Prospective Research Is to Conduct a Single-SubjectCase Study

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¶ … prospective research is to conduct a single-subject study with a college-educated, professional, single, female client who suffers from post-traumatic stress disorder (PTSD) that is the result of sexual assault (date rape). The client's post-traumatic behaviors include engaging in alcohol abuse and sexual promiscuity as coping devices to address her symptoms of anxiety and depression. The client's sexual assault occurred when she was a college student, however, her PTSD has continued well into adulthood and she is now 40-years of age. The annual incidence rate of rape or attempted rape on college campuses is approximately 5% of women students ("American College Health Association," 2013; Kilpatrick, et al., 2007).

The association of post-traumatic stress disorder resulting from sexual trauma has been associated with alcohol abuse in the literature. The client is sufficiently self-aware that she recognizes her increased intake of alcohol in recent years. She admits to dating unavailable men with whom she can engage in sex but avoid attachment, and assumes that these behaviors are driven by her feelings of being undeserving of love. Her symptoms of depression and self-recrimination increase post-coitus, as does her consumption of alcohol. After 15 years of individual counseling, albeit somewhat erratic over the long-term, the client would like to try a different mode of therapy. She is highly motivated to normalize her relationships and her life: she is particularly interested in establishing a healthy heterosexual relationship and perhaps even becoming a parent. A friend of the client's suggested she learn more about the potential of Reiki to address her symptoms of anxiety, depression, and drinking alcohol.

Deliramich and Gray (2008) studied changes in women's sexual activity and behavior following sexual assault, including the relationship between alcohol abuse and promiscuity following sexual assault. A range of behaviors occurs in women following sexual assault, suggesting to researchers that there may be subtypes of sexual assault victims. Notably, researchers have noted that two polar-opposite behavioral sets are common: following sexual assault, women may pointedly avoid sexual activity or they may increase their sexual activity (Deliramich and Gray, 2008). Survivors of sexual assault may also exhibit increased consumption of alcohol; researchers have found that alcohol consumption for survivors of motor vehicle accidents is reportedly less than for survivors of sexual assault (Deliramich and Gray, 2008). In both groups, alcohol was apparently used as a post-traumatic coping strategy that predicted increases in post-traumatic risky sexual behavior. Indeed, researchers asserted that the increased likelihood of engaging in risky sexual behavior could account for some degree of revictimization (Deliramich and Gray, 2008).

A number of therapeutic treatments are utilized with women who have been sexually assaulted as adolescents or as adults. Vickerman and Margolin (2009) conducted a meta-analysis of 32 research studies using 20 sample data sets was employed, in which12 of the 20 studies were focused on women victims with chronic symptoms, three studies were designed for the acute period that directly follows sexual assault, and three studies were actually programs for secondary prevention. The 32 studies covered a range of intervention types, from active interventions to supportive counseling, and sought to treat posttraumatic stress disorder (PTSD), depression, and/or anxiety (Vickerman & Margolin, 2009). Cognitive Processing Therapy; Prolonged Exposure; Stress Inoculation Training; and Eye Movement Desensitization and Reprocessing (Vickerman & Margolin, 2009). Few differences in effectiveness were found in the four active interventions, however, cognitive behavioral interventions led to better PTSD outcomes than did supportive counseling (Vickerman & Margolin, 2009). Regardless, it is important to note that even the most robust treatments left one-third of the women with a diagnosis of PTSD at the end of treatment or when they dropped treatment (Vickerman & Margolin, 2009).

Foa, et al. (1991) studied victims with post-traumatic stress disorder (PTSD; N = 45) under four randomly assigned conditions: Stress inoculation training (SIT), prolonged exposure (PE), supportive counseling (SC), or wait-list control (WL) (Foa, et al., 1991). A female therapist provided nine biweekly 90-min individual sessions (Foa, et al., 1991). Pre-intervention, post-intervention, and 3.5 months follow-up measures of psychological symptoms included general anxiety, depression, PTSD symptoms, and rape-related distress (Foa, et al., 1991). Improvements in psychological symptoms were seen for all interventions immediately at post-treatment and at the follow-up mark (Foa, et al., 1991). As measured immediately following completion of the nine weeks of treatment, PTSD symptoms were significantly more improved for subjects who received stress inoculation training (SIT) than for the subjects who received supportive counseling (SC) and wait-list control (WL) (Foa, et al., 1991). However, at the follow-up mark after 3.5 months passed since treatment, prolonged exposure showed superior outcome measures for PTSD symptoms (Foa, et al., 1991).

Collinge and Sabo (2005) conducted a pilot study without a control group that integrated massage, energy-based therapies (including Reiki), and psychotherapy in a mental health center. The objective of the pilot study was to provide qualitative feedback on the integrated services and to collect data from providing the integrated therapies to a sample of clients with persistent mental health concerns who had been receiving services over the long-term (Collinge & Sabo, 2005). The clients received a brief program of psychotherapy and complementary therapy at a participating community mental health center in Maine, in the private offices of the massage therapists, and the energy healing practitioners (Collinge & Sabo, 2005). Data was collected via pre-intervention interviews and post-intervention self-report instruments (Collinge & Sabo, 2005). The subjects were 20 women and five men who had an average of 7.4 years of mental health treatment and had experienced trauma (Collinge & Sabo, 2005). Ten of the subjects had been sexually abused, and DSM-IV Axis 1 diagnoses included PTSD (n = 10), major depression (n = 9), generalized anxiety disorder (n = 3), and dual diagnosis (n = 3). (Collinge & Sabo, 2005).

The subjects were assigned to one modality of complementary therapy and all subjects received ongoing psychotherapy throughout the study (Collinge & Sabo, 2005). Interventions were determined for each individual subject through the availability of practitioners, client interest, and clinical judgment (Collinge & Sabo, 2005). The modalities available in this pilot study included acupuncture, Healing Touch, massage, and Reiki, and a mean number of five sessions took place (Collinge & Sabo, 2005). Instrumentation was developed specifically for the study with a Likert rating scale for satisfaction with the intervention services, and for the subjects' perceptions of changes along four dimensions of trauma recovery: bodily sensation, bodily shame, interpersonal boundary setting, and interpersonal safety (Collinge & Sabo, 2005). Outcome ratings were strong from both subjects and the mental health clinicians (Collinge & Sabo, 2005). Clinicians observed enhanced psychotherapeutic outcomes for clients, and the subjects concurred, reporting significant levels of perceived (self-reported) change on each outcome measure (Collinge & Sabo, 2005). Moreover, the subjects indicated that they were highly satisfied with the services.

The literature indicates that a variety of therapeutic interventions can be effective with sexual assault victims suffering from PTSD, notably, a combination of psychotherapy and integrated complementary therapies. In addition to clients experiencing enhanced mental health outcomes, an adjunct benefit may be improved quality of life for long-term users of mental health services. From this, the current research proposes the following null and alternative hypotheses:

Ho: The client will not demonstrate improved mental health outcomes related to her PTSD, alcohol abuse, and sexual promiscuity from integrated therapy that Reiki massage sessions and Reiki journaling over a 6-week period.

Ha: The client will demonstrate improved mental health outcomes related to her PTSD, alcohol abuse, and sexual promiscuity from integrated therapy that Reiki massage sessions and Reiki journaling over a 6-week period.

The next section of the research proposal addresses methodology, which includes data collection and data analysis.

Methodology

Single subject research design (SSRD), also known as time-series research, consists of the study of a single individual or system by taking repeated measurements of one or more dependent variables as the independent variable(s) are systematically applied, withdrawn, or varied (Kazidin, 2010). The proposed research is designed as a simple A-B design in which the baseline phase (A) is roughly as long as the intervention phase (B) (Kazidin, 2010). The proposed single-subject research study that will last for roughly six weeks, having actually begun on September 15, 2014. The independent variables are attendance at the Reiki sessions and entries when writing Reiki journals. The client attends 60-minute-long Reiki sessions in order to experience holistic support of her endeavors for self-improvement. The Reiki sessions are expected to increase the client's self-awareness, reduce her symptoms of anxiety and depression, and result in reduced levels of alcoholic intake, which are the dependent variables.

Data collection. The client keeps a daily Reiki journal, self-reports and tracks her levels of anxiety and depression, and logs the number of alcoholic drinks she has had in any one day. The number of Reiki sessions she attends is also recorded by the client in her journal. The client will engage in remote therapeutic interactions with her therapist by emailing a weekly progress report, in which the client will delineate her levels of anxiety and depression.… [END OF PREVIEW]

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