On June 5th, 2024 under a Freedom of Information Request (FOI), NHS Talking Therapies informed me that in the year 2022-2023, 23,069 people with post-traumatic stress disorder had just one assessment/ treatment session with the Service.
The FOI data reveal that for those attending just one session, those with PTSD have higher mean scores on both the PHQ-9 (17.9) and GAD-7 (15.6) than any other diagnostic group. Further these mean scores are higher than those who start treatment mean PHQ-9 of 15.5 and GAD-7 14.1. It thus appears that those who have only one session are likely more traumatised than those who go on to have treatment.
It appears that there is something radically wrong with the traditional trauma-focussed approach to trauma adopted by NHS Talking Therapies. My new self-help book, Moving On After Trauma (2nd edition) published by London: Routledge on June 13th 2024, takes a radically different, more user-friendly approach. Instead of positing that the primary difficulty lies with arrested information processing at the time of the trauma and the consequent need to re-live it therapeutically, I suggest that what is pivotal is the centrality accorded to the trauma for today and that there is no need for a re-traumatisation of the client. My clinical handbook ‘Personalising Trauma Treatment: Reframing and Reimagining’ published in 2022 by Routledge, spells out the specifics of this approach for clinicians.
Accordingly I am adding a ‘Moving On After Trauma’ page to this website for clinicians, those who have been traumatised and those travelling the road with them. Here are my 12 rules for Moving On:
- Begin building a bridge between yourself now and the person you were before the trauma. Start by doing a little of what you did before. Constucting gradually as wide a ranging an investment portfolio as you can manage.
- Expected that building the bridge, like all forms of construction, will be steps forward and one backwards. It will need daily commitment.
- Don’t block the memories of the trauma, the harder you push them away the more they spring back.
- Put the traumatic memories in their place by questioning their relevance to today’s plans.
- Don’t get hooked by what could have happened. That is just a horror video which spoils today, with dark imaginings.
- Expect that the traumatic memory will knock at the door of your mind daily. But it is only asking about its’ relevance to today. Calmly answer this visitor.
- Go by what you would bet £5 on happening today, not by how vivid the traumatic memory is and how upsetting you find it.
- Remember that guilt is about deliberately doing something wrong. Trauma related guilt is bogus, it arises from either believing you should have looked into your crystal ball before the trauma or that you actually had the time to have done something differently. Feeling guilty and being guilty are not the same.
- Refuse to see flashbacks/nightmares as credible forecasts of what is going to happen today. Being constantly on the edge of your seat is about the past not the future.
- Give people the time of day. Expect to feel disconnected from others as you are looking at your world through war-zone glasses. Try on the pre-trauma glasses, they are more reliable. The view through them is based on a lifetimes experience rather than on a single drama.
- Refuse to take your alarm going off as evidence of danger- it’s just a ‘dodgy alarm’. Tripped easily by anything not exactly as you would want it, reminders or any unusual but not abnormal bodily sensation/s.
- Refuse to look at yourself and your personal world through the window of the trauma. Don’t make the trauma, pain or disability central.
Dr Mike Scott
