• A survey of specialized traumatic stress services in the United Kingdom

      Regel, Stephen; Joseph, Stephen (2013)
      Specialist care following psychological trauma in the UK has, since 2005, been governed by the National Institute for Health and Clinical Excellence (NICE) Guideline 26, for the treatment of post-traumatic stress disorder. NICE guidance states that the preferred first-line treatment is trauma-focused cognitive behavioural therapy that incorporates techniques of eye movement, desensitization and reprocessing. In light of this guidance, the rationale for this survey was to assess the nature and scope of services available in UK specialist trauma services and range of available therapeutic approaches delivered. Thirteen organizations responded to the survey. Ten were NHS services and three were non-statutory organizations. Professional positions were primarily populated by psychologists. The total number of referrals to UK specialist trauma services surveyed in the 12 months prior to the survey was 2041 with a mean of 157. Trauma-focused cognitive behavioural therapy was the most common therapeutic treatment, but person-centred therapy was found to have increased in availability within specialist trauma services. This arguably reflects the widening availability of person-centred therapy in the improving access to psychological therapies initiative and perhaps suggests some divergence from more uniform cognitive and behavioural approaches within NHS therapy services. Implications for practice are discussed.
    • Adapting the protocol for narrative exposure therapy for adults with mild intellectual disabilities

      Marlow, Katie; Schroder, Thomas; Renton, Jess (2022)
      Background Narrative exposure therapy (NET) is a trauma‐focused cognitive behavioural therapy, recommended by the National Institute for Health and Care Excellence in 2018, to treat posttraumatic stress disorder in adults. There is a lack of research exploring the effectiveness of NET with adults with intellectual disabilities. The aim of this study is to develop an adapted version of the NET protocol (IDNET) for use with adults with mild intellectual disability. Methods A qualitative research design was employed. Stage one involved systematically adapting the NET protocol for adults with mild intellectual disabilities in collaboration with a service user group comprising eight consultants. Stage two involved gaining professionals' views on the adapted protocol and on the use of NET in intellectual disability services. This comprised a focus group of eight clinical psychologists specialising in intellectual disabilities and an expert panel of three NET clinicians. The framework approach was conducted on the focus group data only following guidance from a previous study. Findings An adapted NET protocol and collection of ‘easy read’ therapy materials were developed (IDNET), which incorporated feedback from the three stakeholder groups. Key concepts of ‘Optimism and motivation to adapt NET for people with mild intellectual disabilities’ and ‘Factors related to NET in practice’ were developed to describe the views of clinical psychologists. A number of issues were raised by professionals regarding the delivery of IDNET. Conclusions Professionals were optimistic about IDNET; however, issues raised regarding the delivery of IDNET require exploration when IDNET is trialled in practice. Specific implications for clinical practice and future research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Source: journal abstract)
    • Alternative therapy or good nursing care? Therapeutic touch with mentally disordered offenders

      Brimsted, Anne; Miller, A.; Robinson, David K. (1998)
      Therapeutic touch (TT) is an alternative therapy that has been used for many years within the general nursing and medical context and is becoming increasingly popular in psychiatry. This paper gives an account of TT in a selected patient and explores its potential as an alternative therapy with patients in forensic psychiatric care.
    • An affective-cognitive processing model of post-traumatic growth

      Joseph, Stephen; Murphy, David; Regel, Stephen (2012)
      A topic that has begun to attract interest from clinical psychologists and psychotherapists is post-traumatic growth. First, we provide a general overview of the field, setting out the historical development, main concepts, measurement issues and research findings. Second, we review evidence showing that the relationship between post-traumatic stress and post-traumatic growth is likely curvilinear. Third, a new affective-cognitive processing model of post-traumatic growth will be introduced in which post-traumatic stress is understood to be the engine of post-traumatic growth. Fourth, points of clinical intervention are described showing the ways in which therapists can facilitate post-traumatic growth.; Copyright © 2012 John Wiley & Sons, Ltd.
    • An investigation of the factors associated with an increased risk of psychological morbidity in burn injured patients

      Tedstone, Josephine E. (1998)
      Previous research aimed at identifying factors that increase the risk of major burns patients experiencing psychological problems post-burn has generally ignored the potential role of psychological factors. In a prospective study, patients with burn injuries ranging from < 1 per cent up to 40 per cent were interviewed within 2 weeks of sustaining the burn and followed up at ca 3 months post-burn in order to assess the effects of both non-psychological and psychological factors on their subsequent mental health. The factors investigated included burn related information, demographic information, previous psychiatric history, levels of psychological morbidity at 2 weeks post-burn, responsibility for the injury, previous life events, compensation claims and factors from the coping literature including appraisal, coping strategies and coping efficacy. Forward stepwise multiple regression analyses were used to investigate the relationships between these factors and subsequent mental health. Post-burn psychological morbidity was strongly associated with psychological factors including levels of psychological morbidity in the first 2 weeks of sustaining the injury and factors from the coping literature.;
    • An investigation of the prevalence of psychological morbidity in burn-injured patients

      Tedstone, Josephine E. (1997)
      Research on the psychological impact of burn injuries has concentrated on major burns, while small burns have been largely neglected. In a prospective study, 45 patients with burn injuries ranging from 1 per cent or less up to 40 per cent total body surface area were assessed using semi-structured interviews within 2 weeks of sustaining the burn, and followed-up at approximately 3 months postburn to investigate the prevalence of mental health problems. The prevalence of clinically significant levels of anxiety, intrusions and avoidance remained similar at 2 weeks and 3 months postburn, however, the prevalence of depression and Post Traumatic Stress Disorder (PTSD) increased 6- and 4-times, respectively, by 3 months. Patients with small burn injuries of 1 per cent or less also experienced clinically significant levels of psychological difficulties postburn. The implications for the identification of patients at risk of future psychological morbidity are discussed.;
    • Are acceptance and commitment therapy-based interventions effective for reducing burnout in direct-care staff? A systematic review and meta-analysis

      Tickle, Anna C. (2018)
      Purpose Work-related stress amongst staff working in direct care roles in mental health and intellectual disability settings is associated with a range of problematic outcomes. There has been a proliferation of research into the use of acceptance and commitment therapy (ACT)-based interventions in this staff population. The purpose of this paper is to review the extant literature. Design/methodology/approach A systematic search of the literature was conducted, and seven studies identified which met the criteria for inclusion in the review, of which four were eligible for meta-analysis. Findings Results of the meta-analysis were most convincing for the effectiveness of ACT-interventions to reduce psychological distress within a subgroup of those with higher distress at baseline. There was no statistically significant effect for the amelioration of burnout, nor for an increase in psychological flexibility (a key ACT construct). Research limitations/implications Conceptual issues are considered including the purpose and treatment targets of ACT interventions, such as supporting valued living rather than diminishing stress per se. Methodological issues are discussed around the measurement of psychological flexibility. Originality/value This review makes recommendations for future research and for the implementation of ACT-interventions for work-related stress in these settings.
    • Associations among childhood trauma, childhood mental disorders, and past-year posttraumatic stress disorder in military and civilian men

      Syed Sheriff, Rebecca (2019)
      To identify early life factors associated with posttraumatic stress disorder (PTSD), we investigated the association between childhood trauma and mental disorders with International Classification of Diseases (ICD)-diagnosed past-year PTSD in employed military and civilian men. Data were derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study (N = 1,356) and the 2007 Australian Bureau of Statistics (ABS) National Survey of Mental Health and Wellbeing Study (N = 2,120) and analyzed using logistic regression and generalized structural equation modeling. After controlling for demographics, PTSD was associated with childhood anxiety, adjusted odds ratio (AOR) = 3.94, 95% CI [2.36, 6.58]; and depression, AOR = 7.01, 95% CI [2.98, 16.49], but not alcohol use disorders, in the ADF. In civilians, PTSD was associated with childhood anxiety only, AOR = 7.06, 95% CI [3.50, 14.22]. These associations remained significant after controlling for childhood and adult trauma in both populations and service factors and deployment, combat, or adult trauma in the ADF. In both populations, PTSD was associated with more than three types of childhood trauma: AOR = 2.97, 95% CI [1.53, 5.75] for ADF and AOR = 5.92, 95% CI [3.00, 11.70] for ABS; and childhood interpersonal, but not noninterpersonal, trauma: AOR = 3.08, 95% CI [1.61, 5.90] for ADF and AOR = 6.63, 95% CI [2.74, 16.06] for ABS. The association between childhood trauma and PTSD was fully mediated by childhood disorder in the ADF only. Taking a lifetime perspective, we have identified that the risk of PTSD from childhood trauma and disorder is potentially predictable and, therefore, modifiable.
    • Childhood determinants of suicidality: comparing males in military and civilian employed populations

      Syed Sheriff, Rebecca (2018)
      BackgroundTo better understand the associations of childhood trauma and childhood disorder with past-year suicidality (thoughts, plans or attempts), we compared male military and civilian populations aged 18–60 years old.MethodsData derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Australian Bureau of Statistics Australian National Survey of Mental Health and Wellbeing were compared using logistic regression and Generalized Structural Equation Modelling (GSEM).ResultsA greater proportion of the ADF experienced suicidality than civilians. Those who experienced childhood trauma that was not interpersonal in nature were not at increased odds of suicidality, in either population. A higher proportion of the ADF experienced three or more types of trauma in childhood and first experienced three or more types of trauma in adulthood. Both were associated with suicidality in the ADF and civilians. Childhood anxiety had a strong and independent association with suicidality in the ADF (controlling for demographics and childhood trauma, adult trauma and adult onset disorder). Childhood anxiety fully mediated the relationship between childhood trauma and suicidality in the ADF, but not in civilians.ConclusionsThese data highlight the need to take a whole life approach to understanding suicidality, and the importance of categorizing the nature of childhood trauma exposure. Importantly, childhood anxiety was not only associated with suicidality, it fully mediated the relationship between childhood trauma and suicidality in the more trauma exposed (military) population only. These findings have the potential to inform the development of strategies for suicide prevention.
    • Childhood trauma and childhood mental disorder in military and employed civilian men

      Syed Sheriff, Rebecca (2020)
      We aimed to retrospectively investigate childhood trauma and childhood mental disorder in military and employed civilian men aged 18 to 54 years. Data, derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Australian Bureau of Statistics National Survey of Mental Health and Wellbeing Study, were analyzed and compared using direct age standardization and logistic regression. A greater proportion of ADF reported childhood trauma, multiple trauma types, trauma onset below 12 years of age, and interpersonal trauma than civilian employed men. A greater proportion of ADF reported childhood noninterpersonal trauma, such as accidents, than civilian employed men, with a marked difference in those aged 45 to 54 years. In both populations, childhood disorder was associated with childhood trauma; however, childhood depression was not associated with childhood noninterpersonal trauma in either population. A deeper understanding of the longer-term risk and resilience conferred by different childhood trauma profiles is needed.
    • Childhood trauma and the impact of deployment on the development of mental disorder in military males

      Syed Sheriff, Rebecca (2019)
      BackgroundChildhood adversity is associated with mental disorder following military deployment. However, it is unclear how different childhood trauma profiles relate to developing a post-deployment disorder. We investigated childhood trauma prospectively in determining new post-deployment probable disorder.MethodsIn total, 1009 Regular male ADF personnel from the Australian Defence Force (ADF) Middle East Area of Operations (MEAO) Prospective Study provided pre- and post-deployment self-report data. Logistic regression and generalised structural equation modelling were utilised to examine associations between childhood trauma and new post-deployment probable disorder and possible mediator pathways through pre-deployment symptoms.ResultsThere were low rates of pre-deployment probable disorder. New post-deployment probable disorder was associated with childhood trauma, index deployment factors (combat role and deployment trauma) and pre-deployment symptoms but not with demographic, service or adult factors prior to the index deployment (including trauma, combat or previous deployment). Even after controlling for demographic, service and adult factors prior to the index deployment as well as index deployment trauma, childhood trauma was still a significant determinant of new post-deployment probable disorder. GSEM demonstrated that the association between interpersonal childhood trauma and new post-deployment probable disorder was fully mediated by pre-deployment symptoms. This was not the case for those who experienced childhood trauma that was not interpersonal in nature.ConclusionsTo determine the risk of developing a post-deployment disorder an understanding of the types of childhood trauma encountered is essential, and pre-deployment symptom screening alone is insufficient. Copyright © Cambridge University Press 2019.
    • Client-centred therapy for severe childhood abuse: A case study

      Murphy, David (2009)
      Aims: This case study demonstrates the experience of client change in non-directive client-centred therapy for a client ('Mac') who had experienced severe and repeated childhood abuse within an institutional care setting and shows how complex posttraumatic stress involving difficulties in identity, problems forming and maintaining non-abusive interpersonal relationships were encountered within the therapy. Method: The data were taken from the detailed notes of 160 sessions of client-centred therapy. Following detailed reading and re-reading a phenomenological analysis of the data produced four emergent themes. Results: The four themes were labelled: post-traumatic distress, acceptance and understanding, new meaning-accurate symbolisation and growth and relationship. Conclusion: The findings suggest that following severe trauma the experience of being in a client-centred therapeutic relationship was related to a reduction in post-traumatic distress. In turn, new meaning was created through accurate symbolisation of previously denied and/or distorted traumatic experience. Additionally, the client displayed growth in the development of a small number of non-abusive relationships that improved his quality of life. It is proposed that client-centred therapy can help client adjustment to the consequences of severe and traumatic childhood abuse.
    • Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis

      das Nair, Roshan (2021)
      Background: Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. Objectives: This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy. Data sources: The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. Review methods: Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I-2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. Results: A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I-2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I-2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I-2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. Limitations: Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. Conclusion: Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. Future work: Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. Study registration: This study is registered as PROSPERO CRD42017078690.
    • Commonalities and new directions in post-trauma support interventions: From pathology to the promotion of post-traumatic growth

      Regel, Stephen (2012)
      This chapter will aim to address a number of issues in order to lend clarity to the debate by beginning with (1) providing a brief overview of the development of Psychological Debriefing (PD) and the direction of research in the field; (2) examining the current trend to re-invent the wheel by renaming CISM and PD interventions; (3) deconstructing some of the myths surrounding PD, especially that of retraumatization through the provision of PD; and (4) examining and illustrating how the literature has added to the lack of clarity and confusion. The chapter will also go on to examine some key issues in the provision of PD within the context of post-trauma support, such as training in PD, the role of assessment prior to initiating peer support group crisis intervention meetings, and what the NICE Guidelines for PTSD really recommend with regard to early interventions. We will then move on to argue for the use of CISM, PD, and other workplace trauma support interventions within the context of social and organizational support given that there is significant evidence to indicate that social support is seen as a significant protective factor following exposure to traumatic events and the lack of social support as a major risk factor. Finally we will argue for a more sophisticated approach to research and practice in the field of workplace trauma support by suggesting a new paradigm for understanding the rationale for providing such support. This will be through addressing issues related to measuring the effectiveness of interventions within the context of post-traumatic growth rather than the presence or absence of pathology, an issue, which has dominated the literature with regard to assessing the effectiveness of early interventions. The promotion of psychological well-being (PWB) and resilience will also be addressed. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: chapter)
    • Current perspectives on assessment and therapy with survivors of torture: The use of a cognitive behavioural approach

      Regel, Stephen (2007)
      Increasing numbers of refugees are presenting to mental health services in Europe and Scandinavia and pose significant clinical challenges for practitioners. The most clinically challenging to engage in a psychotherapeutic context are survivors of torture and politically organized violence. Much of the literature on therapeutic work with torture survivors has tended to focus on psychodynamic approaches. There have also been attempts to describe other approaches, such as the use of testimony, with some attempts to study and describe cognitive behavioural approaches in torture survivors. It has been demonstrated that cognitive behavioural therapy is effective for PTSD, as recommended by the NICE (2005) guidelines for the assessment and management of PTSD in primary and secondary care. This paper will review and critique the current literature on therapy with refugees and survivors of torture. Through case examples, the use of CBT will be illustrated as an effective treatment intervention for this group. It will be demonstrated that the model can have effective clinical outcomes and provide a practical, problem-orientated approach to working with survivors of torture and political violence. This paper will also describe the use of assessment and treatment approaches using CBT principles, demonstrating the flexibility and applicability of the model. It also demonstrates the utility of CBT in different cultural contexts, despite perceived cultural limitations. Implications for assessment and practice in a cross-cultural setting will be discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(journal abstract)
    • Early interventions following exposure to traumatic events: Implications for practice from recent research

      Regel, Stephen (2012)
      It is has been argued that early interventions for individuals, groups or others affected by traumatic events should not be routinely offered as there is the danger of causing more harm. The notion of "watchful waiting" has been espoused in clinical guidelines for the assessment and treatment of posttraumatic stress disorder (PTSD). Instead, a more proactive early intervention is suggested for potentially traumatic events that have the potential to lead to high psychic distress, PTSD, or complicated grief reactions for a significant number of those affected. This involves providing strategies tailored to the needs of these individuals and families and not providing conventional individual therapeutic interventions. Early intervention is wise as recent research has demonstrated that early misconceptions and negative appraisals about one's own reactions to a trauma can be significant in the development and maintenance of posttraumatic reactions and early intervention may help in forming adequate appraisals, thus counteracting misunderstandings and misperceptions. Adopting a "watchful waiting" approach with individuals and families has the potential to hinder and impede their longer-term coping responses. Recent advances, especially in the field of memory research, have implications for early interventions. We present recent findings, which make the case for early interventions following exposure to traumatic events.
    • Early interventions following traumatic bereavement

      Regel, Stephen (2014)
      A 'traumatic bereavement' is such when the loss is sudden, violent or unexpected; for example, a road traffic collision, suicide or homicide. The experience is terrifying and shocking; individuals cannot prepare for, or protect themselves from, the event. Many traumatically bereaved people find their profound shock, loss or grief is compounded by a lack of help at this terrible time. They need early support, information and advice to help them cope, understand the reactions they are experiencing, and make sense of what has happened. Accessing early support following a traumatic bereavement can make a significant difference to someone's long-term recovery. This report explores: common reactions to traumatic bereavement and how they develop; the role of assessment; and some strategies to manage the challenges that arise as a consequence.
    • Expanding the bounds of military psychiatry: Three clinical encounters

      Moldavsky, Daniel (2008)
      This paper deals with clinical situations frequently encountered in military psychiatry. Using three narratives of soldiers assessed at the Israeli Defence Forces (IDF) during a period of marked conflict between Israel and the Palestinian Authority, the author portrays ethical dilemmas generated during assessments for fitness to go to combat. When the focus of the assessment is the soldier's refusal to serve in the army, particularly during periods of increased conflict, the psychiatrist faces a dilemma because of double loyalties, to the army of which he is a part, and to the soldier and his right to live. Based on previous literature and experience, some cases of refusal to serve may be understood going beyond the boundaries imposed by the medical model. The author discusses these issues in the context of Israeli society. In Israel, conscription is universal, and the army is not professional. However, given the lack of social legitimacy in Israel for refusal to serve in the IDF due to conscientious objection, soldiers who are otherwise aware of the ethical dilemmas imposed upon them by the harsh Israeli reality are left with no option other than to get exempted from military duties on psychiatric grounds. The author discusses how social and historical factors contribute to the construction of psychiatric and psychological symptoms.;