Empirically Supported Trauma Treatment for an Adult Latino Man Diagnosed With PTSD

Abstract

Treatment initiation and engagement of clients with posttraumatic stress disorder (PTSD) can be challenging due to early treatment dropout when a client with PTSD is unwilling to confront feared trauma-related stimuli and experience anxious arousal during exposure. Increased attention to these engagement issues is especially warranted with traditionally underserved populations (i.e., ethnic minorities, low socioeconomic status, rural residence). This case study describes Victor, a 34-year-old Latino man victimized during a robbery in the rural Southeastern United States, and explains the successful cultural modifications made to Victor's 10 sessions of prolonged exposure (PE) therapy. Telemedicine, or conducting therapy sessions over a secure Internet connection, was used to overcome barriers associated with rural clients with limited access to specialized and bilingual services. Victor showed marked reductions in PTSD symptoms after completion of PE via telemedicine. This article explains the client's presenting complaints, history, assessment, barriers to care, cultural modifications, and treatment implications.

Exposure in an Increasingly Bilingual World: Native Language Exposure Therapy With a Non-Language Matched Therapist

“…Prolonged exposure therapy (PET; Powers, Halpern, Ferenschak, Gillihan, & Foa, 2010) has achieved empirically supported treatment status (Chambless & Hollon, 1998). However, some authors have noted that the implementation of PET in the "real-world" with underserved populations remains a challenge (López, Shealy, & Rheingold, 2014). PET was designed based on Foa and Kozak's Emotional Processing Theory (EPT) which is based on the theoretical framework suggesting that fear structures exist within the brain that link stimuli, responses, and meaning (Foa & Kozak, 1986).…”

Written Exposure Therapy: The Case for Latinos

“…As noted by López et al (2014), PET remains an efficacious treatment for PTSD but the implementation of PET in real-world settings is not without its challenges. This may be exacerbated in certain cultural contexts and with specific populations.…”

“…However, an effectiveness study, the sample of which was largely composed of Latinos with PTSD (Benuto, O'Donohue, Bennett, & Casas, 2019), found positive treatment outcomes for Latinos who underwent PET. In addition, case studies have documented effectiveness of PET with a Latina female with a complex trauma history (Benuto & Bennett, 2015) and a Latino man who was victimized during a robbery (López, Shealy, & Rheingold, 2014). Despite these positive notes, exposure therapy is not without its limitations (i.e., the potential for the client to have difficulty tolerating imaginal exposure) and cultural factors may exacerbate some of these limitations.…”

“…Indeed, López et al (2014) highlighted how engagement of clients with PTSD can be challenging due to early treatment dropout if the client is unwilling to confront trauma-related stimuli or experience anxiety during exposure. They also identified specific barriers relevant to the Latino population, including the tendency for Latino men to resist mental health treatment, logistical difficulties (e.g., transportation or language), and cultural values (e.g., machismo and immigration status).…”

Treating Posttraumatic Stress Disorder in Diverse Settings: Recent Advances and Challenges for the Future

“…PE contains two treatment components: (1) imaginal exposure, in which the patient is asked to revisit the trauma memory imaginally by recounting details about the trauma in session, describing thoughts, feelings, and behaviors associated with the trauma, and then listens to a recording of this recounting of the trauma memory for homework, and (2) in vivo exposure, in which the patient is asked to approach reminders (i.e., triggers) of the trauma, such as places or objects, that the patient typically avoids because of the trauma. PE has been used both with racial/ethnic minority patients in the USA [45, 46, 47••] and in international settings [48, 49]. A recent study by Jeffreys and colleagues [47••] documented that African-Americans responded significantly better to PE than other racial groups and that there were no differences in treatment response between Hispanic and non-Hispanic Whites.…”