The assessment and treatment of post-traumatic stress disorder

Moving on after trauma

Health and Wellbeing at Work Conference,

presented by Dr Michael J Scott, Consultant Psychologist

to some 500 attendees at the Birmingham NEC, February 25th 2009

Screening For Trauma Responses:
Using The First Step Questionnaire (FSQ), the FSQ covers:

• Depression
• Post-traumatic stress disorder
• Alcohol/substance abuse/dependence
• Panic disorder and agoraphobia
• Generalised anxiety disorder
• Eating disorders
• Obsessive compulsive disorder
• Psychosis
• Mania

Example from the FSQ - PTSD

3. In your life, have you ever had any experience that was so frightening, horrible or upsetting that, in the past month, you:

i. Have had nightmares about it or thought about it when you did not want to?
Yes No Don’t know

ii. Tried hard not to think about it or went out of your way to avoid situations that reminded you of it?
Yes No Don’t know

iii. Were constantly on guard, watchful, or easily startled?
Yes No Don’t know

iv. Felt numb or detached from others, activities, or your surroundings?
Yes No Don’t know?

Is this something with which you would like help? Yes No Don’t know

PTSD & The Dodgy Alarm

The brain’s alarm - the amygdala

PTSD Treatment

• gradually ‘daring’ the victim to do what they have been avoiding
  
  
• better ways of handling the traumatic memory
  
  
• override the alarm by putting the trauma into context
  
  
• weaning the victim off an addiction to what could have happened
  
  
• restoring relationships and mood
  
  

PTSD and Comorbidity - nearly three quarters suffer from at least one other disorder

• Depression 55.7%
  
  
• Social phobia 35.2%
  
  
• Panic disorder 23.8%
  
  
• Specific phobia 18.2%
  
  
• Generalised anxiety disorder 12.5%
  
  
• Substance alcohol disorder 11.3%
  
  
• Obsessive compulsive disorder 8.0%
  
  

Treatment Of Each Identified Disorder Is Necessary

• The good news is that 70% of clients no longer meet criteria for PTSD at the end of treatment compared16% on a waiting list
  
  
• The even better news is that gains are maintained at 3 to 12 month follow up
  
  
• However there are doubts about the generalisability of findings because of restrictions on comorbidity in the studies conducted
  
  

Ways Forward

• Employees can be screened and their progress audited using the FSQ [details of which are in Simply Effective Cognitive Behaviour Therapy (2009) London: Routledge]
  
  
• Traumatised employees can be assisted using the self-help book Moving On After Trauma (2008) London: Routledge
  
  
• Comprehensive CBT for all the common mental disorders can be delivered using Simply Effective Cognitive Behaviour Therapy (2009)London: Routledge
  
  

Materials

• For copies of the First Step Questionnaire and the 7 Minute Mental Health Screen see my website www.simplyeffectivecbt.com
  
  
• For copies of this presentation and my notes see:
  [ http://www.posttraumaticstress.co.uk/psychology-publications/assessment-treatment-ptsd.php ] (this page).
  
  
• To contact me e-mail (or see contacts page)