PTSD Treatment Planning & Protocols 3 — Questions and Answers
Question 1: Under the VA/DoD Clinical Practice Guidelines, which two psychotherapies receive the strongest (Category A) recommendation for PTSD?
- EMDR and Supportive Counseling
- Prolonged Exposure and Cognitive Processing Therapy (Correct answer)
- Stress Inoculation Training and Motivational Interviewing
- DBT and Acceptance and Commitment Therapy
Correct answer: Prolonged Exposure and Cognitive Processing Therapy
The VA/DoD guidelines give the highest evidence rating to Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) for PTSD treatment.
Question 2: A client's treatment plan must address safety planning because she endorses passive suicidal ideation. According to best practice, this safety plan should be:
- Created solely by the clinician to ensure clinical accuracy
- A collaboratively developed document reviewed and updated regularly (Correct answer)
- Deferred until PTSD symptoms remit to avoid overwhelming the client
- Limited to crisis hotline numbers only
Correct answer: A collaboratively developed document reviewed and updated regularly
Evidence-based safety planning is a collaborative process (Stanley-Brown model) that is regularly reviewed and updated as risk levels change.
Question 3: Which element is considered a contraindication for beginning trauma-focused PTSD treatment?
- Mild depression comorbidity
- Active, untreated psychosis (Correct answer)
- History of childhood trauma
- Presence of hypervigilance symptoms
Correct answer: Active, untreated psychosis
Active psychosis impairs reality testing and the ability to engage with exposure-based or cognitive interventions safely, making stabilization a prerequisite.
Question 4: When adapting a PTSD treatment plan for a client from a collectivist cultural background, the most important consideration is:
- Shortening the protocol to reduce burden
- Avoiding any discussion of trauma narrative
- Incorporating family or community values and potentially involving trusted support figures (Correct answer)
- Translating written materials into the client's language only
Correct answer: Incorporating family or community values and potentially involving trusted support figures
Culturally responsive adaptation includes recognizing collectivist values, exploring how community and family roles influence trauma meaning and recovery, and adapting accordingly.
Question 5: The 'Window of Tolerance' concept in PTSD treatment planning is used to:
- Determine the maximum number of exposure sessions allowed
- Guide pacing of trauma work so the client remains within an optimal arousal zone (Correct answer)
- Establish the threshold for hospitalizing a client
- Measure symptom improvement across treatment phases
Correct answer: Guide pacing of trauma work so the client remains within an optimal arousal zone
The Window of Tolerance guides titration of therapeutic intensity so clients are neither hyper- nor hypo-aroused, supporting effective trauma processing.
Question 6: A client completes 12 sessions of CPT with significant symptom reduction but continues to struggle with trauma-related shame. The most appropriate next step is:
- Discharge immediately because the protocol is complete
- Restart CPT from session one
- Address residual shame with targeted interventions or a booster protocol (Correct answer)
- Switch to purely supportive therapy indefinitely
Correct answer: Address residual shame with targeted interventions or a booster protocol
Residual shame after CPT often warrants targeted booster sessions or adjunctive interventions rather than full protocol restart or premature discharge.
Question 7: Which pharmacological agents are FDA-approved as first-line treatments for PTSD and should be reflected in an integrated treatment plan?
- Benzodiazepines (e.g., lorazepam)
- SSRIs sertraline and paroxetine (Correct answer)
- Atypical antipsychotics (e.g., quetiapine)
- Beta-blockers (e.g., propranolol)
Correct answer: SSRIs sertraline and paroxetine
Sertraline (Zoloft) and paroxetine (Paxil) are the only FDA-approved medications for PTSD; benzodiazepines are generally contraindicated.
PTSD Treatment Planning & Protocols 3
Under the VA/DoD Clinical Practice Guidelines, which two psychotherapies receive the strongest (Category A) recommendation for PTSD?