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

Mental health consequences of childhood cancer

mental health childhood cancerWorldwide, more than 175,000 new cases of childhood cancer are diagnosed each year.

Georgie Johnstone, a recent vacation scholar at the Trauma Recovery Lab talks you through some thought-provoking new research on cancer and PTSD.

Overall, in children under 15 years living in the industrialised world, childhood cancer is the 4th most common cause of death. However, childhood cancer is no longer the death sentence it once was, with overall survival rates in high-income countries now at about 80 percent.

How are survivors affected by the potentially traumatic experience of their diagnosis and treatment, and how does it impact on the rest of their life and that of their family? Research has indicated that cancer survivors are at an increased risk not only from somatic late effects related to cancer and treatment, but also for depression, anxiety and antisocial behaviour. Lifetime prevalence of cancer-related PTSD has been estimated at 20-35% in survivors and 27-54% in their parents. However, new research in the Journal of Clinical Oncology has challenged these estimates.

The risk of a focusing illusion
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