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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Ptsd resolution5.2

  1. 1. PTSD research and statistics Bill Andrews Pragmatic Research NetworkSunday, 6 February 2011 1
  2. 2. PTSD treatment: the facts; outcomes of therapy Bill Andrews Pragmatic Research NetworkSunday, 6 February 2011 1
  3. 3. Bill Andrews Research Coordinator Pragmatic Research NetworkSunday, 6 February 2011 2The HGIPRN is expanding now to inclue and encourage a wider audience. The HGIPRN willforma sub-set of the total number of data contributors.
  4. 4. Bill Andrews Senior advisor ICCE www.centerforclinicalexcellence.comSunday, 6 February 2011 3The ICCE is a great resource.
  5. 5. What is PTSD? 1/6 DSM-IV-TR, APA, 2000Sunday, 6 February 2011 4
  6. 6. 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, 2000Sunday, 6 February 2011 4
  7. 7. What is PTSD? 2/6 DSM-IV-TR, APA, 2000Sunday, 6 February 2011 5
  8. 8. 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, 2000Sunday, 6 February 2011 5
  9. 9. What is PTSD? 3/6 DSM-IV-TR, APA, 2000Sunday, 6 February 2011 6
  10. 10. What is PTSD? 3/6 • C: Persistent avoidance of stimuli associated with the event(s) DSM-IV-TR, APA, 2000Sunday, 6 February 2011 6
  11. 11. What is PTSD? 4/6 DSM-IV-TR, APA, 2000Sunday, 6 February 2011 7
  12. 12. What is PTSD? 4/6 • D: Elevated arousal that was NOT present prior to the event(s) DSM-IV-TR, APA, 2000Sunday, 6 February 2011 7
  13. 13. What is PTSD? 5/6 DSM-IV-TR, APA, 2000Sunday, 6 February 2011 8
  14. 14. What is PTSD? 5/6 • E: The symptoms must persist for more than 1 month DSM-IV-TR, APA, 2000Sunday, 6 February 2011 8
  15. 15. What is PTSD? 6/6 DSM-IV-TR, APA, 2000Sunday, 6 February 2011 9
  16. 16. 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, 2000Sunday, 6 February 2011 9
  17. 17. Psychological TraumaSunday, 6 February 2011 10It’s easier to understand trauma on a continuum.
  18. 18. Psychological Trauma continuumSunday, 6 February 2011 10It’s easier to understand trauma on a continuum.
  19. 19. Psychological Trauma continuum physiological arousalSunday, 6 February 2011 10It’s easier to understand trauma on a continuum.
  20. 20. Psychological Trauma continuum physiological arousal PTSDSunday, 6 February 2011 10It’s easier to understand trauma on a continuum.
  21. 21. Psychological Trauma continuum physiological arousal acute stress disorder PTS PTSD anxiety depression addictionsSunday, 6 February 2011 10It’s easier to understand trauma on a continuum.
  22. 22. Psychological Trauma continuum physiological arousal acute stress disorder PTS PTSD anxiety depression addictionsSunday, 6 February 2011 10It’s easier to understand trauma on a continuum.
  23. 23. PTSD research and statisticsSunday, 6 February 2011 11
  24. 24. PTSD research and statistics • Scientific methodSunday, 6 February 2011 11
  25. 25. PTSD research and statistics • Scientific method • NICE guidelines (UK context)Sunday, 6 February 2011 11
  26. 26. © W Andrews (Feb. 2009)Sunday, 6 February 2011 12
  27. 27. © W Andrews (Feb. 2009)Sunday, 6 February 2011 12
  28. 28. PTSD research and statisticsSunday, 6 February 2011 13
  29. 29. PTSD research and statistics • Evidence hierarchySunday, 6 February 2011 13
  30. 30. PTSD research and statistics • Evidence hierarchy • RCTSunday, 6 February 2011 13
  31. 31. PTSD research and statistics • Evidence hierarchy • RCT • Meta-analysis of RCT studiesSunday, 6 February 2011 13
  32. 32. Meta-Analysis of Risk Factors for PTSD in Trauma-Exposed AdultsSunday, 6 February 2011 14
  33. 33. Meta-Analysis of Risk Factors for PTSD in Trauma-Exposed Adults 2000. Brewin, Andrews & Valentine. Journal of Consulting and Clinical Psychology. 68. 5.Sunday, 6 February 2011 14
  34. 34. 2000. Brewin, Andrews & Valentine. Journal of Consulting and Clinical Psychology. 68. 5.Sunday, 6 February 2011 15Lack of social support is the greatest predictor of the risk of developing PTSD.
  35. 35. 2000. Brewin, Andrews & Valentine. Journal of Consulting and Clinical Psychology. 68. 5.Sunday, 6 February 2011 15Lack of social support is the greatest predictor of the risk of developing PTSD.
  36. 36. Predictors of PTSDSunday, 6 February 2011 16
  37. 37. Predictors of PTSD • lack of social supportSunday, 6 February 2011 16
  38. 38. Predictors of PTSD • lack of social support • post-trauma life stressSunday, 6 February 2011 16
  39. 39. Predictors of PTSD • lack of social support • post-trauma life stress • trauma severitySunday, 6 February 2011 16
  40. 40. • PTSD treatment NICE Guideline recommendationsSunday, 6 February 2011 17
  41. 41. • PTSD treatment NICE Guideline recommendations • Trauma- focused CBTSunday, 6 February 2011 17
  42. 42. • PTSD treatment NICE Guideline recommendations • Trauma- focused CBT • EMDRSunday, 6 February 2011 17
  43. 43. Trauma Focused TreatmentSunday, 6 February 2011 18The list.
  44. 44. 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)Sunday, 6 February 2011 18The list.
  45. 45. Meta-analysis of PTSD treatmentsSunday, 6 February 2011 19
  46. 46. 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, 2006Sunday, 6 February 2011 19
  47. 47. Meta-analysis of PTSD treatmentsSunday, 6 February 2011 20Agreement of no difference between trauma focused treatments.
  48. 48. Meta-analysis of PTSD treatments • Common focus on the patient’s traumatic memories of the traumatic event & personal meaning of the traumaSunday, 6 February 2011 20Agreement of no difference between trauma focused treatments.
  49. 49. 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 treatmentsSunday, 6 February 2011 20Agreement of no difference between trauma focused treatments.
  50. 50. Meta-analysis of PTSD treatmentsSunday, 6 February 2011 21Controversy over finding that in fact there is no difference between ANY studied treatmentsthat are ‘bona-fide’. This has been hotly debated and all the intense criticism of the finding
  51. 51. Meta-analysis of PTSD treatments • Benish et al, 2008Sunday, 6 February 2011 21Controversy over finding that in fact there is no difference between ANY studied treatmentsthat are ‘bona-fide’. This has been hotly debated and all the intense criticism of the finding
  52. 52. Meta-analysis of PTSD treatments • Benish et al, 2008 • NO DIFFERENCE in OUTCOMES between ANY bona fide treatments, WHETHER TRAUMA FOCUSED OR NOTSunday, 6 February 2011 21Controversy over finding that in fact there is no difference between ANY studied treatmentsthat are ‘bona-fide’. This has been hotly debated and all the intense criticism of the finding
  53. 53. TM c Bill Andrews 2010Sunday, 6 February 2011 22Let’s be pragmatic.
  54. 54. Practice Research NetworksSunday, 6 February 2011 23
  55. 55. Practice Research Networks www.hgiprn.orgSunday, 6 February 2011 23
  56. 56. Pragmatic Research Network TM c Bill Andrews 2010 pragmaticresearchnetwork.blogspot.comSunday, 6 February 2011 24The main purpose of a network is to try to investigate what is going on in practice.
  57. 57. Ask the Customers (n = 130)Sunday, 6 February 2011 25The data speaks for itself.
  58. 58. Ask the Customers (n = 130) !"#$%&( &()-+./0" 1234*56" &()*+," !" #" $!" $#" %!"Sunday, 6 February 2011 25The data speaks for itself.
  59. 59. Ask the Customers (n = 130) !"#$%&( !"#$%&( &()-+./0" &()-+./0" 1234*$!" 1234*56" &()*+," &()*+," !" #" $!" $#" %!" %#" !" #" $!" $#" %!"Sunday, 6 February 2011 25The data speaks for itself.
  60. 60. Ask the Customers (n = 130) !"#$%&( !"#$%&( &()-+./0" &()-+./0" 1234*$!" 1234*56" &()*+," &()*+," !" #" $!" $#" %!" %#" !" #" $!" $#" %!" !"#$ ()*.,/01" 234" ()*+,-(" !" #!" $!!" $#!" %!!" %#!" &!!" &#!"Sunday, 6 February 2011 25The data speaks for itself.
  61. 61. Ask the Customers (n = 130) !"#$%&( !"#$%&( &()-+./0" &()-+./0" 1234*$!" 1234*56" &()*+," &()*+," !" #" $!" $#" %!" %#" !" #" $!" $#" %!" !"#$ !"#$"% ()*.,/01" *+,-1/234" 234" 567.6" ()*+,-(" *+,-./0+" !" #!" $!!" $#!" %!!" %#!" &!!" &#!" !" #!" $!" %!" &!" !" (!" )!"Sunday, 6 February 2011 25The data speaks for itself.
  62. 62. Ask the Customers (n = 130) !"#$%&( !"#$%&( &()-+./0" &()-+./0" 1234*$!" 1234*56" &()*+," &()*+," !" #" $!" $#" %!" %#" !" #" $!" $#" %!" !"#$ !"#$"% ()*.,/01" *+,-1/234" 234" 567.6" ()*+,-(" *+,-./0+" !" #!" $!!" $#!" %!!" %#!" &!!" &#!" !" #!" $!" %!" &!" !" (!" )!"Sunday, 6 February 2011 25The data speaks for itself.
  63. 63. Ask the Customers (n = 130) !"!#$%&(!% ()*+,01$ )*/$ 23245$6782$ .+/,+$ ()*+,!-$ !"#$ !"%$ !"&$ $ "!$ "$Sunday, 6 February 2011 26The effect sizes are large.
  64. 64. Ask the Customers (n = 130) !"!#$%&(!% ()*+,01$ )*/$ 23245$6782$ .+/,+$ ()*+,!-$ !"#$ !"%$ !"&$ $ "!$ "$Sunday, 6 February 2011 26The effect sizes are large.
  65. 65. Ask the very distressed (n = 44)Sunday, 6 February 2011 27Clients seem to be moving to below the cut-off, even when the more distressed cohort arelooked at.
  66. 66. Ask the very distressed (n = 44) IES-E +,-.,/$" 0123456"47"89"1":"&&" +,-.,/#" !" #!" $!" %!" &!" !" (!" )!" *!"Sunday, 6 February 2011 27Clients seem to be moving to below the cut-off, even when the more distressed cohort arelooked at.
  67. 67. Ask the very distressed (n = 44) CORE-34 IES-E ()*+&,"-%" +,-.,/$" ./01234"25"67"/"8",," 0123456"47"89"1":"&&" ()*+&,"-$" +,-.,/#" !" #" $!" $#" %!" %#" &!" !" #!" $!" %!" &!" !" (!" )!" *!"Sunday, 6 February 2011 27Clients seem to be moving to below the cut-off, even when the more distressed cohort arelooked at.
  68. 68. Ask the very distressed (n = 44) CORE-34 IES-E ()*+&,"-%" +,-.,/$" ./01234"25"67"/"8",," 0123456"47"89"1":"&&" ()*+&,"-$" +,-.,/#" !" #" $!" $#" %!" %#" &!" !" #!" $!" %!" &!" !" (!" )!" *!"Sunday, 6 February 2011 27Clients seem to be moving to below the cut-off, even when the more distressed cohort arelooked at.
  69. 69. Ask the very distressedSunday, 6 February 2011 28The data compares very favourably with one of the studies into PTSD from Northern Ireland.
  70. 70. Ask the very distressed Duffy et al n = 47 bdi conversion ()*+&,"-%" ./01"23"/."4"5",6" ()*+&,"-$" !" #" $!" $#" %!" %#" &!"Sunday, 6 February 2011 28The data compares very favourably with one of the studies into PTSD from Northern Ireland.
  71. 71. Ask the very distressed Duffy et al n = 47 Andrews et al n = 44 bdi conversion CORE-34 ()*+&,"-%" ()*+&,"-%" ./01234"25"67"/"8",," ./01"23"/."4"5",6" ()*+&,"-$" ()*+&,"-$" !" #" $!" $#" %!" %#" &!" !" #" $!" $#" %!" %#" &!"Sunday, 6 February 2011 28The data compares very favourably with one of the studies into PTSD from Northern Ireland.
  72. 72. Ask the very distressed Duffy et al n = 47 Andrews et al n = 44 bdi conversion CORE-34 ()*+&,"-%" ()*+&,"-%" ./01234"25"67"/"8",," ./01"23"/."4"5",6" ()*+&,"-$" ()*+&,"-$" !" #" $!" $#" %!" %#" &!" !" #" $!" $#" %!" %#" &!"Sunday, 6 February 2011 28The data compares very favourably with one of the studies into PTSD from Northern Ireland.
  73. 73. Predictors of PTSD • lack of social support • post-trauma life stress • trauma severitySunday, 6 February 2011 29
  74. 74. Likely Predictors of PTSD ResolutionSunday, 6 February 2011 30
  75. 75. Likely Predictors of PTSD Resolution • recognising the importance of social supportSunday, 6 February 2011 30
  76. 76. Likely Predictors of PTSD Resolution • recognising the importance of social support • teaching skills for management of post-trauma life stressSunday, 6 February 2011 30
  77. 77. 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 traumaSunday, 6 February 2011 30
  78. 78. 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 treatmentSunday, 6 February 2011 30
  79. 79. Meta-analysis of PTSD treatmentsSunday, 6 February 2011 31
  80. 80. Meta-analysis of PTSD treatments • NO DIFFERENCE between ANY of these trauma-focused treatmentsSunday, 6 February 2011 31
  81. 81. 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 NOTSunday, 6 February 2011 31
  82. 82. Where Scientists AgreeSunday, 6 February 2011 32
  83. 83. Where Scientists Agree Possible Factors important to successful treatments of PTSDSunday, 6 February 2011 32
  84. 84. Where Scientists Agree Possible Factors important to successful treatments of PTSD • Therapists...ask yourself how many of these you can tick offSunday, 6 February 2011 32
  85. 85. Where Scientists Agree Possible Factors important to successful treatments of PTSD • Therapists...ask yourself how many of these you can tick off • Service Users...ask yourself how many of these have been honoured in your treatmentSunday, 6 February 2011 32
  86. 86. Possible Factors important to successful treatments of PTSDSunday, 6 February 2011 33
  87. 87. Possible Factors important to successful treatments of PTSD • Cogent rationale that is acceptable to patientSunday, 6 February 2011 33
  88. 88. Possible Factors important to successful treatments of PTSD • Cogent rationale that is acceptable to patient • Set of treatment actions consistent with the rationaleSunday, 6 February 2011 33
  89. 89. Possible Factors important to successful treatments of PTSD • 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 relationshipSunday, 6 February 2011 33
  90. 90. Possible Factors important to successful treatments of PTSD • 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 therapySunday, 6 February 2011 33
  91. 91. Possible Factors important to successful treatments of PTSD • 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 hopeSunday, 6 February 2011 33
  92. 92. Possible Factors important to successful treatments of PTSD • 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 resilienceSunday, 6 February 2011 33
  93. 93. Possible Factors important to successful treatments of PTSDSunday, 6 February 2011 34
  94. 94. Possible Factors important to successful treatments of PTSD • Education about PTSDSunday, 6 February 2011 34
  95. 95. Possible Factors important to successful treatments of PTSD • Education about PTSD • Opportunity to talk about trauma if desiredSunday, 6 February 2011 34
  96. 96. Possible Factors important to successful treatments of PTSD • Education about PTSD • Opportunity to talk about trauma if desired • Ensuring the patients safety, especially if the patient has been vicitimized (domestic violence, neighborhood violence, or abuse)Sunday, 6 February 2011 34
  97. 97. Possible Factors important to successful treatments of PTSD • Education about PTSD • Opportunity to talk about trauma if desired • Ensuring the patients safety, especially if the patient has been vicitimized (domestic violence, neighborhood violence, or abuse) • Helping patients learn how to avoid re-victimizationSunday, 6 February 2011 34
  98. 98. Possible Factors important to successful treatments of PTSD • Education about PTSD • Opportunity to talk about trauma if desired • Ensuring the patients 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 efficacySunday, 6 February 2011 34
  99. 99. Pragmatic ApproachSunday, 6 February 2011 35The Pragmatic Approach tries to find a middle ground between the different sides of theargument.
  100. 100. 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 YorkSunday, 6 February 2011 35The Pragmatic Approach tries to find a middle ground between the different sides of theargument.
  101. 101. Pragmatic Research Implications for Innovative Psychological Trauma TreatmentsSunday, 6 February 2011 36
  102. 102. Pragmatic Research Implications for Innovative Psychological Trauma Treatments • Put the feedback of the service user at the top of the agendaSunday, 6 February 2011 36
  103. 103. Pragmatic Research Implications for Innovative Psychological Trauma Treatments • Put the feedback of the service user at the top of the agenda • Gather robust pre/post data using internationally recognised self-report measuresSunday, 6 February 2011 36
  104. 104. Pragmatic Research Implications for Innovative Psychological Trauma Treatments • 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 dataSunday, 6 February 2011 36
  105. 105. Pragmatic Research Implications for Innovative Psychological Trauma Treatments • 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 treatmentsSunday, 6 February 2011 36
  106. 106. Pragmatic Research Implications for Innovative Psychological Trauma Treatments • 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 perspectivesSunday, 6 February 2011 36
  107. 107. Pragmatic Research Implications for Innovative Psychological Trauma Treatments • 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 controlSunday, 6 February 2011 36
  108. 108. Steve Hollon “ with respect to randomization I would paraphrase Churchill on democracy, that it is a terrible processthat has little to recommend it except that it is better than the alternatives” (Hollon, S. 2009)Sunday, 6 February 2011 37
  109. 109. 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.Sunday, 6 February 2011 38Paul suggests we need to move away from this evidence hierarchy.
  110. 110. 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.Sunday, 6 February 2011 39
  111. 111. Prof. Gordon Turnbull Frontiers in Trauma Treatment BILL: What in your opinion are the significant breakthroughs in Trauma Treatment?Sunday, 6 February 2011 40
  112. 112. The New FrontierSunday, 6 February 2011 41
  113. 113. The New Frontier • unprocessed trauma memories control and cause exaggerated function of the ANSSunday, 6 February 2011 41
  114. 114. The New Frontier • unprocessed trauma memories control and cause exaggerated function of the ANS • PTSD is truly a MIND/BODY experienceSunday, 6 February 2011 41
  115. 115. 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 therapiesSunday, 6 February 2011 41
  116. 116. 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 therapySunday, 6 February 2011 41
  117. 117. 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 • EFTSunday, 6 February 2011 41
  118. 118. 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 • AcupunctureSunday, 6 February 2011 41
  119. 119. 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 • AcupressureSunday, 6 February 2011 41
  120. 120. The New FrontierSunday, 6 February 2011 42
  121. 121. The New Frontier • Soothing the chaos in the right hemisphere • EMDR • MindfulnessSunday, 6 February 2011 42
  122. 122. The New FrontierSunday, 6 February 2011 43
  123. 123. The New Frontier • Using a treatment that works on soothing the ANS and works on the right hemisphere is likely to be a good ideaSunday, 6 February 2011 43
  124. 124. MedicationsSunday, 6 February 2011 44
  125. 125. Medications • Propranolol (lowering adrenaline) useful in the Acute Stress Reaction phase to reduce the ‘etching’ of the emotionally charged memoriesSunday, 6 February 2011 44
  126. 126. 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 floodingSunday, 6 February 2011 44
  127. 127. AvoidanceSunday, 6 February 2011 45
  128. 128. 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 flashbackSunday, 6 February 2011 45
  129. 129. 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 resistanceSunday, 6 February 2011 45
  130. 130. 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’Sunday, 6 February 2011 45
  131. 131. Bill’s take home messageSunday, 6 February 2011 46
  132. 132. Bill’s take home message • have a healthy sense of curiositySunday, 6 February 2011 46
  133. 133. Bill’s take home message • have a healthy sense of curiosity • keep an open mindSunday, 6 February 2011 46
  134. 134. Bill’s take home message • have a healthy sense of curiosity • keep an open mind • systematically reflect on your workSunday, 6 February 2011 46
  135. 135. 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 researchSunday, 6 February 2011 46
  136. 136. Bill’s take home messageSunday, 6 February 2011 47
  137. 137. Bill’s take home messageSunday, 6 February 2011 47
  138. 138. Bill’s take home message • measure your outcomesSunday, 6 February 2011 47
  139. 139. Bill’s take home message • measure your outcomes • support research and/or get involved in case study research yourselfSunday, 6 February 2011 47
  140. 140. Bill’s take home message • measure your outcomes • support research and/or get involved in case study research yourself • be respectful of other modalitiesSunday, 6 February 2011 47
  141. 141. 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 clientsSunday, 6 February 2011 47
  142. 142. Pragmatic Research Network pragmaticresearchnetwork.blogspot.comSunday, 6 February 2011 48
  143. 143. THE END www.centerforclinicalexcellence.com wandrews22@mac.comSunday, 6 February 2011 49

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