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

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
Continue reading

Moving from universal to selective prevention: results of a web-based early intervention for PTSD

Joanne MouthaanThis is a post by Joanne Mouthaan. As a PhD candidate, Joanne conducted a large prospective longitudinal trial of mental health in traumatic injury patients in Amsterdam. Now in the final stage of her thesis, she is working as a lecturer at the Department of Clinical and Health Psychology of Leiden University, The Netherlands.

Our team’s goal is to gain more insight into a) the incidence and development of mental health problems after injury, b) possible bio/psycho/social factors contributing to these problems, and c) prevention of mental health problems by intervening early. From 2005 to 2010, we recruited approximately 900 patients from two level-1 trauma centers (the Academic Medical Center and the VU University Medical Center). Regarding the issue of prevention, we developed a web-based early psychological intervention called Trauma TIPS, the main subject of this post.

Traumatic injury and PTSD

Around the world, traumatic injury is one of the most common traumatic events, accounting for 9% of global mortality. Because of its high incidence, injuries cause millions of people to experience (temporary or permanent) disabilities on a yearly basis, including mental health problems (see http://www.who.int/topics/injuries/en/). PTSD develops in 10-20% of injury patients. Therefore, prevention of PTSD has been mentioned by some as the holy grail of trauma research. Continue reading