The Treatment of PTSD Has Been Destabilised……

by the advent of stabilisation groups and overvaluing trauma focussed CBT. In the wake of an extreme trauma IAPT clients can be referred to stabilisation groups. Such groups will often meet weekly for 6 weeks and participants are encouraged not to talk about the trauma but rather about its effects. However there is no empirical evidence that such groups make a real world difference. In support of such groups the work of Judith Herman  [ Group Trauma Treatment in Early Recovery (2019) Guilford Press] is often cited, her groups are for those in ‘early recovery’ but there is no specification of what is meant by ‘early’ or from what the person is recovering. IAPT’s assessment process is as vague as Judith Herman’s.

 

Sienna, a Civil Servant had a horrendous rta and after an IAPT telephone assessment was referred to a stabilisation group, she assumed it was for PTSD. The group made no difference to her functioning, nor did the 3 individual sessions of trauma focusssed cbt afterwards. Sienna dropped out of the TFCBT because it was too painful but she never did have PTSD!

 

But the problems in the treatment of PTSD are not confined to IAPT. Although trauma focussed CBT (TFCBT) is the NICE recommended treatment for PTSD, inspection of the randomised controlled trials reveals that on average only one in two people recover. NICE’s guidance can be overvalued, with clinicians continuing to pursue TFCBT when it is clearly not working. With a parallel insistence that they confront the scene of their trauma. Client’s are often more pragmatic thinking that they could get by without re-exposure to the scene, but with the therapist urging the client not to be ‘defeated’. Given the power imbalance the client is unlikely to be able to effectively voice their opinion. There is a pressing need for creative solutions when TFCBT doesn’t work and for a re-examination of the theory on which the latter rests.

I am proposing to run a ‘Getting Back To Me’ workshop next year.

 

Dr Mike Scott 

2 thoughts to “The Treatment of PTSD Has Been Destabilised……”

  1. Hi Andrew
    The following would suggest it might be a move in the right direction but the effect may be slight.

    A study by Larsen et al (2016) showed that cognitive processing therapy conducted without a written account of the trauma (non-trauma focused CPT) showed lower levels of symptom exacerbation (14.7%) during treatment than did both cognitive processing therapy with written trauma accounts (standard trauma focussed CPT) (28.6%) and prolonged exposure (20.0%). Further the dropout rate was lower in cognitive processing therapy minus the written account (22%) than it was for the traditional cognitive processing therapy (34%) [ Resick, Galovski and O’Brien Uhlmansiek (2008)]. Non trauma focussed CPT appears more acceptable to clients than standard CPT and as effective.

    Larsen, S.E., Wiltsey Stirman S., & Smith, B.N (2016) Symptom exacerbations in trauma-focused treatments: associations with treatment outcome and non-completion. Behaviour Research and Therapy, 77: 68-77

    It suggests the processing of the traumatic memory per se is not actually the central issue as exponents of TFCBT contend. I think the action is actually elsewhere.
    Best wishes

    Mike

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