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PTSD research and statistics Bill Andrews Pragmatic Research Network 1 Sunday, 6 February 2011

Ptsd resolution5.2

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This presentation explains the background to the current definition of PTSD as it still stands in 2011 and the NICE guideline current treatment recommendations. It then considers some controversy in the field amongst the researchers regarding the lack of effect differences between different treatments and finishes with pragmatic suggestions about future direction.

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Page 1: Ptsd resolution5.2

PTSD research and statistics

Bill Andrews

Pragmatic Research Network

1Sunday, 6 February 2011

Page 2: Ptsd resolution5.2

Bill Andrews

Pragmatic Research Network

PTSD treatment: the facts; outcomes of therapy

1Sunday, 6 February 2011

Page 3: Ptsd resolution5.2

Bill AndrewsResearch Coordinator

Pragmatic Research Network

2Sunday, 6 February 2011

The HGIPRN is expanding now to inclue and encourage a wider audience. The HGIPRN will forma sub-set of the total number of data contributors.

Page 4: Ptsd resolution5.2

Bill AndrewsSenior advisor

ICCEwww.centerforclinicalexcellence.com

3Sunday, 6 February 2011

The ICCE is a great resource.

Page 5: Ptsd resolution5.2

What is PTSD? 1/6

DSM-IV-TR, APA, 2000

4Sunday, 6 February 2011

Page 6: Ptsd resolution5.2

What is PTSD? 1/6

• A: An event(s), witnessed, experienced or confronted by; actual or threatened death of physical injury, or physical integrity of others AND the individual’s response was of intense fear, helplessness or horror

DSM-IV-TR, APA, 2000

4Sunday, 6 February 2011

Page 7: Ptsd resolution5.2

What is PTSD? 2/6

DSM-IV-TR, APA, 2000

5Sunday, 6 February 2011

Page 8: Ptsd resolution5.2

What is PTSD? 2/6

• B: The event(s) is re-expereinced in the form of intrusive thoughts, distressing dreams, and/or a feeling that the event is reoccurring

DSM-IV-TR, APA, 2000

5Sunday, 6 February 2011

Page 9: Ptsd resolution5.2

What is PTSD? 3/6

DSM-IV-TR, APA, 2000

6Sunday, 6 February 2011

Page 10: Ptsd resolution5.2

What is PTSD? 3/6

• C: Persistent avoidance of stimuli associated with the event(s)

DSM-IV-TR, APA, 2000

6Sunday, 6 February 2011

Page 11: Ptsd resolution5.2

What is PTSD? 4/6

DSM-IV-TR, APA, 2000

7Sunday, 6 February 2011

Page 12: Ptsd resolution5.2

What is PTSD? 4/6

• D: Elevated arousal that was NOT present prior to the event(s)

DSM-IV-TR, APA, 2000

7Sunday, 6 February 2011

Page 13: Ptsd resolution5.2

What is PTSD? 5/6

DSM-IV-TR, APA, 2000

8Sunday, 6 February 2011

Page 14: Ptsd resolution5.2

What is PTSD? 5/6

• E: The symptoms must persist for more than 1 month

DSM-IV-TR, APA, 2000

8Sunday, 6 February 2011

Page 15: Ptsd resolution5.2

What is PTSD? 6/6

DSM-IV-TR, APA, 2000

9Sunday, 6 February 2011

Page 16: Ptsd resolution5.2

What is PTSD? 6/6

• F: The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

DSM-IV-TR, APA, 2000

9Sunday, 6 February 2011

Page 17: Ptsd resolution5.2

Psychological Trauma

10Sunday, 6 February 2011

It’s easier to understand trauma on a continuum.

Page 18: Ptsd resolution5.2

Psychological Trauma

continuum

10Sunday, 6 February 2011

It’s easier to understand trauma on a continuum.

Page 19: Ptsd resolution5.2

Psychological Trauma

physiological arousal

continuum

10Sunday, 6 February 2011

It’s easier to understand trauma on a continuum.

Page 20: Ptsd resolution5.2

Psychological Trauma

physiological arousal PTSD

continuum

10Sunday, 6 February 2011

It’s easier to understand trauma on a continuum.

Page 21: Ptsd resolution5.2

Psychological Trauma

acute stress disorderphysiological arousal PTS PTSD

addictionsdepressionanxiety

continuum

10Sunday, 6 February 2011

It’s easier to understand trauma on a continuum.

Page 22: Ptsd resolution5.2

Psychological Trauma

acute stress disorderphysiological arousal PTS PTSD

addictionsdepressionanxiety

continuum

10Sunday, 6 February 2011

It’s easier to understand trauma on a continuum.

Page 23: Ptsd resolution5.2

PTSD research and statistics

11Sunday, 6 February 2011

Page 24: Ptsd resolution5.2

PTSD research and statistics

• Scientific method

11Sunday, 6 February 2011

Page 25: Ptsd resolution5.2

PTSD research and statistics

• Scientific method

• NICE guidelines (UK context)

11Sunday, 6 February 2011

Page 26: Ptsd resolution5.2

© W Andrews (Feb. 2009)

12Sunday, 6 February 2011

Page 27: Ptsd resolution5.2

© W Andrews (Feb. 2009)

12Sunday, 6 February 2011

Page 28: Ptsd resolution5.2

PTSD research and statistics

13Sunday, 6 February 2011

Page 29: Ptsd resolution5.2

PTSD research and statistics

• Evidence hierarchy

13Sunday, 6 February 2011

Page 30: Ptsd resolution5.2

PTSD research and statistics

• Evidence hierarchy

• RCT

13Sunday, 6 February 2011

Page 31: Ptsd resolution5.2

PTSD research and statistics

• Evidence hierarchy

• RCT

• Meta-analysis of RCT studies

13Sunday, 6 February 2011

Page 32: Ptsd resolution5.2

Meta-Analysis of Risk Factors for PTSD in Trauma-Exposed Adults

14Sunday, 6 February 2011

Page 33: Ptsd resolution5.2

Meta-Analysis of Risk Factors for PTSD in Trauma-Exposed Adults

2000. Brewin, Andrews & Valentine. Journal of Consulting and Clinical Psychology. 68. 5.

14Sunday, 6 February 2011

Page 34: Ptsd resolution5.2

2000. Brewin, Andrews & Valentine. Journal of Consulting and Clinical Psychology. 68. 5.

15Sunday, 6 February 2011

Lack of social support is the greatest predictor of the risk of developing PTSD.

Page 35: Ptsd resolution5.2

2000. Brewin, Andrews & Valentine. Journal of Consulting and Clinical Psychology. 68. 5.

15Sunday, 6 February 2011

Lack of social support is the greatest predictor of the risk of developing PTSD.

Page 36: Ptsd resolution5.2

Predictors of PTSD

16Sunday, 6 February 2011

Page 37: Ptsd resolution5.2

Predictors of PTSD

• lack of social support

16Sunday, 6 February 2011

Page 38: Ptsd resolution5.2

Predictors of PTSD

• lack of social support

• post-trauma life stress

16Sunday, 6 February 2011

Page 39: Ptsd resolution5.2

Predictors of PTSD

• lack of social support

• post-trauma life stress

• trauma severity

16Sunday, 6 February 2011

Page 40: Ptsd resolution5.2

• PTSD treatmentNICE Guideline recommendations

17Sunday, 6 February 2011

Page 41: Ptsd resolution5.2

• PTSD treatmentNICE Guideline recommendations

• Trauma- focused CBT

17Sunday, 6 February 2011

Page 42: Ptsd resolution5.2

• PTSD treatmentNICE Guideline recommendations

• Trauma- focused CBT

• EMDR

17Sunday, 6 February 2011

Page 43: Ptsd resolution5.2

Trauma Focused Treatment

18Sunday, 6 February 2011

The list.

Page 44: Ptsd resolution5.2

Trauma Focused Treatment

• Prolonged exposure

• Image habituation training

• Imaginal flooding (implosive flooding) therapy

• Imaginal exposure and biofeedback-assisted desenitization treatment

• Cognitive reprocessing therapy

• Cognitive restructuring plus exposure

• Cognitive trauma therapy

• Brief eclectic therapy (elements of psychodynamic therapy)

18Sunday, 6 February 2011

The list.

Page 45: Ptsd resolution5.2

Meta-analysis of PTSD treatments

19Sunday, 6 February 2011

Page 46: Ptsd resolution5.2

Meta-analysis of PTSD treatments

• Australian Centre for Post-Traumatic Mental Health, 2007

• Bisson & Andrew, 2009

• Bisson et al, 2007

• Bradley et al, 2005

• Seidler & Wagner, 2006

19Sunday, 6 February 2011

Page 47: Ptsd resolution5.2

Meta-analysis of PTSD treatments

20Sunday, 6 February 2011

Agreement of no difference between trauma focused treatments.

Page 48: Ptsd resolution5.2

Meta-analysis of PTSD treatments

• Common focus on the patient’s traumatic memories of the traumatic event & personal meaning of the trauma

20Sunday, 6 February 2011

Agreement of no difference between trauma focused treatments.

Page 49: Ptsd resolution5.2

Meta-analysis of PTSD treatments

• Common focus on the patient’s traumatic memories of the traumatic event & personal meaning of the trauma

• NO DIFFERENCE between ANY of these trauma-focused treatments

20Sunday, 6 February 2011

Agreement of no difference between trauma focused treatments.

Page 50: Ptsd resolution5.2

Meta-analysis of PTSD treatments

21Sunday, 6 February 2011

Controversy over finding that in fact there is no difference between ANY studied treatments that are ‘bona-fide’. This has been hotly debated and all the intense criticism of the finding has been robustly defended.

Page 51: Ptsd resolution5.2

Meta-analysis of PTSD treatments

• Benish et al, 2008

21Sunday, 6 February 2011

Controversy over finding that in fact there is no difference between ANY studied treatments that are ‘bona-fide’. This has been hotly debated and all the intense criticism of the finding has been robustly defended.

Page 52: Ptsd resolution5.2

Meta-analysis of PTSD treatments

• Benish et al, 2008

• NO DIFFERENCE in OUTCOMES between ANY bona fide treatments, WHETHER TRAUMA FOCUSED OR NOT

21Sunday, 6 February 2011

Controversy over finding that in fact there is no difference between ANY studied treatments that are ‘bona-fide’. This has been hotly debated and all the intense criticism of the finding has been robustly defended.

Page 53: Ptsd resolution5.2

Bill Andrews 2010c

TM

22Sunday, 6 February 2011

Let’s be pragmatic.

Page 54: Ptsd resolution5.2

Practice Research Networks

23Sunday, 6 February 2011

Page 55: Ptsd resolution5.2

Practice Research Networks

www.hgiprn.org

23Sunday, 6 February 2011

Page 56: Ptsd resolution5.2

Pragmatic Research Network

Bill Andrews 2010c

TM

pragmaticresearchnetwork.blogspot.com

24Sunday, 6 February 2011

The main purpose of a network is to try to investigate what is going on in practice.

Page 57: Ptsd resolution5.2

Ask the Customers (n = 130)

25Sunday, 6 February 2011

The data speaks for itself.

Page 58: Ptsd resolution5.2

Ask the Customers (n = 130)

!" #" $!" $#" %!"

&'()*+,'"

&'()-+./0"

!"#$%&'(

1234*56"

25Sunday, 6 February 2011

The data speaks for itself.

Page 59: Ptsd resolution5.2

Ask the Customers (n = 130)

!" #" $!" $#" %!" %#"

&'()*+,'"

&'()-+./0"

!"#$%&'(

1234*$!"

!" #" $!" $#" %!"

&'()*+,'"

&'()-+./0"

!"#$%&'(

1234*56"

25Sunday, 6 February 2011

The data speaks for itself.

Page 60: Ptsd resolution5.2

Ask the Customers (n = 130)

!" #" $!" $#" %!" %#"

&'()*+,'"

&'()-+./0"

!"#$%&'(

1234*$!"

!" #" $!" $#" %!"

&'()*+,'"

&'()-+./0"

!"#$%&'(

1234*56"

!" #!" $!!" $#!" %!!" %#!" &!!" &#!"

'()*+,-("

'()*.,/01"

!"#$

234"

25Sunday, 6 February 2011

The data speaks for itself.

Page 61: Ptsd resolution5.2

Ask the Customers (n = 130)

!" #" $!" $#" %!" %#"

&'()*+,'"

&'()-+./0"

!"#$%&'(

1234*$!"

!" #" $!" $#" %!"

&'()*+,'"

&'()-+./0"

!"#$%&'(

1234*56"

!" #!" $!!" $#!" %!!" %#!" &!!" &#!"

'()*+,-("

'()*.,/01"

!"#$

234"

!" #!" $!" %!" &!" '!" (!" )!"

*+,-./0+"

*+,-1/234"

!"#$"%

567.6"

25Sunday, 6 February 2011

The data speaks for itself.

Page 62: Ptsd resolution5.2

Ask the Customers (n = 130)

!" #" $!" $#" %!" %#"

&'()*+,'"

&'()-+./0"

!"#$%&'(

1234*$!"

!" #" $!" $#" %!"

&'()*+,'"

&'()-+./0"

!"#$%&'(

1234*56"

!" #!" $!!" $#!" %!!" %#!" &!!" &#!"

'()*+,-("

'()*.,/01"

!"#$

234"

!" #!" $!" %!" &!" '!" (!" )!"

*+,-./0+"

*+,-1/234"

!"#$"%

567.6"

25Sunday, 6 February 2011

The data speaks for itself.

Page 63: Ptsd resolution5.2

Ask the Customers (n = 130)

!"#$ !"%$ !"&$ '$ '"!$ '"'$

()*+,!-$

.+/,+$

)*/$

()*+,01$

!"!#$%&'(!%

23245$6782$

26Sunday, 6 February 2011

The effect sizes are large.

Page 64: Ptsd resolution5.2

Ask the Customers (n = 130)

!"#$ !"%$ !"&$ '$ '"!$ '"'$

()*+,!-$

.+/,+$

)*/$

()*+,01$

!"!#$%&'(!%

23245$6782$

26Sunday, 6 February 2011

The effect sizes are large.

Page 65: Ptsd resolution5.2

Ask the very distressed (n = 44)

27Sunday, 6 February 2011

Clients seem to be moving to below the cut-off, even when the more distressed cohort are looked at.

Page 66: Ptsd resolution5.2

Ask the very distressed (n = 44)

!" #!" $!" %!" &!" '!" (!" )!" *!"

+,-.,/#"

+,-.,/$"

0123456"47"89"1":"&&"

IES-E

27Sunday, 6 February 2011

Clients seem to be moving to below the cut-off, even when the more distressed cohort are looked at.

Page 67: Ptsd resolution5.2

Ask the very distressed (n = 44)

!" #" $!" $#" %!" %#" &!"

'()*+&,"-$"

'()*+&,"-%"

./01234"25"67"/"8",,"

!" #!" $!" %!" &!" '!" (!" )!" *!"

+,-.,/#"

+,-.,/$"

0123456"47"89"1":"&&"

IES-ECORE-34

27Sunday, 6 February 2011

Clients seem to be moving to below the cut-off, even when the more distressed cohort are looked at.

Page 68: Ptsd resolution5.2

Ask the very distressed (n = 44)

!" #" $!" $#" %!" %#" &!"

'()*+&,"-$"

'()*+&,"-%"

./01234"25"67"/"8",,"

!" #!" $!" %!" &!" '!" (!" )!" *!"

+,-.,/#"

+,-.,/$"

0123456"47"89"1":"&&"

IES-ECORE-34

27Sunday, 6 February 2011

Clients seem to be moving to below the cut-off, even when the more distressed cohort are looked at.

Page 69: Ptsd resolution5.2

Ask the very distressed

28Sunday, 6 February 2011

The data compares very favourably with one of the studies into PTSD from Northern Ireland.

Page 70: Ptsd resolution5.2

Ask the very distressed

!" #" $!" $#" %!" %#" &!"

'()*+&,"-$"

'()*+&,"-%"

'./01"23"/."4"5",6"

Duffy et al n = 47bdi conversion

28Sunday, 6 February 2011

The data compares very favourably with one of the studies into PTSD from Northern Ireland.

Page 71: Ptsd resolution5.2

Ask the very distressed

!" #" $!" $#" %!" %#" &!"

'()*+&,"-$"

'()*+&,"-%"

'./01"23"/."4"5",6"

!" #" $!" $#" %!" %#" &!"

'()*+&,"-$"

'()*+&,"-%"

./01234"25"67"/"8",,"

Duffy et al n = 47bdi conversion

Andrews et al n = 44CORE-34

28Sunday, 6 February 2011

The data compares very favourably with one of the studies into PTSD from Northern Ireland.

Page 72: Ptsd resolution5.2

Ask the very distressed

!" #" $!" $#" %!" %#" &!"

'()*+&,"-$"

'()*+&,"-%"

'./01"23"/."4"5",6"

!" #" $!" $#" %!" %#" &!"

'()*+&,"-$"

'()*+&,"-%"

./01234"25"67"/"8",,"

Duffy et al n = 47bdi conversion

Andrews et al n = 44CORE-34

28Sunday, 6 February 2011

The data compares very favourably with one of the studies into PTSD from Northern Ireland.

Page 73: Ptsd resolution5.2

Predictors of PTSD

• lack of social support

• post-trauma life stress

• trauma severity

29Sunday, 6 February 2011

Page 74: Ptsd resolution5.2

Likely Predictors of PTSD Resolution

30Sunday, 6 February 2011

Page 75: Ptsd resolution5.2

Likely Predictors of PTSD Resolution

• recognising the importance of social support

30Sunday, 6 February 2011

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Likely Predictors of PTSD Resolution

• recognising the importance of social support

• teaching skills for management of post-trauma life stress

30Sunday, 6 February 2011

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Likely Predictors of PTSD Resolution

• recognising the importance of social support

• teaching skills for management of post-trauma life stress

• Using effective techniques to help de-traumatize trauma

30Sunday, 6 February 2011

Page 78: Ptsd resolution5.2

Likely Predictors of PTSD Resolution

• recognising the importance of social support

• teaching skills for management of post-trauma life stress

• Using effective techniques to help de-traumatize trauma

• Be guided by feedback from service users as to what seems to work in treatment

30Sunday, 6 February 2011

Page 79: Ptsd resolution5.2

Meta-analysis of PTSD treatments

31Sunday, 6 February 2011

Page 80: Ptsd resolution5.2

Meta-analysis of PTSD treatments

• NO DIFFERENCE between ANY of these trauma-focused treatments

31Sunday, 6 February 2011

Page 81: Ptsd resolution5.2

Meta-analysis of PTSD treatments

• NO DIFFERENCE between ANY of these trauma-focused treatments

• (Controversially) NO DIFFERENCE between ANY bona fide treatments, WHETHER TRAUMA FOCUSED OR NOT

31Sunday, 6 February 2011

Page 82: Ptsd resolution5.2

Where Scientists Agree

32Sunday, 6 February 2011

Page 83: Ptsd resolution5.2

Possible Factors important to successful treatments of PTSD

Where Scientists Agree

32Sunday, 6 February 2011

Page 84: Ptsd resolution5.2

• Therapists...ask yourself how many of these you can tick off

Possible Factors important to successful treatments of PTSD

Where Scientists Agree

32Sunday, 6 February 2011

Page 85: Ptsd resolution5.2

• Therapists...ask yourself how many of these you can tick off

• Service Users...ask yourself how many of these have been honoured in your treatment

Possible Factors important to successful treatments of PTSD

Where Scientists Agree

32Sunday, 6 February 2011

Page 86: Ptsd resolution5.2

Possible Factors important to successful treatments of PTSD

33Sunday, 6 February 2011

Page 87: Ptsd resolution5.2

• Cogent rationale that is acceptable to patient

Possible Factors important to successful treatments of PTSD

33Sunday, 6 February 2011

Page 88: Ptsd resolution5.2

• Cogent rationale that is acceptable to patient

• Set of treatment actions consistent with the rationale

Possible Factors important to successful treatments of PTSD

33Sunday, 6 February 2011

Page 89: Ptsd resolution5.2

• Cogent rationale that is acceptable to patient

• Set of treatment actions consistent with the rationale

• Development and monitoring of a safe, respectful, and trusting therapeutic relationship

Possible Factors important to successful treatments of PTSD

33Sunday, 6 February 2011

Page 90: Ptsd resolution5.2

• Cogent rationale that is acceptable to patient

• Set of treatment actions consistent with the rationale

• Development and monitoring of a safe, respectful, and trusting therapeutic relationship

• Agreement about tasks and goals of therapy

Possible Factors important to successful treatments of PTSD

33Sunday, 6 February 2011

Page 91: Ptsd resolution5.2

• Cogent rationale that is acceptable to patient

• Set of treatment actions consistent with the rationale

• Development and monitoring of a safe, respectful, and trusting therapeutic relationship

• Agreement about tasks and goals of therapy

• Nurturing hope

Possible Factors important to successful treatments of PTSD

33Sunday, 6 February 2011

Page 92: Ptsd resolution5.2

• Cogent rationale that is acceptable to patient

• Set of treatment actions consistent with the rationale

• Development and monitoring of a safe, respectful, and trusting therapeutic relationship

• Agreement about tasks and goals of therapy

• Nurturing hope

• Identifying patient resources, strengths, survival skills and intra and interpersonal resources in building resilience

Possible Factors important to successful treatments of PTSD

33Sunday, 6 February 2011

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Possible Factors important to successful treatments of PTSD

34Sunday, 6 February 2011

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• Education about PTSD

Possible Factors important to successful treatments of PTSD

34Sunday, 6 February 2011

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• Education about PTSD

• Opportunity to talk about trauma if desired

Possible Factors important to successful treatments of PTSD

34Sunday, 6 February 2011

Page 96: Ptsd resolution5.2

• Education about PTSD

• Opportunity to talk about trauma if desired

• Ensuring the patient's safety, especially if the patient has been vicitimized (domestic violence, neighborhood violence, or abuse)

Possible Factors important to successful treatments of PTSD

34Sunday, 6 February 2011

Page 97: Ptsd resolution5.2

• Education about PTSD

• Opportunity to talk about trauma if desired

• Ensuring the patient's safety, especially if the patient has been vicitimized (domestic violence, neighborhood violence, or abuse)

• Helping patients learn how to avoid re-victimization

Possible Factors important to successful treatments of PTSD

34Sunday, 6 February 2011

Page 98: Ptsd resolution5.2

• Education about PTSD

• Opportunity to talk about trauma if desired

• Ensuring the patient's safety, especially if the patient has been vicitimized (domestic violence, neighborhood violence, or abuse)

• Helping patients learn how to avoid re-victimization

• Fostering independence and self efficacy

Possible Factors important to successful treatments of PTSD

34Sunday, 6 February 2011

Page 99: Ptsd resolution5.2

Pragmatic Approach

35Sunday, 6 February 2011

The Pragmatic Approach tries to find a middle ground between the different sides of the argument.

Page 100: Ptsd resolution5.2

Pragmatic Approach

• “Coming down from the lofty perch of ideological purity, pragmatism meets the world as we find it and asks: How can we improve it - not in some ideal way with a predetermined endpoint, but in a practical way in the here and now, within a context of the social, cultural, political, and economic realities we are given?”

1999. Fishman, D.B. The Case for Pragmatic Psychology. New York University Press. New York

35Sunday, 6 February 2011

The Pragmatic Approach tries to find a middle ground between the different sides of the argument.

Page 101: Ptsd resolution5.2

Pragmatic Research Implications for Innovative Psychological Trauma Treatments

36Sunday, 6 February 2011

Page 102: Ptsd resolution5.2

• Put the feedback of the service user at the top of the agenda

Pragmatic Research Implications for Innovative Psychological Trauma Treatments

36Sunday, 6 February 2011

Page 103: Ptsd resolution5.2

• Put the feedback of the service user at the top of the agenda

• Gather robust pre/post data using internationally recognised self-report measures

Pragmatic Research Implications for Innovative Psychological Trauma Treatments

36Sunday, 6 February 2011

Page 104: Ptsd resolution5.2

• Put the feedback of the service user at the top of the agenda

• Gather robust pre/post data using internationally recognised self-report measures

• Benchmark the results with published data

Pragmatic Research Implications for Innovative Psychological Trauma Treatments

36Sunday, 6 February 2011

Page 105: Ptsd resolution5.2

• Put the feedback of the service user at the top of the agenda

• Gather robust pre/post data using internationally recognised self-report measures

• Benchmark the results with published data

• Map the innovative treatment onto existing approved treatments

Pragmatic Research Implications for Innovative Psychological Trauma Treatments

36Sunday, 6 February 2011

Page 106: Ptsd resolution5.2

• Put the feedback of the service user at the top of the agenda

• Gather robust pre/post data using internationally recognised self-report measures

• Benchmark the results with published data

• Map the innovative treatment onto existing approved treatments

• Carry out case study research to elaborate on the features of particular treatments from multiples of perspectives

Pragmatic Research Implications for Innovative Psychological Trauma Treatments

36Sunday, 6 February 2011

Page 107: Ptsd resolution5.2

• Put the feedback of the service user at the top of the agenda

• Gather robust pre/post data using internationally recognised self-report measures

• Benchmark the results with published data

• Map the innovative treatment onto existing approved treatments

• Carry out case study research to elaborate on the features of particular treatments from multiples of perspectives

• Where funding allows, carry out an RCT to establish the differential effectiveness of the innovative treatment over and above wait-list control

Pragmatic Research Implications for Innovative Psychological Trauma Treatments

36Sunday, 6 February 2011

Page 108: Ptsd resolution5.2

Steve Hollon

“ with respect to randomization I would paraphrase Churchill on democracy, that it is a terrible process that has little to recommend it except that it is better

than the alternatives”

(Hollon, S. 2009)

37Sunday, 6 February 2011

Page 109: Ptsd resolution5.2

Paul Salkovskis

Salkovskis, (2002). Empirically grounded clinical interventions: Cognitive-behavioural therapy progresses through a multi-dimensional approach to clinical science. Behavioural and Cognitive Psychotherapy, 2002, 30, 3–9, Cambridge University Press.

38Sunday, 6 February 2011

Paul suggests we need to move away from this evidence hierarchy.

Page 110: Ptsd resolution5.2

Paul Salkovskis“The risk inherent in the current practice of evidence-based mental health is that the field will degenerate into a parody, a kind of one-dimensional science, and there are signs that this has already occurred to some degree”

Salkovskis, (2002). Empirically grounded clinical interventions: Cognitive-behavioural therapy progresses through a multi-dimensional approach to clinical science. Behavioural and Cognitive Psychotherapy, 2002, 30, 3–9, Cambridge University Press.

39Sunday, 6 February 2011

Page 111: Ptsd resolution5.2

Prof. Gordon Turnbull

Frontiers in Trauma Treatment

BILL: What in your opinion are the significant breakthroughs in Trauma Treatment?

40Sunday, 6 February 2011

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The New Frontier

41Sunday, 6 February 2011

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The New Frontier

• unprocessed trauma memories control and cause exaggerated function of the ANS

41Sunday, 6 February 2011

Page 114: Ptsd resolution5.2

The New Frontier

• unprocessed trauma memories control and cause exaggerated function of the ANS

• PTSD is truly a MIND/BODY experience

41Sunday, 6 February 2011

Page 115: Ptsd resolution5.2

The New Frontier

• unprocessed trauma memories control and cause exaggerated function of the ANS

• PTSD is truly a MIND/BODY experience

• Emphasis shift to the body focussed therapies

41Sunday, 6 February 2011

Page 116: Ptsd resolution5.2

The New Frontier

• unprocessed trauma memories control and cause exaggerated function of the ANS

• PTSD is truly a MIND/BODY experience

• Emphasis shift to the body focussed therapies

• Sensorimotor therapy

41Sunday, 6 February 2011

Page 117: Ptsd resolution5.2

The New Frontier

• unprocessed trauma memories control and cause exaggerated function of the ANS

• PTSD is truly a MIND/BODY experience

• Emphasis shift to the body focussed therapies

• Sensorimotor therapy

• EFT

41Sunday, 6 February 2011

Page 118: Ptsd resolution5.2

The New Frontier

• unprocessed trauma memories control and cause exaggerated function of the ANS

• PTSD is truly a MIND/BODY experience

• Emphasis shift to the body focussed therapies

• Sensorimotor therapy

• EFT

• Acupuncture

41Sunday, 6 February 2011

Page 119: Ptsd resolution5.2

The New Frontier

• unprocessed trauma memories control and cause exaggerated function of the ANS

• PTSD is truly a MIND/BODY experience

• Emphasis shift to the body focussed therapies

• Sensorimotor therapy

• EFT

• Acupuncture

• Acupressure

41Sunday, 6 February 2011

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The New Frontier

42Sunday, 6 February 2011

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The New Frontier

• Soothing the chaos in the right hemisphere

• EMDR

•Mindfulness

42Sunday, 6 February 2011

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The New Frontier

43Sunday, 6 February 2011

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The New Frontier

•Using a treatment that works on soothing the ANS and works on the right hemisphere is likely to be a good idea

43Sunday, 6 February 2011

Page 124: Ptsd resolution5.2

Medications

44Sunday, 6 February 2011

Page 125: Ptsd resolution5.2

Medications

• Propranolol (lowering adrenaline) useful in the Acute Stress Reaction phase to reduce the ‘etching’ of the emotionally charged memories

44Sunday, 6 February 2011

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Medications

• Propranolol (lowering adrenaline) useful in the Acute Stress Reaction phase to reduce the ‘etching’ of the emotionally charged memories

• Opiate antagonists (e.g. Naloxone) help to prevent dissociation, which is associated with endorphin flooding

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Avoidance

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Avoidance

• Avoidance is a key feature of PTSD and dissociation commonly occurs at the time of the trauma and so becomes an integral part of the flashback

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Avoidance

• Avoidance is a key feature of PTSD and dissociation commonly occurs at the time of the trauma and so becomes an integral part of the flashback

• Dissociation is probably THE most common cause of treatment resistance

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Avoidance

• Avoidance is a key feature of PTSD and dissociation commonly occurs at the time of the trauma and so becomes an integral part of the flashback

• Dissociation is probably THE most common cause of treatment resistance

• Even just going to see a Trauma Therapist is enough to make the endorphins ‘pop’

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Bill’s take home message

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Bill’s take home message

• have a healthy sense of curiosity

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Bill’s take home message

• have a healthy sense of curiosity

• keep an open mind

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Bill’s take home message

• have a healthy sense of curiosity

• keep an open mind

• systematically reflect on your work

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Bill’s take home message

• have a healthy sense of curiosity

• keep an open mind

• systematically reflect on your work

• take a balanced and informed view of the research

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Bill’s take home message

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Bill’s take home message

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Bill’s take home message

• measure your outcomes

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Bill’s take home message

• measure your outcomes

• support research and/or get involved in case study research yourself

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Bill’s take home message

• measure your outcomes

• support research and/or get involved in case study research yourself

• be respectful of other modalities

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Bill’s take home message

• measure your outcomes

• support research and/or get involved in case study research yourself

• be respectful of other modalities

• trust your clients

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Pragmatic Research Network

pragmaticresearchnetwork.blogspot.com

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THE ENDwww.centerforclinicalexcellence.com

[email protected]

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