Does your therapist use the PSS-I or PSS-I-5? (PTSD Symptom Scale Interview)

Recovery4Me

MyPTSD Pro
The center where I have been going to for a few years has changed Directors within the Mental Health Dept. Currently my normal talk therapy which included working on various components within DBT (such as Radical Acceptance) has been tossed aside for an interview style proceeding any discussion known as PTSD Symptom Scale Interview (PSS-I and PSS-I-5). ? Is anyone else being blessed (coughs) with this of late?

It has several questions for quantitative measuring which takes (per authorities of the test) 20 minutes if one can focus lol. However, since my disassociation is rather high at this time, most of the 40 minutes of my Therapy Session are absorbed within my grappling for recall then refocusIng in order to address. The scale on the questions as well as the questions theirselves (which in my current mood swing) appear to be a form of agitation rather than self assessment.

After three sessions being hogged by this bloody construct, it became apparent to my T. that my scale was increasing. Dah. He offered to send me the test prior to the talk, so we might communicate the numbers then proceed. We shall see.

So I was wondering if you currently were undergoing this style of modality that is claimed by some to be helpful to the client. For me, knowing my PTSD is increasing during a Pandemic, ect isn’t necessarily a toolkit. However, you might have a different opinion and I am willing to learn as sometimes I can be a donkey’s butt before I accept...change. Thanks.
 

joeylittle

Administrator
an interview style proceeding any discussion known as PTSD Symptom Scale Interview (PSS-I and PSS-I-5). ? Is anyone else being blessed (coughs) with this of late?
This isn't really to do with treatment. It's just an evaluative measure - a quantifiable way for the therapist or doctor to track overall change in the client/patient.

It may be a new reporting requirement for your insurance; or, if your therapist works in a group, it may be a new policy for the group....OR, they may have decided they want the info from the ongoing assessment.

It's also how a clinician would properly determine whether your PTSD is active or dormant. When therapy is effectively addressing PTSD, the individual will eventually no longer meet PTSD criteria. They may still meet criteria for anxiety or depression or any other associated set of symptoms or course - it's not some sort of score sheet where you suddenly become problem-free - but it can help determine what therapeutic interventions to focus on.

You should really only need to do it once a month, or less.

You can read more about it here: info on PSS-I-5
 

Recovery4Me

MyPTSD Pro
You should really only need to do it once a month, or less.


I am grateful for your input as I did not consider the quantitative system advantages in highlighting the various components or symptoms. I will address it with my T however, as to the reason why each session is now involving this tool as I am going every two weeks as I have been escalating.

Thank you for your assistance on placement as well as thread title.
 
Last edited:

Recovery4Me

MyPTSD Pro
PHQ9, PCL-5, GAD-7 are the interview scales I take prior to therapy. Does anyone else’s Health Center or Therapist use those scales with you and do you find some of those questions unsettling?

I find some of the questions outdated or noninclusive with respect to an global pandemic.

For example on the PCL-5:
Question 13- “Feeling distant or cut off from other people?”
^ the person is to rate their emotion on a scale from 0-4 (zero being not at all)

I chose this simple question as an example to offer ... that a field or system in charge of mental health as well as determining the ‘norm’ within an mental health spectrum might wish to readdress what is now normalized.

Isolation, scarcity, economic downturn, natural disasters, fear, ect may also result in a list of “problems that people sometimes have in response to a very stressful experience” (per Instructions on the top of page) for my PCL-5. However, the past flags or indicators can not be loosely wrapped into one size fits all during these times perhaps allowing more people (whom need mental help) to fall within those cracks during 2021.
 

siniang

MyPTSD Pro
PHQ9, PCL-5, GAD-7 are the interview scales I take prior to therapy. Does anyone else’s Health Center or Therapist use those scales with you and do you find some of those questions unsettling?

I have to do PHQ9 and GAD-7 before each appointment (my clinic/insurance asks to do these every 14 days, and I have therapy every other week). I find them ... stupid. Not so much unsettling, just...pointless.

PHQ9 consistently puts me in the "depression" category, actually caused my official MDD diagnosis. It does not distinguish enough whether symptoms might be due to another comorbid mental disorder (*cough* PTSD) or any other causes for the symptoms. For example, I consistently check "tired" "nearly every day" because I have chronic fatigue. Basically all the symptoms scoring high on PHQ9 are physical symptoms... not those of an actual mood disorder (and my T agrees).

Similar issues with GAD-7. I have comorbid ADHD. Both GAD-7 and PHQ9 have questions about feeling restless and having trouble focusing... no shit, Sherlock.

I guess they are ok'ish as a tool to track baselines/trends of symptoms. But with TONS of caveats. And certainly not as a diagnostic tool, especially when not considering other comorbid Dx's.

And YES, I absolutely share your concern that the questions do not consider (because they're not asking) for external circumstances, such as a global pandemic.
 

Friday

Moderator
I find some of the questions outdated or noninclusive with respect to an global pandemic.

For example on the PCL-5:
Question 13- “Feeling distant or cut off from other people?”
^ the person is to rate their emotion on a scale from 0-4 (zero being not at all)

Curiously enough I was chatting with my T abot this recently. My mom? Would definitely say “yes” or answer the highest level possible. She’s not a hugely social person, even during the best of times, but she’s a “Lady who brunches” type of social. 4-6 days a week she’s meeting for brunches, a couple days a week, she lunches, and most days she’s at the gym, with her gym-friends. In addition she goes on one or two trips a year to visit distant family for a few months, and she has both weekly and monthly social events, museum stuff, in addition to the whole charity circuit thing.

During the pandemic?
- She has a couple weekly zoom meetings
- She’s on the phone 1-2 hours a day, with 2 or 3 different people

SHE feels cut/off & distant from people, because of the circumstance/situation. As it’s a massive scale-back from what she prefers.

As opposed to someone with PTSD who can be working with people all day long, come home to family, and either have social engagements on the weekend (or sleep through them) IE be up to their eyeballs in “people” anytime they’re not asleep, and STILL “feel” cut off / distant / disconnected. The “alone in a crowd thing” -OR- literally spend weeks/months not interacting with anyone, even at the grocery store (delivered) or gas station (self pump)... if we’re assuming functional enough to actually be going to therapy and engaging wih at least one person, once a month. Voice harsh from disuse. Around people occasionally but not interacting with them.

Hence the whole feeling disconnected because it’s lower than they prefer compared to feeling disconnected regardless of their actual level of interaction = easily distinguishable by a pro, versus self-assessment seeming worse than it really is.
 

Recovery4Me

MyPTSD Pro
PHQ9 consistently puts me in the "depression" category, actually caused my official MDD diagnosis.

To my knowledge, my labeling has anchored on needed medical documentation (example for my service dog) within PTSD. However, your point is well taken and there is an credible concern as to the statistics plus people being grouped inaccurately.

For example, I consistently check "tired" "nearly every day" because I have chronic fatigue.

That question also concerns me. I have chronic fatigue as a result of Ménière’s ears disease. Today, I stood on my small soapbox while spouting to my T, that such a questionnaire did not seem to allow for those whom have disabilities or disease versus depression. Although he agreed, it does not change the concern.

Similar issues with GAD-7. I have comorbid ADHD. Both GAD-7 and PHQ9 have questions about feeling restless and having trouble focusing... no shit, Sherlock.

Yes! Lol me too! Thank you for sharing that, I needed the giggle.

As opposed to someone with PTSD who can be working with people all day long, come home to family

I find myself constantly grateful for your shares, nodding while silently exclaiming that is what I wanted to explain. However, your narratives carve it into life and add the form to bring it home. Thank you.

Hence the whole feeling disconnected because it’s lower than they prefer compared to feeling disconnected regardless of their actual level of interaction = easily distinguishable by a pro, versus

^ This is where I find myself (system wise) at one discomfort. When there is a tally of those said points, exactly how are they being specifically tuned to promote a range indicator of PTSD?

For example @siniag has offered a her share of being labeled MDD: others that I have spoken with are still fighting for being recognized with PTSD versus forms of depression (which although not mutually exclusive may feel dismissive). The therapy treatment, methodology, pharmaceuticals vary, so it is just darn unsettling to me that this standardized docket appears radically unequipped. * huffs, stomps off and gets over self *
 

siniang

MyPTSD Pro
Today, I stood on my small soapbox while spouting to my T, that such a questionnaire did not seem to allow for those whom have disabilities or disease versus depression

Yeah, I've been on that same soap box during our last session (and not for the first time). After doing the PHQ9 T commented on how my depression score is lower than usual, has actually not been that low for months and months, and asked me whether this is also how I feel, whether I feel/felt "less depressed".

To which I replied that I cannot answer the question. Because I don't feel "depressed". I haven't felt "depressed". I don't know what that means.

I've been tired - because I have chronic fatigue (on medical record) and because I consistently and persistently sleep like crap (PTSD).
I've been frustrated - because life happens and because I can't focus and get the work done I want/need to get done (ADHD).
I've been stressed - because work deadlines.
I've been irritable - because hubby's been a pain in the a.

But I have not been feeling "depressed".

I never not even once checked any of the more tell-tale "depression" signs ("feeling bad about yourself", "feeling like a failure", "thinking about hurting yourself", ...). I just score really high on some of the other, more physical, questions, which push up the overall total.

Between my officially Dx'ed PTSD, GAD, ADHD, and chronic fatigue, and just normal life stressors (heck, I'm a PhD student living in a global pandemic), any and all of those questions I tend to score high on - and which add up to put me over the "threshold" - are more than covered.

My MDD Dx came first, based on that questionnaire and the subsequent assessment interview. My PTSD Dx didn't come till the second sessions because we ran out of the time the first.

Both my PsyDoc and my T agree that I don't have a mood disorder. Yet, just based on that questionnaire alone I do and it always needs explaining of "what's been going on" to basically do that cross-diagnosis of "unless explained better by xyz" afterwards. It's annoying as f, actually. It's still on my file for some reason and it impacts assessments when I see other health providers (as my primary care doc. "Oh, you have depression? There is your explanation for feeling tired" ... *facepalm times 5* And yes, that has happened).

The therapy treatment, methodology, pharmaceuticals vary, so it is just darn unsettling to me that this standardized docket appears radically unequipped. * huffs, stomps off and gets over self *

And this right there is my beef with those standardized questionnaires as well.

Yes, an actual pro can distinguish and put nuances to the answers - but the computer where it's recorded and others looking at those records, e.g. an insurance provider, may not.

As I said before, it's probably a rather easy tool to monitor symptoms/trends in a rather straight-forward point system, but that's about it. It's only valuable for those who have actually been treading you for a while and know your story and nuances.

But hey, I mean, there's all kinds of problems with standardized anything, in general.

It's also how a clinician would properly determine whether your PTSD is active or dormant. When therapy is effectively addressing PTSD, the individual will eventually no longer meet PTSD criteria. They may still meet criteria for anxiety or depression or any other associated set of symptoms or course - it's not some sort of score sheet where you suddenly become problem-free - but it can help determine what therapeutic interventions to focus on.

Considering the significant symptom overlap, even within the actual diagnostic criteria, this is problematic, though. Someone who's been diagnosed with PTSD has a good amount of depression and/or anxiety symptoms. So how do you determine just with those questionnaires whether those depression/anxiety symptoms one still has aren't actually the PTSD and the PTSD isn't *actually* dormant? And if you can't - what's the point? Just because someone does no longer meet full PTSD criteria but still has depression/anxiety symptoms doesn't mean they now suddenly have a mood/anxiety disorder.

Genuine question, I'm trying to understand :)

Disclaimer: I don't know what exactly PSS-I and PSS-I-5 ask
 

Recovery4Me

MyPTSD Pro
heck, I'm a PhD student living in a global pandemic

Amazing fortitude is required for such an endeavor considering your challenges. I can not begin to offer the respect that I have for you going the distance within your education. I found all those certain characteristics such as my ADHD required an different style of learning mode (then was the pedagogy at that time). However, although instant retrieval was problematic during intervals, I integrated the information on the foundational level that became practical when I was challenged during task. As well it enabled me to share with some of my students that also were challenged in the same areas - the PTSD or ADHD.

Perhaps that is also some of the core rub for me with standardization of screening test while wishing there was a subset that included allowances for a significant correlating factors that would contribute to an holistic approach of diagnosis. An application software might be better equipped to open up a sub menu to determine the root driving factor of the other symptoms when flagged by numeric value. An asterisk later implemented within the score (or various abbreviated or letter symbols) might be instantly viewed by those said professionals ( for example-within the insurance area or research development within grants) allowing fine tuning for some within the mental health spectrum. Groupings, statistics can be misleading without the proper questions being asked or considered.
 
Top