What would Juan qualify for a diagnosis of PTSD according to DSM 5?

If so,
what symptoms does he have that would meet the DSM criteria? What
symptoms does he not exhibit that you would expect to see? How might
you explain the lack of symptoms?
Criteria of PTSD according to DSM 5
A. exposure to actual or
threatened death

B. Present one or more intrusion

symptom

C. persistence avoidance to
stimuli associate with the
traumatic event
D. negative alterations in
cognitions and mood

Juans criteria
Juan lost his best friend Rico in a car
accident. Juan mention that he can
hear the crash and saw Ricos face
just moment before accident
Juan had mention about his pleasant
dream about Rico. however, it was
not a distressing dream as mention
in criterion B.
Juan refuses to go out with friend
because it reminds him of his best
friend so much.

E. marked alteration in arousal

and reactivity associated with
traumatic events

Juan showed persistent ability to

experience positive emotion. He
mentioned his mind is blank and
everything seems surreal for him. He
also keeps blaming for himself and
wishes he was the one who are
dead.
Juan has problem in concentrating
schools and difficulties to staying
asleep.

F. disturbance of criteria B, C, D
and E is more than one moth

Juan met psychologist after six week

of the accident.

G. the disturbance cause clinically

significant distress or
impairment.

The assessment such as Child

Depression Index proved that Juan is
having a depression. These
situations affect Juans education
due to his lack of ability to stay focus
in class and cant keep up with the
learning.
There is not mention whether Juan is
taking any substance or medical.

H. the disturbance does not

attribute by psychological
effect of substance or medical.

Based on the table above, we can conclude that Juan appears to have all the criteria
for a person with PTSD. However, there is one symptom that is not fit with the
criteria. Juan symptoms does not same as criteria B. according to criteria B, dream
that occurs usually in form of distressing such as dreaming about the accident
vividly. Juan mentions that the dream was about him and Rico in the kitchen. They
were laughing about Rico drank a milk straight from the carton. The lack of
symptom may occur because child and adolescent perceive PTSD differently. Juan
comfort dream about Rico might help him to overcome PTSD. The current research
stated that lucid dream may help to reduce nightmare in patient with PTSD.
Nightmares may be viewed differently in different cultures. Rates of trauma as low
as 16% have been reported among adolescents (4), although a number of other
studies suggest about 40% of adolescents experience a traumatic event before age
18 (58). The high exposure of children and adolescents to trauma has led to efforts
to evaluate its impact, including the development of posttraumatic stress disorder
(PTSD). nightmares are thought to mean that the dreamer is open to physical or
spiritual harm. In other cultures, it is believed that the dreams may contain
messages from spirits or may forecast the future.
Culturally, do you think that Juans Hispanic background makes his
situation better or worse than if he were from a different culture? What
does research says about culture and emotional expression?
In my opinion, Juan ethnicity can make his situation worse. According to Pole, Best,
Metzler & Marmar (2005) Hispanic people are less likely from non-Hispanic whites
to admit they has personal distress and they are at risk to commit social isolation.
Another research on culture and emotion is done by Pittmen (2014) mentions
Latinos with PTSD are less likely to seek treatment than non-Latino Whites, and
perceived lack of provider cultural competence is a barrier for some of them to seek
psychological care. As we can recall again, Juan was reluctant to share his emotion
regarding the accident. Since that is the first meeting with psychologist, he is more
comfortable to share about his education problem. Furthermore, his peers seem like
blaming Juan for the accident and accused him cause the death of Rico. We assume
his peers reaction cause Juan to lost social support among friend. However, low
emotion expression not only occurs among Hispanic. Chinese American and African
American are also lack of emotional expression. Research proved that white
Americans are more prone to express their feeling and thought. However I think we
must appreciate individual uniqueness in Juan. Almost a decade, surveys have
reported that among ethnic and racial minority youth in the United States, Latinas
have the highest rates of suicidal behavior compared to African American and nonHispanic White adolescent( Zayat & Pillas, 2008). Juan is intelligent adolescent
because he does not commit to suicide even thought he thought so. For him his
family is important and he does not want to hurt his family by commit suicide.
Based on Juans symptoms develop a CBT program using TF-CBT to assist
him in reducing his feeling of self blame and survivor guilt. If Juan were

fearful to getting behind the wheel and driving again, develop a

systematic desensitization program that would help him regain his
confident about driving again.
American Academy of Child and Adolescent Psychiatry (2012) stated that The
trauma focus cognitive behavioral therapy was most recommend intervention for
children with PTSD (Wilmhurst, 2015). TF-CBT is a short-term treatment approach
that can work in as few as 12 sessions. It also may be provided for longer periods of
time depending on the childs and familys needs. Individual sessions for the child
and for the parents or caregivers, as well as joint parent-child sessions, are part of
the treatment. As with any therapy, forming a therapeutic relationship with the child
and parent is critical to TF-CBT. The specific components of TF-CBT are summarized
by the acronym PRACTICE:
Component
Psycho education /
parenting skill

Session
1-2

Goals
The goal of this session is to educate client about
normalize and validate the symptoms of PTSD.
Client will be informed about this situations is
also happen to others.
Since Juan keep blame him selves, it is important
to reconstruct his mind. The client will be
informed about what the step is involved in TFCBT and amount of session.

Relaxation skills

deep
-

Affective

4-6

Provide client with skills to manage distress in

their environment such as home or school.
relaxation skill are needed in entire process of
FT-CBT
In this stage, we will help client to identify their
feeling. They can use triangle of feeling
(association of thought, feeling and behavior).
To help the client access automatic thoughts that
the client may not immediately be aware of, but
which are causing distress. Plus, to help clients
and caregivers understand our ability to change
our feelings and behavior by becoming aware of
and changing unhelpful or inaccurate thoughts
To help reducing self blame, we can use
narration. Juan will narrate his story of the
accident. Even thought it seem like we want to
bring back the bad memories but it is important.
By narrative clients can identify unhelpful of
inaccurate cognitions that need to be altered.

Matching or ot
Behavior game
Identify more h
feel better, wh
distressful feel

expression and
modulating skills

Cognitive coping

7-8

skills

Trauma narration
and processing of
traumatic
experiences

9-10

the Socratic qu

breathing
inhale fo
hold bre
exhale f

brainstorming

We can use an
with narrative.
rapping, collag

In vivo mastery of

11-12

Separate harmless trauma reminders or triggers

from fear and to reduce avoidance that interferes
with daily functioning.

Client can
-scared to
-scared to
-scared to

13-14

Provide opportunity for praise, support,

encouragement from a trusted adult.
Juan parents can hear Juans point of view about
the accident and allowed he to share opinion
with his parents.

prepared suita

15-16

To help Juan comes out with a plan to avoids

negative things and accidents in future,

Create a forma
Identify risks/t
(either from se
Role plays new

trauma reminders

Conjoint child
parent sessions

Enhancing safety
and future
developmental
trajectory

crea
driv
sit in
ent

SYSTEMATIC DESENSITIZATION OF FEAR TO DRIVING.

There are few steps of desensitization:
1. Create hierarchy of fear
2. Relaxation skills
3. Desensitization sessions

1. Create hierarchy of fear

List of those situations involved in and leading up to your target situation ranked in order
from the least disturbing to the most disturbing.
intensity
most disturbing

least disturbing

fear/antecedents
driving a car for 10 km
driving a car for 1 km
pushing gas pedal
starting the cars engine
sitting in driver sit
entering a car
open a car door
watching other people driving car in
distance
watching people driving in television

2. Relaxation skills
practice deep breathing :
o inhale for 7 second
o hold breath for 4 second
o exhale for 7 second
3. Desensitization sessions
Sit in comfortable possible and Juan will start with least disturbing antecedent. Each
antecedent will be pair with deep breathing. It is not compulsory to finish the entire
antecedent in one session. it must be adjust according to clients ability and limitation.

watching people driving in television

deep breathing
watching other people driving car in
distance
deep breathing