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.
Posttraumatic stress disorder (PTSD) is an anxiety disorder that a person may develop after experiencing or witnessing an extreme, overwhelming traumatic event during which they felt intense fear, helplessness, or horror.
Overview of Post Traumatic Stress Disorder including diagnostic criteria from ICD-10 and DSM-5, prevalence, course, differential diagnosis, co-morbidity, assessment, risk, prognostic and protective factors, etiology and management.
Posttraumatic stress disorder (PTSD) is an anxiety disorder that a person may develop after experiencing or witnessing an extreme, overwhelming traumatic event during which they felt intense fear, helplessness, or horror.
Overview of Post Traumatic Stress Disorder including diagnostic criteria from ICD-10 and DSM-5, prevalence, course, differential diagnosis, co-morbidity, assessment, risk, prognostic and protective factors, etiology and management.
The festival season has began. For some people the season has triggered painful memories of loss and grief. It becomes very important to understand PTSD and. Our awareness can help them in their healing process.
Post-traumatic stress disorder (PTSD) is a
real illness. You can get PTSD after living through or seeing a traumatic
event, such as war, a hurricane, rape, physical abuse or
a bad accident. PTSD makes you feel stressed and afraid after the danger is
over. It affects your life and the people around you.
PTSD can cause problems like:
-- Flashbacks, or feeling like the event is
happening again
-- Trouble sleeping or nightmares
-- Feeling alone
-- Angry outbursts
-- Feeling worried, guilty or sad
PTSD starts at different times for
different people. Signs of PTSD may start soon after a frightening event and
then continue. Other people develop new or more severe signs months or even
years later. PTSD can happen to anyone, even children.
Medicines can help you feel less afraid and
tense. It might take a few weeks for them to work. Talking to a specially
trained doctor or counselor also helps many people with PTSD. This is called
talk therapy.
PTSD is a disease first introduced into the diagnostic and statistical manual of mental disorders (DSM) in 1980
With the world experiencing an unprecedented onslaught of disasters and traumas, it is imperative that health workers are aware of the disease and the factors that affect it
Post Traumatic Stress Disorder (PTSD) is a natural emotional reaction to a deeply shocking and disturbing experience. It is a normalreaction to an abnormalsituation.
•Any human being has the potential to develop PTSD
•Cause external –Psychiatric Injury not Mental Illness
•Not resulting from the individual’s personality –Victim is not inherently weak or inferior
Presentation delivered to the New Zealand Suicide Prevention Conference in September 2013. The presentation draws on the Institute's experience and expertise in developing media resources and community resources for reporting about and discussing suicide.
The festival season has began. For some people the season has triggered painful memories of loss and grief. It becomes very important to understand PTSD and. Our awareness can help them in their healing process.
Post-traumatic stress disorder (PTSD) is a
real illness. You can get PTSD after living through or seeing a traumatic
event, such as war, a hurricane, rape, physical abuse or
a bad accident. PTSD makes you feel stressed and afraid after the danger is
over. It affects your life and the people around you.
PTSD can cause problems like:
-- Flashbacks, or feeling like the event is
happening again
-- Trouble sleeping or nightmares
-- Feeling alone
-- Angry outbursts
-- Feeling worried, guilty or sad
PTSD starts at different times for
different people. Signs of PTSD may start soon after a frightening event and
then continue. Other people develop new or more severe signs months or even
years later. PTSD can happen to anyone, even children.
Medicines can help you feel less afraid and
tense. It might take a few weeks for them to work. Talking to a specially
trained doctor or counselor also helps many people with PTSD. This is called
talk therapy.
PTSD is a disease first introduced into the diagnostic and statistical manual of mental disorders (DSM) in 1980
With the world experiencing an unprecedented onslaught of disasters and traumas, it is imperative that health workers are aware of the disease and the factors that affect it
Post Traumatic Stress Disorder (PTSD) is a natural emotional reaction to a deeply shocking and disturbing experience. It is a normalreaction to an abnormalsituation.
•Any human being has the potential to develop PTSD
•Cause external –Psychiatric Injury not Mental Illness
•Not resulting from the individual’s personality –Victim is not inherently weak or inferior
Presentation delivered to the New Zealand Suicide Prevention Conference in September 2013. The presentation draws on the Institute's experience and expertise in developing media resources and community resources for reporting about and discussing suicide.
San Francisco VA Mental Health Summit 2016 Presentation by Megan McCarthySwords to Plowshares
San Francisco Veteran Mental Health Summit 2016
Presentation by Megan McCarthy, Ph.D.
Deputy Director, Office of Suicide Prevention
U.S Department of Veterans Affairs
August 12, 2016
This is my latest presentation about PTSD from a warrior's perspective and an attempt to turn the traits that are important for us (courage for example) into a means to help deal with PTSD.
Note, this presentation has some disturbing images in it.
Частина 1. Як мозок визначає, що для нас є важливим? Синапси, нейромедіаторні...ProstirChasopys
28 листопада в рамках лекторія BRAINY Сергій Данілов розповів про механізми синаптичної передачі, нейромедіаторні системи та роль ядер ретикулярної формації при формуванні уваги.
This is a version of presenation that I give for free around the state of Oregon. My intent is to change the way the military and veterans talk about combat stress injurie and PTSD, to make it more of an open topic. Currently we hear the term and we 'tune out' and don't seek the help so many of us need. Understanding what is happening in the brain and soul, with respect to our uniform and our warrior ethos, has helped many soldiers/marines begin treatment. I am always reworking this to make the message better. I try to relate to the audience and use my credentials as infantry instructor and combat vet to that effect.
Course Description (From www.PESI.com):
Attend this day of training and leave with a brand new toolkit of skills, interventions, and principles for rapid success with traumatized clients. Join Jamie Marich and learn the standard of care for treatment in the field of traumatic stress – and its key ingredients. Implement evidence-based treatment protocols and interventions for establishing safety, desensitizing and reprocessing trauma memories, metabolizing and resolving grief/loss and finally, assisting clients in reconnecting to lives full of hope, connection, and achievement.
Jamie is a certified EMDR Therapist and approved consultant through the EMDR International Association (EMDR). She is additionally a member of the American Academy of Experts in Traumatic Stress, the International Association of Trauma Professionals (IATP), and has earned Certification in Disaster Thanatology.
Jamie began her career in social services as a humanitarian aid worker in post-war Bosnia-Herzegovina opening her eyes to the widespread, horrific impact of traumatic stress and grief.
Objectives:
Describe the etiology and impact of traumatic stress on the client utilizing multiple assessment strategies.
Assess a client’s reaction to a traumatic event and make an appropriate diagnosis.
Explain how grief, bereavement, and mourning are accounted for in the new DSM-5®.
Implement interventions to assist a client in dealing with the biopsychosocial manifestations of trauma, PTSD, and traumatic grief/complicated mourning.
Utilize appropriate evidence-based interventions to assist a client in dealing with the biopsychosocial-spiritual manifestations of trauma.
Explain the effects of trauma on the structure and function of the brain.
Understanding Opioid Dependence: a significant harm of long-term opioid therapyMark Sullivan
In this presentation, I argue that prescription opioid policy is often framed as a balance of the right to pain relief vs the risk of addiction. But our brains have evolved to make both physical and social injury painful, with our endogenous opioid system modulating both forms of pain to promote both forms of survival. Long-term exogenous opioid medications disrupt this system and thereby impair human social and emotional function.
Cognitive Behavior Therapy (CBT) for Psychosiscitinfo
Presented by: Dawn I. Velligan, Ph.D.
Professor, Department of Psychiatry
Director, Division of Schizophrenia and Related Disorders
Meredith L. Draper, Ph.D.
Assistant Professor, Department of Psychiatry
University of Texas Health Science Center, San Antonio
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. PTSD research and statistics
Bill Andrews
Pragmatic Research Network
Sunday, 6 February 2011 1
2. PTSD treatment: the facts;
outcomes of therapy
Bill Andrews
Pragmatic Research Network
Sunday, 6 February 2011 1
3. Bill Andrews
Research Coordinator
Pragmatic Research Network
Sunday, 6 February 2011 2
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.
4. Bill Andrews
Senior advisor
ICCE
www.centerforclinicalexcellence.com
Sunday, 6 February 2011 3
The ICCE is a great resource.
5. What is PTSD? 1/6
DSM-IV-TR, APA, 2000
Sunday, 6 February 2011 4
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, 2000
Sunday, 6 February 2011 4
7. What is PTSD? 2/6
DSM-IV-TR, APA, 2000
Sunday, 6 February 2011 5
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, 2000
Sunday, 6 February 2011 5
9. What is PTSD? 3/6
DSM-IV-TR, APA, 2000
Sunday, 6 February 2011 6
10. What is PTSD? 3/6
• C: Persistent avoidance of stimuli
associated with the event(s)
DSM-IV-TR, APA, 2000
Sunday, 6 February 2011 6
11. What is PTSD? 4/6
DSM-IV-TR, APA, 2000
Sunday, 6 February 2011 7
12. What is PTSD? 4/6
• D: Elevated arousal that was NOT present
prior to the event(s)
DSM-IV-TR, APA, 2000
Sunday, 6 February 2011 7
13. What is PTSD? 5/6
DSM-IV-TR, APA, 2000
Sunday, 6 February 2011 8
14. What is PTSD? 5/6
• E: The symptoms must persist for more
than 1 month
DSM-IV-TR, APA, 2000
Sunday, 6 February 2011 8
15. What is PTSD? 6/6
DSM-IV-TR, APA, 2000
Sunday, 6 February 2011 9
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, 2000
Sunday, 6 February 2011 9
28. PTSD research and statistics
Sunday, 6 February 2011 13
29. PTSD research and statistics
• Evidence hierarchy
Sunday, 6 February 2011 13
30. PTSD research and statistics
• Evidence hierarchy
• RCT
Sunday, 6 February 2011 13
31. PTSD research and statistics
• Evidence hierarchy
• RCT
• Meta-analysis of RCT studies
Sunday, 6 February 2011 13
32. Meta-Analysis of Risk Factors for
PTSD in Trauma-Exposed Adults
Sunday, 6 February 2011 14
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. 2000. Brewin, Andrews & Valentine. Journal of Consulting and Clinical Psychology. 68. 5.
Sunday, 6 February 2011 15
Lack of social support is the greatest predictor of the risk of developing PTSD.
35. 2000. Brewin, Andrews & Valentine. Journal of Consulting and Clinical Psychology. 68. 5.
Sunday, 6 February 2011 15
Lack of social support is the greatest predictor of the risk of developing PTSD.
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, 2006
Sunday, 6 February 2011 19
47. Meta-analysis of PTSD treatments
Sunday, 6 February 2011 20
Agreement of no difference between trauma focused treatments.
48. Meta-analysis of PTSD treatments
• Common focus on the patient’s traumatic
memories of the traumatic event &
personal meaning of the trauma
Sunday, 6 February 2011 20
Agreement of no difference between trauma focused treatments.
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 treatments
Sunday, 6 February 2011 20
Agreement of no difference between trauma focused treatments.
50. Meta-analysis of PTSD treatments
Sunday, 6 February 2011 21
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
51. Meta-analysis of PTSD treatments
• Benish et al, 2008
Sunday, 6 February 2011 21
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
52. Meta-analysis of PTSD treatments
• Benish et al, 2008
• NO DIFFERENCE in OUTCOMES
between ANY bona fide treatments,
WHETHER TRAUMA FOCUSED OR NOT
Sunday, 6 February 2011 21
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
53. TM
c Bill Andrews 2010
Sunday, 6 February 2011 22
Let’s be pragmatic.
56. Pragmatic Research Network
TM
c Bill Andrews 2010
pragmaticresearchnetwork.blogspot.com
Sunday, 6 February 2011 24
The main purpose of a network is to try to investigate what is going on in practice.
57. Ask the Customers (n = 130)
Sunday, 6 February 2011 25
The data speaks for itself.
58. Ask the Customers (n = 130)
!"#$%&'(
&'()-+./0"
1234*56"
&'()*+,'"
!" #" $!" $#" %!"
Sunday, 6 February 2011 25
The data speaks for itself.
59. Ask the Customers (n = 130)
!"#$%&'( !"#$%&'(
&'()-+./0" &'()-+./0"
1234*$!" 1234*56"
&'()*+,'" &'()*+,'"
!" #" $!" $#" %!" %#" !" #" $!" $#" %!"
Sunday, 6 February 2011 25
The data speaks for itself.
60. Ask the Customers (n = 130)
!"#$%&'( !"#$%&'(
&'()-+./0" &'()-+./0"
1234*$!" 1234*56"
&'()*+,'" &'()*+,'"
!" #" $!" $#" %!" %#" !" #" $!" $#" %!"
!"#$
'()*.,/01"
234"
'()*+,-("
!" #!" $!!" $#!" %!!" %#!" &!!" &#!"
Sunday, 6 February 2011 25
The data speaks for itself.
63. Ask the Customers (n = 130)
!"!#$%&'(!%
()*+,01$
)*/$
23245$6782$
.+/,+$
()*+,!-$
!"#$ !"%$ !"&$ '$ '"!$ '"'$
Sunday, 6 February 2011 26
The effect sizes are large.
64. Ask the Customers (n = 130)
!"!#$%&'(!%
()*+,01$
)*/$
23245$6782$
.+/,+$
()*+,!-$
!"#$ !"%$ !"&$ '$ '"!$ '"'$
Sunday, 6 February 2011 26
The effect sizes are large.
65. Ask the very distressed (n = 44)
Sunday, 6 February 2011 27
Clients seem to be moving to below the cut-off, even when the more distressed cohort are
looked at.
66. Ask the very distressed (n = 44)
IES-E
+,-.,/$"
0123456"47"89"1":"&&"
+,-.,/#"
!" #!" $!" %!" &!" '!" (!" )!" *!"
Sunday, 6 February 2011 27
Clients seem to be moving to below the cut-off, even when the more distressed cohort are
looked at.
67. Ask the very distressed (n = 44)
CORE-34 IES-E
'()*+&,"-%" +,-.,/$"
./01234"25"67"/"8",,"
0123456"47"89"1":"&&"
'()*+&,"-$" +,-.,/#"
!" #" $!" $#" %!" %#" &!" !" #!" $!" %!" &!" '!" (!" )!" *!"
Sunday, 6 February 2011 27
Clients seem to be moving to below the cut-off, even when the more distressed cohort are
looked at.
68. Ask the very distressed (n = 44)
CORE-34 IES-E
'()*+&,"-%" +,-.,/$"
./01234"25"67"/"8",,"
0123456"47"89"1":"&&"
'()*+&,"-$" +,-.,/#"
!" #" $!" $#" %!" %#" &!" !" #!" $!" %!" &!" '!" (!" )!" *!"
Sunday, 6 February 2011 27
Clients seem to be moving to below the cut-off, even when the more distressed cohort are
looked at.
69. Ask the very distressed
Sunday, 6 February 2011 28
The data compares very favourably with one of the studies into PTSD from Northern Ireland.
70. Ask the very distressed
Duffy et al n = 47
bdi conversion
'()*+&,"-%"
'./01"23"/."4"5",6"
'()*+&,"-$"
!" #" $!" $#" %!" %#" &!"
Sunday, 6 February 2011 28
The data compares very favourably with one of the studies into PTSD from Northern Ireland.
71. Ask the very distressed
Duffy et al n = 47 Andrews et al n = 44
bdi conversion CORE-34
'()*+&,"-%" '()*+&,"-%"
./01234"25"67"/"8",,"
'./01"23"/."4"5",6"
'()*+&,"-$" '()*+&,"-$"
!" #" $!" $#" %!" %#" &!" !" #" $!" $#" %!" %#" &!"
Sunday, 6 February 2011 28
The data compares very favourably with one of the studies into PTSD from Northern Ireland.
72. Ask the very distressed
Duffy et al n = 47 Andrews et al n = 44
bdi conversion CORE-34
'()*+&,"-%" '()*+&,"-%"
./01234"25"67"/"8",,"
'./01"23"/."4"5",6"
'()*+&,"-$" '()*+&,"-$"
!" #" $!" $#" %!" %#" &!" !" #" $!" $#" %!" %#" &!"
Sunday, 6 February 2011 28
The data compares very favourably with one of the studies into PTSD from Northern Ireland.
73. Predictors of PTSD
• lack of social support
• post-trauma life stress
• trauma severity
Sunday, 6 February 2011 29
75. Likely Predictors of
PTSD Resolution
• recognising the importance of social support
Sunday, 6 February 2011 30
76. Likely Predictors of
PTSD Resolution
• recognising the importance of social support
• teaching skills for management of post-trauma
life stress
Sunday, 6 February 2011 30
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 trauma
Sunday, 6 February 2011 30
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 treatment
Sunday, 6 February 2011 30
80. Meta-analysis of PTSD treatments
• NO DIFFERENCE between ANY of these
trauma-focused treatments
Sunday, 6 February 2011 31
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 NOT
Sunday, 6 February 2011 31
83. Where Scientists Agree
Possible Factors important to successful treatments of PTSD
Sunday, 6 February 2011 32
84. Where Scientists Agree
Possible Factors important to successful treatments of PTSD
• Therapists...ask yourself how many of these you can
tick off
Sunday, 6 February 2011 32
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 treatment
Sunday, 6 February 2011 32
87. Possible Factors important to
successful treatments of PTSD
• Cogent rationale that is acceptable to patient
Sunday, 6 February 2011 33
88. Possible Factors important to
successful treatments of PTSD
• Cogent rationale that is acceptable to patient
• Set of treatment actions consistent with the rationale
Sunday, 6 February 2011 33
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 relationship
Sunday, 6 February 2011 33
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 therapy
Sunday, 6 February 2011 33
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 hope
Sunday, 6 February 2011 33
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 resilience
Sunday, 6 February 2011 33
94. Possible Factors important to
successful treatments of PTSD
• Education about PTSD
Sunday, 6 February 2011 34
95. Possible Factors important to
successful treatments of PTSD
• Education about PTSD
• Opportunity to talk about trauma if desired
Sunday, 6 February 2011 34
96. Possible Factors important to
successful treatments of PTSD
• 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)
Sunday, 6 February 2011 34
97. Possible Factors important to
successful treatments of PTSD
• 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
Sunday, 6 February 2011 34
98. Possible Factors important to
successful treatments of PTSD
• 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
Sunday, 6 February 2011 34
99. Pragmatic Approach
Sunday, 6 February 2011 35
The Pragmatic Approach tries to find a middle ground between the different sides of the
argument.
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 York
Sunday, 6 February 2011 35
The Pragmatic Approach tries to find a middle ground between the different sides of the
argument.
102. Pragmatic Research Implications for
Innovative Psychological Trauma Treatments
• Put the feedback of the service user at the top of the agenda
Sunday, 6 February 2011 36
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
measures
Sunday, 6 February 2011 36
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 data
Sunday, 6 February 2011 36
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 treatments
Sunday, 6 February 2011 36
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 perspectives
Sunday, 6 February 2011 36
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 control
Sunday, 6 February 2011 36
108. 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)
Sunday, 6 February 2011 37
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 38
Paul suggests we need to move away from this evidence hierarchy.
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. Prof. Gordon Turnbull
Frontiers in Trauma Treatment
BILL: What in your opinion are the
significant breakthroughs in
Trauma Treatment?
Sunday, 6 February 2011 40
113. The New Frontier
• unprocessed trauma memories control and cause
exaggerated function of the ANS
Sunday, 6 February 2011 41
114. The New Frontier
• unprocessed trauma memories control and cause
exaggerated function of the ANS
• PTSD is truly a MIND/BODY experience
Sunday, 6 February 2011 41
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 therapies
Sunday, 6 February 2011 41
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 therapy
Sunday, 6 February 2011 41
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
• EFT
Sunday, 6 February 2011 41
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
• Acupuncture
Sunday, 6 February 2011 41
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
• Acupressure
Sunday, 6 February 2011 41
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 idea
Sunday, 6 February 2011 43
125. Medications
• Propranolol (lowering adrenaline)
useful in the Acute Stress Reaction
phase to reduce the ‘etching’ of the
emotionally charged memories
Sunday, 6 February 2011 44
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 flooding
Sunday, 6 February 2011 44
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 flashback
Sunday, 6 February 2011 45
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 resistance
Sunday, 6 February 2011 45
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
132. Bill’s take home message
• have a healthy sense of curiosity
Sunday, 6 February 2011 46
133. Bill’s take home message
• have a healthy sense of curiosity
• keep an open mind
Sunday, 6 February 2011 46
134. Bill’s take home message
• have a healthy sense of curiosity
• keep an open mind
• systematically reflect on your work
Sunday, 6 February 2011 46
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 research
Sunday, 6 February 2011 46
138. Bill’s take home message
• measure your outcomes
Sunday, 6 February 2011 47
139. Bill’s take home message
• measure your outcomes
• support research and/or get involved
in case study research yourself
Sunday, 6 February 2011 47
140. Bill’s take home message
• measure your outcomes
• support research and/or get involved
in case study research yourself
• be respectful of other modalities
Sunday, 6 February 2011 47
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 clients
Sunday, 6 February 2011 47