Psychological Treatments for Traumatic Stress that Promote a Return to Work

Larissa Meysner

Clinical Psychologist

Leadership, Learning & Life Enhancementwww.peoplesense.com.au

Post-traumatic Stress

• What is Post-traumatic stress disorder?• What is it not?

• Evidence based treatments• Trauma-focused cognitive behavioural therapy (TF-CBT)

• Eye movement desensitisation reprocessing (EMDR)

• First responders• How do they differ?

• What can we learn from them?

• The role of exposure in return to work

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Mental stress claims All accepted claims

Lost time (working weeks)

(Safe Work Australia, 2013)

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14000

Mental stress claims All accpeted claims

Direct cost ($)

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Intrusion

Avoidance

Hyper-arousal

Negative thoughts or

mood

Criterion A

Exposure to actual or threatened death, serious injury, or sexual violence. This may be have been directly or as a witness.

Post-traumatic Stress Disorder (DSM-5)

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Trauma-focused CBT

Key Elements - Behavioural

Psychoeducation

Relaxation and distress tolerance skills

Trauma narration

Exposure (visualisation, narrative and then in-vivo)

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Virtual Reality - Exposure

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Key Elements - Cognitive

Cognitive restructuring

Relapse management

Trauma-focused CBT

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Trauma-focused CBT

Key Elements

Psychoeducation

Relaxation and distress tolerance skills

Cognitive restructuring

Trauma narration

Exposure (visualisation, narrative and then in-vivo)

Relapse management

• Involves homework• Skills learnt can be generalised to other areas/problems

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EMDR

Meaning

e.g. I am not safe

Affect

e.g. fear

Sensory

e.g. Loud bangs,

flashing lights

A current trigger sets off the old memory network, activating behavioural (avoiding,

escaping) and cognitive (blocking, dissociating) responses

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Memory

• Historical (vs. relived)

• Less vivid

• Faded

• Fragmented

Distress

• Emotional and bodily distress subsides

• Subjective units of distress (SUDS; 0-10 scale)

Belief about self

• Thoughts about self now and as they relate to old memory

• Strengthen positive thoughts

Reactivates memory networkEye movements facilitate processing of information

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EMDR vs CBT

• Equally efficacious (about 80%)

• EMDR clients consistently demonstrated a more rapid rate of improvement recovery

• Compared with prolonged exposure, eclectic psychotherapy, CBT • (e.g. Nijdam et al., 2012;

Ironson et al., 2002)

Nijdam et al., 2012, British Journal of Psychiatry

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EMDR – Scope of Improvement

• Treating the whole person

• Pre-existing trauma

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EMDR – Scope of Improvement

• Treating the whole person

• Pre-existing trauma

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Case example

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Case example

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Intake Midpoint Final

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Intake Midpoint Final

Depression

Anxiety

Stress

• Comprehensive assessment

• Three active sessions of EMDR

• Positive memory recall

• Increase in emotional reactivity

• Positive self-belief• “I don’t have

to be lonely, but I can be alone”

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First Responders

Trauma world

Now world

• Each world has rules, assumptions, beliefs

• Aim of treatment is to help person come back into the ‘now world’

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First Responders Guidelines

• Emergency workers will usually require 8 to 12 sessions of trauma-focused psychological treatment (either CBT or EMDR), each lasting between 60 and 120 minutes.

Leadership, Learning & Life Enhancementwww.peoplesense.com.au

First Responders Guidelines

• Emergency workers will usually require 8 to 12 sessions of trauma-focused psychological treatment (either CBT or EMDR), each lasting between 60 and 120 minutes.

• However, non-trauma focused psychological interventions, such as relaxation or supportive counselling should not be used routinely for treatment of PTSD amongst emergency workers • …Unless trauma focused interventions treatments are not available or cannot

be tolerated by the worker.

Leadership, Learning & Life Enhancementwww.peoplesense.com.au

First Responders Guidelines

• Emergency workers will usually require 8 to 12 sessions of trauma-focused psychological treatment (either CBT or EMDR), each lasting between 60 and 120 minutes.

• However, non-trauma focused psychological interventions, such as relaxation or supportive counselling should not be used routinely for treatment of PTSD amongst emergency workers • …Unless trauma focused interventions treatments are not available or cannot

be tolerated by the worker.

• Feared or avoided situations, including those in the workplace, should be systematically addressed through in vivo exposure with the view to optimise functioning.

• Occupational recovery should be considered from the very beginning of treatment. Remaining at, or returning to, work should be an aim of treatment and considered an important part of the recovery of emergency workers with PTSD.

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PTSD prevents them from

working

Long term absence prevents

them from overcoming PTSD

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Any questions?