Ptsd resolution5.2
-
Upload
bill-andrews -
Category
Health & Medicine
-
view
1.368 -
download
3
description
Transcript of Ptsd resolution5.2
PTSD research and statistics
Bill Andrews
Pragmatic Research Network
1Sunday, 6 February 2011
Bill Andrews
Pragmatic Research Network
PTSD treatment: the facts; outcomes of therapy
1Sunday, 6 February 2011
Bill AndrewsResearch Coordinator
Pragmatic Research Network
2Sunday, 6 February 2011
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.
Bill AndrewsSenior advisor
ICCEwww.centerforclinicalexcellence.com
3Sunday, 6 February 2011
The ICCE is a great resource.
What is PTSD? 1/6
DSM-IV-TR, APA, 2000
4Sunday, 6 February 2011
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
4Sunday, 6 February 2011
What is PTSD? 2/6
DSM-IV-TR, APA, 2000
5Sunday, 6 February 2011
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
5Sunday, 6 February 2011
What is PTSD? 3/6
DSM-IV-TR, APA, 2000
6Sunday, 6 February 2011
What is PTSD? 3/6
• C: Persistent avoidance of stimuli associated with the event(s)
DSM-IV-TR, APA, 2000
6Sunday, 6 February 2011
What is PTSD? 4/6
DSM-IV-TR, APA, 2000
7Sunday, 6 February 2011
What is PTSD? 4/6
• D: Elevated arousal that was NOT present prior to the event(s)
DSM-IV-TR, APA, 2000
7Sunday, 6 February 2011
What is PTSD? 5/6
DSM-IV-TR, APA, 2000
8Sunday, 6 February 2011
What is PTSD? 5/6
• E: The symptoms must persist for more than 1 month
DSM-IV-TR, APA, 2000
8Sunday, 6 February 2011
What is PTSD? 6/6
DSM-IV-TR, APA, 2000
9Sunday, 6 February 2011
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
9Sunday, 6 February 2011
Psychological Trauma
10Sunday, 6 February 2011
It’s easier to understand trauma on a continuum.
Psychological Trauma
continuum
10Sunday, 6 February 2011
It’s easier to understand trauma on a continuum.
Psychological Trauma
physiological arousal
continuum
10Sunday, 6 February 2011
It’s easier to understand trauma on a continuum.
Psychological Trauma
physiological arousal PTSD
continuum
10Sunday, 6 February 2011
It’s easier to understand trauma on a continuum.
Psychological Trauma
acute stress disorderphysiological arousal PTS PTSD
addictionsdepressionanxiety
continuum
10Sunday, 6 February 2011
It’s easier to understand trauma on a continuum.
Psychological Trauma
acute stress disorderphysiological arousal PTS PTSD
addictionsdepressionanxiety
continuum
10Sunday, 6 February 2011
It’s easier to understand trauma on a continuum.
PTSD research and statistics
11Sunday, 6 February 2011
PTSD research and statistics
• Scientific method
11Sunday, 6 February 2011
PTSD research and statistics
• Scientific method
• NICE guidelines (UK context)
11Sunday, 6 February 2011
© W Andrews (Feb. 2009)
12Sunday, 6 February 2011
© W Andrews (Feb. 2009)
12Sunday, 6 February 2011
PTSD research and statistics
13Sunday, 6 February 2011
PTSD research and statistics
• Evidence hierarchy
13Sunday, 6 February 2011
PTSD research and statistics
• Evidence hierarchy
• RCT
13Sunday, 6 February 2011
PTSD research and statistics
• Evidence hierarchy
• RCT
• Meta-analysis of RCT studies
13Sunday, 6 February 2011
Meta-Analysis of Risk Factors for PTSD in Trauma-Exposed Adults
14Sunday, 6 February 2011
Meta-Analysis of Risk Factors for PTSD in Trauma-Exposed Adults
2000. Brewin, Andrews & Valentine. Journal of Consulting and Clinical Psychology. 68. 5.
14Sunday, 6 February 2011
2000. Brewin, Andrews & Valentine. Journal of Consulting and Clinical Psychology. 68. 5.
15Sunday, 6 February 2011
Lack of social support is the greatest predictor of the risk of developing PTSD.
2000. Brewin, Andrews & Valentine. Journal of Consulting and Clinical Psychology. 68. 5.
15Sunday, 6 February 2011
Lack of social support is the greatest predictor of the risk of developing PTSD.
Predictors of PTSD
16Sunday, 6 February 2011
Predictors of PTSD
• lack of social support
16Sunday, 6 February 2011
Predictors of PTSD
• lack of social support
• post-trauma life stress
16Sunday, 6 February 2011
Predictors of PTSD
• lack of social support
• post-trauma life stress
• trauma severity
16Sunday, 6 February 2011
• PTSD treatmentNICE Guideline recommendations
17Sunday, 6 February 2011
• PTSD treatmentNICE Guideline recommendations
• Trauma- focused CBT
17Sunday, 6 February 2011
• PTSD treatmentNICE Guideline recommendations
• Trauma- focused CBT
• EMDR
17Sunday, 6 February 2011
Trauma Focused Treatment
18Sunday, 6 February 2011
The list.
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)
18Sunday, 6 February 2011
The list.
Meta-analysis of PTSD treatments
19Sunday, 6 February 2011
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
19Sunday, 6 February 2011
Meta-analysis of PTSD treatments
20Sunday, 6 February 2011
Agreement of no difference between trauma focused treatments.
Meta-analysis of PTSD treatments
• Common focus on the patient’s traumatic memories of the traumatic event & personal meaning of the trauma
20Sunday, 6 February 2011
Agreement of no difference between trauma focused treatments.
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
20Sunday, 6 February 2011
Agreement of no difference between trauma focused treatments.
Meta-analysis of PTSD treatments
21Sunday, 6 February 2011
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 has been robustly defended.
Meta-analysis of PTSD treatments
• Benish et al, 2008
21Sunday, 6 February 2011
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 has been robustly defended.
Meta-analysis of PTSD treatments
• Benish et al, 2008
• NO DIFFERENCE in OUTCOMES between ANY bona fide treatments, WHETHER TRAUMA FOCUSED OR NOT
21Sunday, 6 February 2011
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 has been robustly defended.
Bill Andrews 2010c
TM
22Sunday, 6 February 2011
Let’s be pragmatic.
Practice Research Networks
23Sunday, 6 February 2011
Practice Research Networks
www.hgiprn.org
23Sunday, 6 February 2011
Pragmatic Research Network
Bill Andrews 2010c
TM
pragmaticresearchnetwork.blogspot.com
24Sunday, 6 February 2011
The main purpose of a network is to try to investigate what is going on in practice.
Ask the Customers (n = 130)
25Sunday, 6 February 2011
The data speaks for itself.
Ask the Customers (n = 130)
!" #" $!" $#" %!"
&'()*+,'"
&'()-+./0"
!"#$%&'(
1234*56"
25Sunday, 6 February 2011
The data speaks for itself.
Ask the Customers (n = 130)
!" #" $!" $#" %!" %#"
&'()*+,'"
&'()-+./0"
!"#$%&'(
1234*$!"
!" #" $!" $#" %!"
&'()*+,'"
&'()-+./0"
!"#$%&'(
1234*56"
25Sunday, 6 February 2011
The data speaks for itself.
Ask the Customers (n = 130)
!" #" $!" $#" %!" %#"
&'()*+,'"
&'()-+./0"
!"#$%&'(
1234*$!"
!" #" $!" $#" %!"
&'()*+,'"
&'()-+./0"
!"#$%&'(
1234*56"
!" #!" $!!" $#!" %!!" %#!" &!!" &#!"
'()*+,-("
'()*.,/01"
!"#$
234"
25Sunday, 6 February 2011
The data speaks for itself.
Ask the Customers (n = 130)
!" #" $!" $#" %!" %#"
&'()*+,'"
&'()-+./0"
!"#$%&'(
1234*$!"
!" #" $!" $#" %!"
&'()*+,'"
&'()-+./0"
!"#$%&'(
1234*56"
!" #!" $!!" $#!" %!!" %#!" &!!" &#!"
'()*+,-("
'()*.,/01"
!"#$
234"
!" #!" $!" %!" &!" '!" (!" )!"
*+,-./0+"
*+,-1/234"
!"#$"%
567.6"
25Sunday, 6 February 2011
The data speaks for itself.
Ask the Customers (n = 130)
!" #" $!" $#" %!" %#"
&'()*+,'"
&'()-+./0"
!"#$%&'(
1234*$!"
!" #" $!" $#" %!"
&'()*+,'"
&'()-+./0"
!"#$%&'(
1234*56"
!" #!" $!!" $#!" %!!" %#!" &!!" &#!"
'()*+,-("
'()*.,/01"
!"#$
234"
!" #!" $!" %!" &!" '!" (!" )!"
*+,-./0+"
*+,-1/234"
!"#$"%
567.6"
25Sunday, 6 February 2011
The data speaks for itself.
Ask the Customers (n = 130)
!"#$ !"%$ !"&$ '$ '"!$ '"'$
()*+,!-$
.+/,+$
)*/$
()*+,01$
!"!#$%&'(!%
23245$6782$
26Sunday, 6 February 2011
The effect sizes are large.
Ask the Customers (n = 130)
!"#$ !"%$ !"&$ '$ '"!$ '"'$
()*+,!-$
.+/,+$
)*/$
()*+,01$
!"!#$%&'(!%
23245$6782$
26Sunday, 6 February 2011
The effect sizes are large.
Ask the very distressed (n = 44)
27Sunday, 6 February 2011
Clients seem to be moving to below the cut-off, even when the more distressed cohort are looked at.
Ask the very distressed (n = 44)
!" #!" $!" %!" &!" '!" (!" )!" *!"
+,-.,/#"
+,-.,/$"
0123456"47"89"1":"&&"
IES-E
27Sunday, 6 February 2011
Clients seem to be moving to below the cut-off, even when the more distressed cohort are looked at.
Ask the very distressed (n = 44)
!" #" $!" $#" %!" %#" &!"
'()*+&,"-$"
'()*+&,"-%"
./01234"25"67"/"8",,"
!" #!" $!" %!" &!" '!" (!" )!" *!"
+,-.,/#"
+,-.,/$"
0123456"47"89"1":"&&"
IES-ECORE-34
27Sunday, 6 February 2011
Clients seem to be moving to below the cut-off, even when the more distressed cohort are looked at.
Ask the very distressed (n = 44)
!" #" $!" $#" %!" %#" &!"
'()*+&,"-$"
'()*+&,"-%"
./01234"25"67"/"8",,"
!" #!" $!" %!" &!" '!" (!" )!" *!"
+,-.,/#"
+,-.,/$"
0123456"47"89"1":"&&"
IES-ECORE-34
27Sunday, 6 February 2011
Clients seem to be moving to below the cut-off, even when the more distressed cohort are looked at.
Ask the very distressed
28Sunday, 6 February 2011
The data compares very favourably with one of the studies into PTSD from Northern Ireland.
Ask the very distressed
!" #" $!" $#" %!" %#" &!"
'()*+&,"-$"
'()*+&,"-%"
'./01"23"/."4"5",6"
Duffy et al n = 47bdi conversion
28Sunday, 6 February 2011
The data compares very favourably with one of the studies into PTSD from Northern Ireland.
Ask the very distressed
!" #" $!" $#" %!" %#" &!"
'()*+&,"-$"
'()*+&,"-%"
'./01"23"/."4"5",6"
!" #" $!" $#" %!" %#" &!"
'()*+&,"-$"
'()*+&,"-%"
./01234"25"67"/"8",,"
Duffy et al n = 47bdi conversion
Andrews et al n = 44CORE-34
28Sunday, 6 February 2011
The data compares very favourably with one of the studies into PTSD from Northern Ireland.
Ask the very distressed
!" #" $!" $#" %!" %#" &!"
'()*+&,"-$"
'()*+&,"-%"
'./01"23"/."4"5",6"
!" #" $!" $#" %!" %#" &!"
'()*+&,"-$"
'()*+&,"-%"
./01234"25"67"/"8",,"
Duffy et al n = 47bdi conversion
Andrews et al n = 44CORE-34
28Sunday, 6 February 2011
The data compares very favourably with one of the studies into PTSD from Northern Ireland.
Predictors of PTSD
• lack of social support
• post-trauma life stress
• trauma severity
29Sunday, 6 February 2011
Likely Predictors of PTSD Resolution
30Sunday, 6 February 2011
Likely Predictors of PTSD Resolution
• recognising the importance of social support
30Sunday, 6 February 2011
Likely Predictors of PTSD Resolution
• recognising the importance of social support
• teaching skills for management of post-trauma life stress
30Sunday, 6 February 2011
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
30Sunday, 6 February 2011
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
30Sunday, 6 February 2011
Meta-analysis of PTSD treatments
31Sunday, 6 February 2011
Meta-analysis of PTSD treatments
• NO DIFFERENCE between ANY of these trauma-focused treatments
31Sunday, 6 February 2011
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
31Sunday, 6 February 2011
Where Scientists Agree
32Sunday, 6 February 2011
Possible Factors important to successful treatments of PTSD
Where Scientists Agree
32Sunday, 6 February 2011
• Therapists...ask yourself how many of these you can tick off
Possible Factors important to successful treatments of PTSD
Where Scientists Agree
32Sunday, 6 February 2011
• 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
Possible Factors important to successful treatments of PTSD
Where Scientists Agree
32Sunday, 6 February 2011
Possible Factors important to successful treatments of PTSD
33Sunday, 6 February 2011
• Cogent rationale that is acceptable to patient
Possible Factors important to successful treatments of PTSD
33Sunday, 6 February 2011
• Cogent rationale that is acceptable to patient
• Set of treatment actions consistent with the rationale
Possible Factors important to successful treatments of PTSD
33Sunday, 6 February 2011
• 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
Possible Factors important to successful treatments of PTSD
33Sunday, 6 February 2011
• 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
Possible Factors important to successful treatments of PTSD
33Sunday, 6 February 2011
• 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
Possible Factors important to successful treatments of PTSD
33Sunday, 6 February 2011
• 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
Possible Factors important to successful treatments of PTSD
33Sunday, 6 February 2011
Possible Factors important to successful treatments of PTSD
34Sunday, 6 February 2011
• Education about PTSD
Possible Factors important to successful treatments of PTSD
34Sunday, 6 February 2011
• Education about PTSD
• Opportunity to talk about trauma if desired
Possible Factors important to successful treatments of PTSD
34Sunday, 6 February 2011
• 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)
Possible Factors important to successful treatments of PTSD
34Sunday, 6 February 2011
• 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
Possible Factors important to successful treatments of PTSD
34Sunday, 6 February 2011
• 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
Possible Factors important to successful treatments of PTSD
34Sunday, 6 February 2011
Pragmatic Approach
35Sunday, 6 February 2011
The Pragmatic Approach tries to find a middle ground between the different sides of the argument.
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
35Sunday, 6 February 2011
The Pragmatic Approach tries to find a middle ground between the different sides of the argument.
Pragmatic Research Implications for Innovative Psychological Trauma Treatments
36Sunday, 6 February 2011
• Put the feedback of the service user at the top of the agenda
Pragmatic Research Implications for Innovative Psychological Trauma Treatments
36Sunday, 6 February 2011
• Put the feedback of the service user at the top of the agenda
• Gather robust pre/post data using internationally recognised self-report measures
Pragmatic Research Implications for Innovative Psychological Trauma Treatments
36Sunday, 6 February 2011
• 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
Pragmatic Research Implications for Innovative Psychological Trauma Treatments
36Sunday, 6 February 2011
• 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
Pragmatic Research Implications for Innovative Psychological Trauma Treatments
36Sunday, 6 February 2011
• 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
Pragmatic Research Implications for Innovative Psychological Trauma Treatments
36Sunday, 6 February 2011
• 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
Pragmatic Research Implications for Innovative Psychological Trauma Treatments
36Sunday, 6 February 2011
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)
37Sunday, 6 February 2011
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.
38Sunday, 6 February 2011
Paul suggests we need to move away from this evidence hierarchy.
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.
39Sunday, 6 February 2011
Prof. Gordon Turnbull
Frontiers in Trauma Treatment
BILL: What in your opinion are the significant breakthroughs in Trauma Treatment?
40Sunday, 6 February 2011
The New Frontier
41Sunday, 6 February 2011
The New Frontier
• unprocessed trauma memories control and cause exaggerated function of the ANS
41Sunday, 6 February 2011
The New Frontier
• unprocessed trauma memories control and cause exaggerated function of the ANS
• PTSD is truly a MIND/BODY experience
41Sunday, 6 February 2011
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
41Sunday, 6 February 2011
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
41Sunday, 6 February 2011
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
41Sunday, 6 February 2011
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
41Sunday, 6 February 2011
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
41Sunday, 6 February 2011
The New Frontier
42Sunday, 6 February 2011
The New Frontier
• Soothing the chaos in the right hemisphere
• EMDR
•Mindfulness
42Sunday, 6 February 2011
The New Frontier
43Sunday, 6 February 2011
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
43Sunday, 6 February 2011
Medications
44Sunday, 6 February 2011
Medications
• Propranolol (lowering adrenaline) useful in the Acute Stress Reaction phase to reduce the ‘etching’ of the emotionally charged memories
44Sunday, 6 February 2011
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
44Sunday, 6 February 2011
Avoidance
45Sunday, 6 February 2011
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
45Sunday, 6 February 2011
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
45Sunday, 6 February 2011
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’
45Sunday, 6 February 2011
Bill’s take home message
46Sunday, 6 February 2011
Bill’s take home message
• have a healthy sense of curiosity
46Sunday, 6 February 2011
Bill’s take home message
• have a healthy sense of curiosity
• keep an open mind
46Sunday, 6 February 2011
Bill’s take home message
• have a healthy sense of curiosity
• keep an open mind
• systematically reflect on your work
46Sunday, 6 February 2011
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
46Sunday, 6 February 2011
Bill’s take home message
47Sunday, 6 February 2011
Bill’s take home message
47Sunday, 6 February 2011
Bill’s take home message
• measure your outcomes
47Sunday, 6 February 2011
Bill’s take home message
• measure your outcomes
• support research and/or get involved in case study research yourself
47Sunday, 6 February 2011
Bill’s take home message
• measure your outcomes
• support research and/or get involved in case study research yourself
• be respectful of other modalities
47Sunday, 6 February 2011
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
47Sunday, 6 February 2011
Pragmatic Research Network
pragmaticresearchnetwork.blogspot.com
48Sunday, 6 February 2011
THE ENDwww.centerforclinicalexcellence.com
49Sunday, 6 February 2011