Tag: rules of thumb

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Rules of Thumb That Can Sabotage The Treatment of PTSD

In routine practice the treatment of PTSD is often ineffective, IAPT’s recovery rate with this disorder is around 16%. But the operation of certain rules of thumb sabotage treatment across the board. Which, if any,  of the following saboteurs do you operate on:

  1. It is probably PTSD because it was an awful incident
  2. It is probably PTSD because there arte flashbacks and nightmares
  3. It is probably PTSD because of a high score on the Impact of Event Scale
  4. Whatever it actually is trauma focused CBT/EMDR offers the best way of resolving it
  5. Formulation rules anyway
  6. You can’t treat more than one disorder at a time
  7. Issues need to be resolved first

 

In January 2018 I was due to make a presentation at an Improving Access to Psychological Therapies (IAPT) Conference, titled ‘Approaching Patients With Trauma – Can IAPT help patients with trauma?, but was overtaken by my own trauma of falling down the stairs at home! Here is the link to the presentation:

https://www.dropbox.com/s/21ye8ewczvmfamn/IAPT-January-23rd-2018-Birmingham-City-Football-Ground.pdf?dl=0

The good news is that I was able to specify how IAPT might change its’ practice, but unfortunately the chances of this happening anytime soon are remote, openness to debate with those outside of IAPT is conspicuous by its’ abscence.

Dr Mike Scott

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From Disaster to Functioning

Talk at Health and Wellbeing at Work Conference, NEC, Birmingham March 6th 2018. My key themes are:

  • ‘Saving Normal’ and watchful waiting in the immediate aftermath of a disaster.
  • Critical Incident Stress Debriefing is unproven and may be harmful.
  • The dangers of trauma focussed CBT/EMDR when a person does not actually have PTSD
  • Daring people to gradually do what they did before – resetting the alarm (amygdala)
  • Poor recovery rate in IAPT for treating trauma responses 10%
  • Ubiquity of rules of thumb for treating trauma victims probably leads to an almost universal low recovery rate
  • Dr Mike Scott
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Brief Assessments Are The Norm And Invariably Wrong

Work on the assumption that the assessments of others are wrong because they have probably operated on some idiosyncratic  rule of thumb to save time. My cynicism about the assessments of colleagues was heightened recently, two years ago I saw a lady who had a phobia about driving and travelling as a passenger in a car and needed CBT. I’ve just discovered that her GP has decided she has PTSD and she is consequently, about to undergo 12 sessions of CBT.

In a previous post I talked about the importance of ‘Watching and Waiting’ but if this is done without the appropriate measuring instrument, a standardised reliable diagnostic interview all is in vain. My suspicion is that the GP, like many clinicians has in mind a ‘cardinal symptom’ of PTSD such as flashbacks and/or nightmares and uses this rule of thumb (heuristic) to determine treatment. The advantage of heuristics is that they are quick, the disadvantage is that they are usually wrong

see Daniel Kahneman’s book, resulting in a waste of resources and the client likely defaulting from CBT

Dr Mike Scott.