One family in Gaza

Images and voices say a lot more than the written word, especially when it comes to trauma. One of the most impressive, touching videos that I have seen on trauma is this one:


A few months after the 2008/9 Israeli attack that killed over 1000 Palestinian people, filmmaker Jen Marlowe visited Gaza. Among the many families she met and the stories she heard, one family stood out. In the video she shows the story of Kamal and Wafaa Awajah and their children. As Marlowe writes:

Wafaa described the execution of their son, Ibrahim. As she spoke, her children played on the rubble of their destroyed home. Kamal talked about struggling to help his kids heal from trauma.

Palestinians in Gaza are depicted either as violent terrorists or as helpless victims. The Awajah family challenges both portrayals. Through one family’s story, the larger tragedy of Gaza is exposed, and the courage and resilience of its people shines through.

Take your time to watch, it is a powerful reminder of why we work in the trauma field.


Why demographics – including sexual orientation – matter in PTSD research

A while ago I started Paper in a Day to get young trauma researchers together. It has been engaging and productive (if you’re interested, the upcoming ISTSS conference will feature one). In a recent edition, four clever minds – Drs Averill, Eubanks Fleming, Holens and Larsen – have thought through research gaps in the PTSD literature. They published a commentary and I wanted to share their thoughts here. They reflect on one of the biggest areas of trauma research, the experiences of military personnel:

As the wars in Afghanistan and Iraq continue, and military service members continue to return home from these two conflicts, more research has been conducted to examine rates of PTSD among these service members (known in the US as OEF/OIF Veterans i.e. Veterans of Operation Enduring Freedom/Operation Iraqi Freedom). This research is important so that we have an understanding of the need for healthcare in newer returning Veterans (which may differ from previous generations). In reviewing some of these articles, many of which are quite well-designed, we noticed a need for some further study to understand the nuances of who develops PTSD and why.

In particular, it would be useful to examine how PTSD prevalence in US OEF/OIF Veterans depends on 1) Veterans Affairs services use (with a particular focus on non-VA users), 2) relationship status, and 3) sexual orientation. Continue reading

On (or off?) sabbatical

It has been a bit silent on the blog in the past few months. And it was for a reason; I was on leave! Since some of you have asked me what I have been up to, I thought I’d write a slightly different blogpost this time, and share my experiences of the first half of 2015…

After doing trauma research for about 10 years, I felt that it was time for a break. My plan was to find time to reflect, experiment with new ideas, and learn, rather than simply continue on the research diesel engine (or, some may prefer the metaphor of a continuous sprint…!).

So I took a few months of unpaid leave. Some people said that I was committing career suicide; as an academic you’re expected to publish continuously. Certainly, the past few months have reduced my average output rate. However, I am very happy that I have done it, and I think that in the long run my work will be better for it. So what have I done exactly?

Help set up the Africa Science Leadership Program Continue reading

Is a trauma focus truly needed in PTSD treatment?

???????????????????????????????????????????????????????????????????????????????????????Last month Joris Haagen shared Part 1 of a saga around the question whether a trauma focus is truly necessary in trauma treatment. Based on a meta-analysis, Benish, Wampold and their colleagues concluded that the answer is No. Their analysis, and in particular the selection of studies, was heavily criticized by Ehlers et al. However, Wampold was not easily defeated and offered a riposte…Over to Joris:

Wampold et al. (2010) argue that their classification criteria are in fact more objective than previous meta-analyses and that the content of supportive therapies in research studies does not match supportive therapy as given in daily practice. For example, no therapist would normally dissuade their client from discussing traumatic experiences as is often the case in experimental studies. Wampold et al. also note that supportive interventions are difficult to capture in a single category because their content varies.

They further state that the distinction that Ehlers et al. make between trauma-focused and non-trauma-focused therapy is not clear-cut. TF-CBT has for instance considerable overlap with stress inoculation therapy (SIT) despite SIT not being considered trauma-focused. A neuro-feedback study is categorized as trauma-focused exposure, even though patients have no possibility to discuss traumatic content. Hypnotherapy and psychodynamic therapy are categorized as non-trauma-focused although both allow for – and even encourage – discussion of traumatic memories. As such, Wampold et al. stood by their view that the available research did not demonstrate the difference between trauma-focused and non-trauma-focused therapy.

Both groups display – at first glance – fundamentally different positions. Continue reading

Do we let patients suffer needlessly?

Joris HaagenPTSD treatment guidelines invariably point to trauma-focused therapy, such as trauma-focused cognitive behavioral therapy (TF-CBT) or Eye Movement Desensitization and Reprocessing (EMDR) as preferred interventions. Is the trauma focus justified? Researcher and psychologist Joris Haagen tells the story of a heated academic debate…

An article by Benish, Imel and Wampold (2008) challenged our belief in the necessity of a trauma focus. According to the authors it does not matter which psychological intervention we employ and whether it is trauma-focused or not. Could this mean that traumatized patients needlessly suffer from therapeutic exposure to horrific memories? The article was the start of a fiery debate between prominent researchers.

Let’s start with the initial article itself. Dr. Benish et al. published a meta-analysis with data from 15 studies and 958 patients in PTSD treatment. The aims of their meta-analysis were most unusual; whereas the last decades were dedicated to the discovery of the most effective therapies, based on the assumption that the effectiveness varies between interventions, Benish et al. assumed and tested the reverse: all therapeutically-intended interventions are equally efficacious. Continue reading