Trauma: the most effective therapeutic modality?

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lingua_franca
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Trauma: the most effective therapeutic modality?

Post by lingua_franca » Sun May 15, 2011 5:09 pm

Does anybody know of any studies that have been done to identify the most effective therapeutic interventions for trauma-related mental health difficulties? I'm particularly interested in interventions for long-standing and recurrent trauma. Everything I have found so far suggests DBT, which would not be practical in this context.

And I know it's a long shot, but has any specific research been done on the most effective psychotherapeutic treatments for people living in conflict zones? My search has turned up some very interesting material on the work of Carl Rogers in Northern Ireland - use of the person-centred model of counselling in reconciliation groups, etc. - but no clinical studies.
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jane doe
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Re: Trauma: the most effective therapeutic modality?

Post by jane doe » Sun May 15, 2011 8:27 pm

Sorry for the vague-ness of this, as I don't have anything immediately to hand, but in my (limited) experience, I have come across the following approaches used in relation to trauma and responses to trauma...

Narrative therapy
CBT
EMDR
Cognitive re-processing techniques

(I've used all of these approaches in different situations, although I've never observed or carried out EMDR, and know v little about it)

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Re: Trauma: the most effective therapeutic modality?

Post by Borrowed Cone » Sun May 15, 2011 8:40 pm

oops just posted something that didn't make sense so just editing...

is your work going to be time-limited?
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Re: Trauma: the most effective therapeutic modality?

Post by Ruthie » Sun May 15, 2011 11:26 pm

Chris Brewin might be a good name to do a search for. He was heavily involved in providing therapy (mainly trauma focused CBT) after the 7/7 London bombings. There's also been similar work in Northern Ireland after Omagh.

However, I'm not sure how much you could generalise to where you are lingua because these were responses to a single trauma for an entire community rather than ongoing, repeated trauma, which is different both theoretically and clinically. That's probably something to bear in mind generally if you are reading and thinking about trauma in a conflict zone. Maryanne Cloitre is a good name to search for type II (repeated trauma as opposed to a single one-off event) but her work is more with people who have experienced childhood abuse, which is different again to the population you're talking about. (Then again, I find Cloitre's prolonged exposure treatment absolutely terrifying and will not use it, even though there is decent evidence that it works. I think there are more gentle, safe and quick ways to the similar outcomes...and hope the evidence base catches up soon :oops: !)

I also think you need to think very much about commmunity based approaches under such circumstances but I don't know of anything of the top of my head. Perhaps the literature on trauma in refugee populations might provide you with something more similar to what your population are experiencing...i.e. ongoing, repeated trauma that impacts an entire community rather than an individual or very small numbers of individuals within an overall community.

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Re: Trauma: the most effective therapeutic modality?

Post by jane doe » Mon May 16, 2011 3:23 pm

The community approach fits well with narrative therapy's take on it - perhaps that would be an avenue worth exploring?

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Re: Trauma: the most effective therapeutic modality?

Post by Kentucky_Freud_Chicken » Wed May 25, 2011 4:19 pm

It's worth pointing out that much of the research into trauma therapy uses the western 'single major incident' construct of 'trauma' so may not be evidence based for ongoing and repeated trauma such as war zones, or 'Complex PTSD' (cPTSD) type trauma (which I think should should just be referred to as 'the effects of ongoing repeated trauma' rather than 'cPTSD' but there we go).

Also there is evidence that the effects of traumatic expereinces involving feelings of guilt and shame may be exacerbated by reliving style therapies (EMDR, cognitive restructuring), if the person is not helped to explain why their experience happened and make sense of it in a helpful way (see Lebowitz and Roth's paper 'I feel like a slut' for an example of the difference between the effects of rape, and traumas not associated with social discourse and politic, i.e. car accidents). This will have particular relevance for someone who has experienced a conflict zone.

I would also do some reading up on critisisms of EMDR, there are plenty.

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Re: Trauma: the most effective therapeutic modality?

Post by BenJMan » Wed Jun 15, 2011 4:32 pm

*does the EMDR dance*

There are plenty of criticisms for every type of therapy :P
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Re: Trauma: the most effective therapeutic modality?

Post by lingua_franca » Mon Sep 05, 2011 12:01 am

I'm back in the UK now and I've just seen that I never said thank you for all this helpful information. I didn't mean to be so rude. :oops: The Internet connection was very erratic and I tended to use it just for e-mail and blogging.

Especial thanks for the mention of narrative therapy. I did some reading on it and the approach seemed to fit our particular situation like a glove. We have found some charitable organisations that give grants to Palestinian healthcare professionals who want to develop their expertise, so it may be that one or two of the qualified therapists will be able to take a course. Thanks, too, for all the other reading suggestions - now that I am back in this country I'll be hitting the library.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

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Re: Trauma: the most effective therapeutic modality?

Post by Pink » Wed Jun 06, 2012 7:27 am

Related to this thread: just seen this on BPS learning centre:

http://www.bps.org.uk/events/rewind-tec ... vid-muss-2

has anyone heard of this 'rewind' technique? Does the fact that it's on the bps website lend it any authenticity? From his website he looks like a medical doctor:

http://www.davidmuss.co.uk/therewindtechnique/

but doesn't appear to have many publications. I'd be curious to know what others think?

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Re: Trauma: the most effective therapeutic modality?

Post by Laura86 » Wed Jun 06, 2012 11:17 am

Hi Pink,

I'm not sure if it's related to this particular person, but I know they use the rewind technique with the Human Givens approach:

http://www.hgi.org.uk/index.htm

http://www.hgi.org.uk/archive/rewind-technique.htm

In my experience 'practitioners' can come from a variety of backgrounds, not necessarily psychologically trained. I think the human givens bunch offer quite a lot of training to others, but personally (and I really hope I don't offend anyone on here) I can't say I'm a massive fan - the practitioners I've met seem to do a lot of pattern matching and it can feel like they're trying to trick you sometimes when you're talking (not to generalise to all though, that's just my experience!). I think some of their ideas can be useful, and of course 'whatever works' for each individual, but I don't think I would necessarily recommend them.

Laura
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Re: Trauma: the most effective therapeutic modality?

Post by jane doe » Wed Jun 06, 2012 6:26 pm

I had an experience of using the rewind technique as a trainee on placement.
I have to say it was very effective - although I'm not sure what the "change" can attributed to...
For example,
Investment in the authority/legitimacy of the therapist? (i.e. I did this (rewind), and this is supposed to help, which means I feel more confident walking, going out etc. etc. which has a knock-on effect on wellbeing, connecting with things I give value to, changing my view of the world - for example, I don't draw conclusions about myself as vulnerable and the world as dangerous)
Actual 'reprocessing' - and the neuro/cognitive factors underpinning this

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Re: Trauma: the most effective therapeutic modality?

Post by Pink » Fri Jun 08, 2012 9:19 pm

Hi Jane and Laura,

thanks for your replies: it's really helpful to

Laura: hear about the human givens approach: that's a new one on me and I'll do some reading and

Jane: to hear that clinical psychologists are using this (and finding it helpful) in the NHS. Were you or your supervisor at the time aware of any evidence base around this? Your comments about the mechanisms of change are interesting: I can't find anything about the theoretical rationale they posit to explain these? I'm not clear from the stuff on the website how it differs from emdr?

to everyone: I've also just come across this: 'brainspotting technique': has anyone heard of this/any experience of it? I can't find many papers but the guy is a chartered psychologist and EMDR trained.

http://www.brainspotting.pro/page/what-brainspotting

I'm really interested in trauma as my background is in working with chronic abuse and dissociation, but my only clinical experience is with EMDR and CBT, and I'm interested in learning about other approaches.

thanks again,

Pink
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Re: Trauma: the most effective therapeutic modality?

Post by CuppaT » Sun Jun 10, 2012 10:29 am

Never heard of brainspotting, sounds interesting.

To add to the list, David Baldwin's Trauma Information Pages, and Jim Hopper's website have a lot of information including studies, links, books etc.

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Re: Trauma: the most effective therapeutic modality?

Post by Gilly » Sun Jun 10, 2012 1:11 pm

Pink wrote:
to everyone: I've also just come across this: 'brainspotting technique': has anyone heard of this/any experience of it? I can't find many papers but the guy is a chartered psychologist and EMDR trained.

http://www.brainspotting.pro/page/what-brainspotting
on first read:

Image
quack quack quack
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Re: Trauma: the most effective therapeutic modality?

Post by Pink » Wed Sep 03, 2014 7:41 am

Bump! Two years later, I've just come across a client being offered this brain spotting thing by a clinical psychologist in private practice, who is also an EMDR consultant. Anyone familiar with it/thoughts? Gilly-why 'quack'?

Pink
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