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

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

The role of siblings in children’s mental health

siblings mental healthWhen you were young(er), did you also engage in personality predictions with your peers based on order in the family? For example, that the oldest of three siblings would be the bossiest and the youngest the most spoiled? Almost everyone (90% of us) have one or more siblings. And we know they play an important role in our lives.

Scientists in the Netherlands have now combined international research examining siblings’ role in children’s mental health. This is an innovative step, since there is quite a lot of research on parenting but not so much on siblings. Moreover, the authors state that the sibling relationship is “one of the most neglected relationships in psychological research and practice.” Also in the child traumatic stress area, I think siblings are still overlooked. Continue reading

Imagery rehearsal therapy for post-trauma nightmares

sleep treatmentMelynda Casement and Leslie Swanson have recently published an interesting meta-analysis on imagery rehearsal therapy. Find the summary below, with thanks to Georgina Johnstone*.


Sleep problems are a central component of posttraumatic stress, both in children and adults. Difficulty maintaining sleep is reported by up to 91% of people with PTSD, with 72% experiencing nightmares.

Imagery rehearsal (IR) therapy is more and more used to overcome these sleep problems. Although not all versions of IR employ exactly the same techniques, they all have a cognitive behavioral orientation and include these three elements: Continue reading