Patrick became a child soldier at the age of 13. He was abducted by Ugandan rebels, who kept him for 3 years.
Schultz and Weisaeth (2015) describe Patrick’s story, his mental health problems, and his treatment, a local cleansing ritual. They conclude that the ritual is safe, effective, and perhaps even more powerful than Western-style therapy. That sounds fascinating and important, right?
In interviews Patrick told about his experiences, including an attack on a convoy:
“Everybody was screaming…The road was all red from the blood… My body was shaking, but I managed to appear calm. If not they would have killed me. The next day I experienced the Ghost People for the first time. I could see them get chopped up and sliced apart with axes. I saw the same scenes over and over again.”
The Ghost People only showed up when Patrick was alone, and scared him enormously. He also suffered from concentration problems and sleeping difficulties. He was clinically depressed and had moderate to severe PTSD.
When his nightmares were occurring twice a week and he saw the Ghost People every day – about 8 years after the convoy attack –, he stated that his life was ruined. He wanted to do a cleansing ritual. Continue reading
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 not use psychological debriefing when a child has been exposed to a traumatic event such as assault or a major car crash.
And when you treat a child who has developed Posttraumatic Stress Disorder (PTSD) due to trauma, do not use pharmacotherapy either (that is, not as a first line treatment).
Rather, apply the principles of psychological first aid in the direct aftermath of trauma and use trauma-focused cognitive behavioral therapy to treat PTSD.
These recommendations come from the brand new, very extensive Australian Guidelines for the Treatment of ASD and PTSD. For the first time, the guidelines include separate sections on children and adolescents.
How are the guidelines developed?
The guidelines are mainly informed by a systematic review of the literature and a staged process of expert consensus. People affected by trauma, clinicians and the public have also had varying levels of input. Continue reading
Books! For a Dutch publication on supporting children after trauma, I have read and re-read a number of books on children and traumatic stress in the past couple of months. Five of them clearly stood out as favorites, mainly because of their innovative ideas, child-centered approach, and/or practical examples of how to help children.
Here they are, in random order. Would you agree with the selection? Continue reading
This guest post is written by Julia Diehle, who is in the final year of her PhD project (supervised by dr. Lindauer and prof. Boer at the Academic Medical Center in Amsterdam). Her research project concerns a randomized controlled trial of Trauma-Focused Cognitive Behavior Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) in children with PTSD.
Treatment dropout will be the topic of next week’s #traumaresearch Twitter chat on Thursday 26 April (9pm Melbourne, 13u Amsterdam; see your local time & how to join). Julia will join us as a special guest, I hope to see many of you there! Now over to Julia:
We do not like to talk about it but treatment dropouts and “no-shows” are a big problem in trauma therapy. Actually not in trauma therapy alone, but in outpatient settings in general. About 50% of adult patients drop out of outpatient therapy¹ and the number of children dropping out of treatment seems to be even higher. Miller and colleagues² found that more than 60% of children did not complete 8 sessions of therapy and that about 17% of the children did not even return after the intake session.
It is all about long-term vs. short-term gains
Trauma-therapy is no fun and treatment gains are achieved on the long term rather than on the short term. Continue reading