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

Trauma research needs to be more global and accessible

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.

But is this imbalance actually still the case? Continue reading

Grief in children and adolescents

The plane crash in Ukraine brings up many questions related to loss and grief. How will those left behind cope with the devastating event? How can we support them? With regard to how young people cope with bereavement, Mariken Spuij’s recent PhD thesis provides new insights. She studied grief and its pathological extreme, Prolonged Grief Disorder, focusing on three topics:

  • The phenomenology and correlates of Prolonged Grief Disorder
  • The role of negative thinking in Prolonged Grief Disorder
  • The development and piloting of the ‘Grief-Help’ intervention for children

Prolonged Grief Disorder

Pathological grief is characterized by persistent severe distress during more than 6 months after the loss, and including symptoms such as separation distress, disbelief regarding the death, numbness, and a sense that life is meaningless. Many of the symptoms are normal grief reactions; it is their intensity and duration that signal a need for additional support.

Similar to the relation between trauma and PTSD, Dr. Spuij and colleagues concluded that Continue reading

One in six children develops PTSD after trauma, but differences exist

children and PTSDHow many children develop Posttraumatic Stress Disorder after a traumatic experience such as an assault, a car crash, war or disaster? William Yule – one of the godfathers of child traumatic stress research – once pointed out that rates reported in separate studies varied from 0 to 100%.

So what is the average rate to be expected? With an international team of collaborators, we conducted a meta-analysis to answer this question.

The wide variety in individual study results suggests that various factors may be in play: apparently not every type of exposure, set of circumstances or group of children is related to similar PTSD rates. In addition, there may be methodological variation in the studies. Continue reading