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

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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Traumatic events do not occur at random

Katie McLaughlinDr. Katie McLaughlin is a clinical psychologist and Assistant Professor in the Department of Psychology at the University of Washington.  She received her doctorate in Clinical Psychology and in Epidemiology and Public Health from Yale University in 2008.  Her research seeks to identify psychological and neurobiological mechanisms linking child trauma exposure to the onset of psychopathology in children and adolescents.

Today, Katie writes about what population-based data can tell us about trauma in U.S. children and adolescents.

The media is filled with stories about traumatized children and adolescents, such as the school shootings at Sandy Hook and Columbine. However, a range of more common traumatic events, such as accidents and caregiver maltreatment, receive less attention.  We sought to understand how common traumatic experiences are in the lives of U.S. youths by conducting a study examining trauma exposure and PTSD in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a nationally-representative sample of 6,483 adolescents aged 13-17. This study is the largest population-based study examining trauma exposure and PTSD in U.S. youths, and the findings reveal trauma and PTSD are significant public health problems in this population.

Trauma Exposure is Pervasive among U.S. Youths

A majority of U.S. youths have experienced a traumatic event by the time they reach adolescence.  Sixty-two percent of teenagers have experienced at least one traumatic event in their lifetime, including interpersonal violence, serious injuries, natural disasters and death of a loved one, and 19 percent have experienced three or more such events.  The prevalence of trauma exposure among children and adolescents is nearly as high as the prevalence in adults based on similar population-based studies.

Traumatic Events do not Occur at Random Continue reading