
of illness; not responding to medical treatment or being very sensitive to medication side effects;
experiencing a disability more severe than what’s generally associated with a condition. The DSM-5
includes seven specific diagnoses in the Somatic Symptom Disorder and Other Related Disorder
category. These diagnoses include (1) somatic symptom disorder, (2) illness anxiety disorder, (3)
conversion disorder (functional neurological symptom disorder), (4) psychological factors affecting a
medical condition, (5) factitious disorder, (6) other unspecified somatic symptom and related disorders,
and (7) unspecified somatic symptom and related disorders (American Psychiatric Association, 2013).
The main symptom of SSD is a person’s belief that he/she has a medical condition, which he or she may
not actually have. Symptoms of SSD include: pain, neurological, digestive, and sexual symptoms. Pain is
the most commonly reported symptom and areas of reported pain can include chest, arms, legs, joints,
back, abdomen, and other areas. Neurological symptoms frequently reported include headaches,
movement disorders, weakness, dizziness, and fainting. Common digestive symptoms are abdominal
pain or bowel problems, diarrhea, incontinence, and constipation. Sexual symptoms include pain during
sexual activity or painful periods.
People with SSD genuinely believe they have a medical condition, so it can be hard to distinguish SSD
from a real medical condition that needs treatment. However, SSD tends to cause an obsessive concern
over symptoms that often get in the way of daily life. The goal of treating SSD is to manage symptoms.
One of the possible risk factors that might increase the risk of having SSD is having anxiety or
depression. Nonmedication strategies, such as cognitive behavior therapy, have been found to be the
most successful for treating SSD. The U.S. Federal and Drug Administration has not designated any
medication for the treatment of SSD. However, medications can be used to treat the underlying anxiety
and depression and antidepressants are a common choice for SSD. Another main symptom of somatic
symptom disorder is pain and antidepressants in addition to helping mood, have been reported to help
ease such symptoms as pain, fatigue, and pain in joints (Stahl, 2013). SNRIs with actions that increase
both serotonin and norepinephrine have been shown to be effective in treating neuropathic pain states
(Stahl, 2013). SSRIs increase only serotonin levels and have not been found to be as effective in the
treatment of pain. SSRIs are more effective against illness anxiety disorder (Somashekar, Jainer &
Wuntakal, 2013). Tricyclic antidepressants, specifically, amitriptyline, have also been shown to provide
benefits for at least one of the following outcomes: pain, morning stiffness, global improvement, sleep,
fatigue, tender point score, and functional symptoms. Antidepressants do tend to work best when
combined with some form of psychotherapy. Alpha-2-delta ligands pregabalin and gabapentin have
been proven to be effective in the treatment of certain pain conditions (Stahl, 2013) and can be used in
treating pain related to somatic disorder.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Arlington, VA: Author.
Somashekar, B., Jainer, A. & Wuntakal, B. (2013). Psychopharmacotherapy of somatic symptoms
disorders. International review of psychiatry, 25. 107-115. 10.3109/09540261.2012.729758.
Stahl, S. M. (2017). Stahl’s essential psychopharmacology: The prescriber’s guide (6th ed.). Cambridge
University Press.
Stahl, S.M. (2013) Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications
(4th ed.). Cambridge University Press.
DB3: : 300 words without references page include. 2-3 references APA format. Peer review articles
within 5 years of publication only in U.S.A.
Behavior therapies focus largely on an internal locus of control and tapping into internal resources to
facilitate change in thoughts, behaviors, and actions. Clients come to therapy for dysfunction in their day
to day lives and behavior therapy focuses on how the therapist and the client can identify dysfunction,
select goals, translate goals into behavior, self-monitor, creating an action plan, and evaluating the plan
(Corey, 2017). Multiple models of behavioral therapy can produce change behavior, but most also do
not address any developmental issues that may have contributed to the behavior itself, therefore the
root cause of the behavior is not addressed or a mode of focus. However, when you really think about it,
behavioral models are behind many successful programs out today; weight loss and motivation
programs use the basic principles to create behavioral changes to meet goals for more positive
outcomes. I’m sure each of us has used this basic model as well to make changes in our own lives.
Psychoanalytic theories mostly stress that coping and either functional or dysfunctional means of doing
so are formed in early childhood (Corey, 2017). This theory postulates that any developmental
milestones that are not processed through completely leads to adult dysfunction in coping, behavior and
thought patterns. The goal is to go back through those milestones with a trained psychoanalytic
therapist to successfully complete these milestones that will help to unravel some of the maladaptive
mechanisms (Corey, 2017). This theory is rooted in how the past influences the present, whereas
behavioral theories focus on the here and now with little attention paid to how current patterns were
formed.
Behavioral therapy is an umbrella term for several different types of therapy; exposure therapies
such as systemic desensitization, in vivo exposure and flooding, and eye movement desensitization and
reprocessing (EMDR); dialectal behavioral therapy (DBT), mindfulness based therapy, cognitive
behavioral therapy (CBT) and choice/reality therapy. Statistically, behavioral therapies are said to be
effective with a strong evidence base, but it is also the most widely studied model, with CBT in the lead
(Hofmann, et al., 2012). The therapy models all have their strengths and weaknesses, but it is difficult to
pinpoint one specific model that is most effective as there is not a one size fits all approach to therapy.
Exposure therapies certainly have strong evidence of support for efficacy in relieving PTSD symptoms in
veterans and those with PTSD in relation to the September 11th attacks in New York City, with an
additional and unintended improvement in depressive symptoms among this population as well (U.S.
Department of Veterans Affairs, 2019). Whereas DBT has a strong evidence base for treating borderline
personality disorder (Corey, 2017). CBT is considered the gold standard and has shown great efficacy in
traditional therapy settings (David, Cristea, & Hofmann, 2018). They all have a substantial place in the
field of psychotherapy.
Each therapy model, though behavioral, is different in terms of structure and specifics of processing.
Each model requires a therapist who has had training, experience and clinical exposure to the specific
model to effectively conduct therapy with a client. Corey (2017) also notes a major weakness of
behavioral therapy is that it does not always take into account the sociocultural environment of the
client, thus limiting the efficacy of therapy for some clients. Another limitation that Corey (2017) notes is
that while behavioral therapy changes a client’s behavior, it does not change the emotions tied to a
behavior. Some behaviorists believe that psychiatry in general does not always have a place in therapy
and that psychiatric diagnoses are unimportant in behavioral therapy (Corey, 2017). My own experience
is that thoughts often influence your general overall thinking patterns and these in turn affect mood,
behaviors, motivation, etc. So, I do feel that thoughts and behaviors play heavily into mood disorders
such as anxiety and depression. Behavioral therapies can alter your thoughts and behaviors, leading to a
more positive thinking pattern overall and behaviors that lead to better outcomes than what led the
client to therapy in the first place. This approach is great, but to me, it deems poor progress is a failure
of the client and negates the faulty chemical imbalances of the disorders that may lead to the
dysfunctional thinking in the first place. Behavioral changes are difficult to make when you are suffering
with a diagnosed mental disorder, and though some behaviorists believe that the disorders are a result
of the dysfunctional thinking patterns to begin with, it can be difficult to pull motivation to make
changes out of someone who has a hard time making it out of bed. I think that the behavioral therapies
are fantastic resources to use on clients who can handle them, but I do not agree that some disorders
and dysfunctional thinking can be treated with psychotherapy alone. An older study from 2008 did show
that when cognitive therapy was compared to antidepressant medications for treating depression, short
term efficacy was similar while long term rates of relapse were much higher in patients treated with
antidepressant medication alone (DeRubeis, Siegle, & Hollon, 2008). This study gives us evidence that
cognitive therapies are an instrumental part of treating depression.
While most studies are of the adult population, some studies have included children to determine
what type of therapy is the best fit for certain conditions. Cohen, Deblinger, & Mannarino (2018)
conducted a research study that spanned several countries to include other populations of children ages
6-18 who were victims of sexual abuse, domestic violence, disaster, commercial sexual exploitation,
and/or complex or mixed traumas that were treated with trauma-focused CBT. The evidence showed
that TF-CBT was highly effective in treating symptoms such as depression, anxiety, and behavioral
problems. Kearny, Pawlukewicz & Guardino (2014) conducted a small-scale study on CBT in children
diagnosed with anxiety, the most commonly diagnosed disorder in children, that showed measurable
and observable improvement in anxiety symptoms among the children. CBT interventions included
identification of physical feelings in connection with anxious feelings, relaxation and meditation therapy,
exploration of cognitive anxious thinking patterns, and mild exposure therapy.
Wheeler (2014) gives an excellent, detailed overview of how childhood and adult trauma is caused as
well as balanced and unbalanced responses and the possible pathways these responses lead to. Trauma
in early childhood can lead to disorders of extreme stress, somatic symptom disorders, psychosomatic
disorders, and/or dissociative disorders that can cause major disruption in the life of that individual
(Wheeler, 2014). Trauma informed care means that caregivers recognize the impact of trauma, the s/s
of trauma and how this impacts the individual as well as family and caregivers, responds by applying
learned concepts of trauma into policies, procedures and practices and resists re-traumatization
(SAMHSA, 2019). Wheeler (2014) stresses that certain situations, sounds, even smells can trigger a
conscious or unconscious memory of trauma and can lead to the hyperarousal state that leads to
dissociation or crisis. Individuals in crisis or dissociative states are unable to process and heal, disrupting
therapy all together. Trauma informed care means that caregivers familiarize themselves with trauma to
the best of their ability, recognize that individuals may have a traumatic history, and apply this
knowledge to the treatment plan to minimize triggering any hyperarousal or dissociative states that will
hinder progression in therapy. In my opinion, not engaging in trauma informed care is a form of neglect
on behalf of the therapist. Anyone in a therapeutic caregiver role should be trauma informed to provide
the best possible care for patients and do their best to avoid triggering trauma memories that are not in
a therapeutic milieu.
References:
Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2018). Trauma-focused cognitive behavioral therapy for
children and families. Psychotherapy Research, 28(1), 47–57.
https://doi.org/10.1080/10503307.2016.1208375 (Links to an external site.)
Corey, G. (2017). Theory and Practice of Counseling and Psychotherapy (10th Ed.). Boston, MA: Cengage
Learning.
David, D., Cristea, I., & Hofmann, S. G. (2018). Why Cognitive Behavioral Therapy Is the Current Gold
Standard of Psychotherapy. Frontiers in psychiatry, 9, 4. doi:10.3389/fpsyt.2018.00004
DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy versus medication for depression:
treatment outcomes and neural mechanisms. Nature reviews. Neuroscience, 9(10), 788–796.
doi:10.1038/nrn2345
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive
Behavioral Therapy: A Review of Meta-analyses. Cognitive therapy and research, 36(5), 427–440.
doi:10.1007/s10608-012-9476-1
Kearny, R., Pawlukewicz, J., & Guardino, M. (2014). Children With Anxiety Disorders: Use of a Cognitive
Behavioral Therapy Model Within a Social Milieu. Journal of Research in Childhood Education, (1), 59.
Retrieved from
https://search.ebscohost.com/login.aspx?direct=true&db=edsbl&AN=ETOCvdc.100027912998.0×00000
1&site=eds-live
Substance Abuse and Mental Health Services Administration (2019). Trauma. Retrieved from:
https://www.integration.samhsa.gov/clinical-practice/trauma-informed (Links to an external site.)
U.S. Department of Veterans Affairs (2019). Prolonged Exposure for PTSD. Retrieved from:
https://www.ptsd.va.gov/professional/treat/txessentials/prolonged_exposure_pro.asp
Wheeler, K. (2014). Psychotherapy for the Advanced Practice Psychiatric Nurse: A How-to Guide for
Evidence-Based Practice (2nd Ed.). New York, NY: Springer Publishing Company.
DB 4: 300 words without references page include. 2-3 references APA format. Peer review articles
within 5 years of publication only in U.S.A.
Discuss Behavior Therapies
Behavioral therapies were originally developed by B.F. Skinner, then one of the first to refer to the idea
of modifying behavior is Edward Thorndike. Other early pioneers are Joseph Wolpe and Hans Eysenck.
Other psychologists, Aaron Beck, and Albert Ellis began adding cognitive elements to behavioral
strategies to form a cognitive behavioral therapy (Wheeler, 2014). There are two basic principles that
contribute to behavioral therapy: classical and operant conditioning. Classic Conditioning contains
forming associations between stimuli. What this saying is previously neutral stimuli are paired with a
stimulus that naturally and automatically evokes a response. After repeated paired happens, an
association is formed and previously neutral stimulus will evolve the response on its own (Cherry, 2019).
Cherry (2019) listed all techniques that belonged to behavioral therapies below. The techniques and
strategies are included flooding, systematic desensitization, and aversion therapy. Simply said that
flooding is exposing people to fear invoking objects or situations intensely and rapidly. This technique
can be used to treat phobia, anxiety, and stress related disorders. Example someone who is fear of dog,
and she/she is going to frequently expose to small friendly dog for an extended period of time.
Systemic desensitization is to make a list of fears and teach individuals to relax while concentrating on
these fears. Aversion therapy is involved pairing an undesirable behavior with an aversive stimulus in
the hope that the unwanted behavior eventually gets reduced. Operant Conditioning focuses on more
like how reinforcemen…
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