Zusa Sadelars (pronouns she, her, hers), a 32-year-old Afghanistan war veteran of multiple deployments, has been experiencing PTSD symptoms for more than five years. She comes to see you because it has gotten too difficult to keep going without help.

Zusa, a White woman, tells you, “I have been trying to consistently avoid thoughts and images related to witnessing my fellow service members being hit by an IED while I was driving a combat supply truck. Over the years, I have become increasingly depressed. I’ve been drinking on a daily basis to help manage my PTSD. I’ve gotten in trouble at work ‘cuz I miss so many days. My husband says I’m ‘not there’ at home around him and the kids, even when I physically am and I guess I agree with him.”

In addition to a range of other PTSD symptoms, Zusa describes her recurring nightmare. “I’m leading a convoy and my truck breaks down. We get out, pop the hood, start working on it. I wave the second truck forward. We’re all waving and smiling. The guys in the other truck, they make fun of our broken truck and our efforts to fix it. ‘Look at that piece of junk truck! Some people will do anything to not have to work today. Good luck getting that clunker fixed!’ They pass us smiling and joking and then while we’re saying some shit back, they hit the IED in front of us. Pieces of the truck and body parts fly around, hitting us”.

“It’s not just a nightmare. It really happened. And I want to stop remembering it.”


Would you refer Zusa to therapy? If so, what type? Please provide evidence for your decision.


“Patients with any severity of symptoms present for ≥3 months should be offered a trauma-focused psychological therapy such as TFCBT.” epocrates

3 references 2019 and above

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