Firefighter-Paramedic With Posttraumatic Stress Disorder, Horrific Images, and Depression: A Clinical Case Study:

Despite the existence of evidence-based treatments for posttraumatic stress disorder (PTSD), no identifiable study reported delivery of exposure therapy for a first responder with PTSD, as well as horrific images that generalized beyond the index trauma to loved ones. Horrific images have been defined as strongly aversive intrusive thoughts such as images of dismembered bodies or disgusting scenes. This clinical case describes the assessment and treatment of Ryan, a 41-year-old, firefighter-paramedic who completed a multifaceted intervention that included imaginal exposure therapy, behavioral activation, and cognitive therapy for depression. PTSD symptoms as measured by the PTSD Checklist for DSM-5 (PCL-5) displayed a clinically significant decrease from 25 at pretreatment to 3 at 2-month-follow-up, indicating Ryan no longer met diagnostic criteria for PTSD. In addition, Ryan endorsed a clinically significant reduction in horrific images from 21 per week at pretreatment to 0 at 2-month-follow-up. Depressive symptoms as measured by the Beck Depression Inventory-Second Edition (BDI-II) demonstrated a clinically significant decrease from 18 at pretreatment to 1 at 2-month-follow-up, indicating Ryan no longer met diagnostic criteria for depression. This clinical case study provides evidence for the feasibility and effectiveness of delivering a multifaceted intervention for a first responder with multiple psychiatric disorders.