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 →
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?
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 →
PTSD 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 →
Imagine a 7-year old boy living in India. One day, his father gets drunk and kills his mother. The boy is a witness to the homicide, and develops a high fever as a response. Imagine you’re the mental health professional who is called to support the boy. Some of the things you would want to know are how children in India respond to severe trauma, what words they use, and what helps them to recover.
Unfortunately, that information is virtually inexistent. Traditionally, trauma research has been conducted in high-income, Western countries. This does make sense from a resources perspective, but it does not make sense from a clinical perspective: we should know most about those who are most in need. Trauma from community violence, war, accidents, and natural disasters hits those in low income countries more than those in high income countries.