Data and Evidence-Based Outcomes
Many promising treatment interventions for the consequences of trauma exist; further work in this area will help to establish an evidence-based approach to trauma treatment.
Facts and Discussion Points:
* A wide variety of treatments are available for Posttraumatic Stress Disorder. Some have been proven effective. Others may work, but have not yet been studied extensively (among these treatments are Cognitive Behavioral Therapies [CBT], Drug Therapies, Eye Movement Desensitization and Reprocessing [EMDR], Group and Individual Therapy).1
* To date, CBT (but not EMDR) has shown promise in controlled studies that exclude or simply fail to include people with chronic and persistent mental illness or addictions. Recent studies of Rosenberg et al.’s use of a Cognitive Restructuring Approach—combined with individual therapy—is showing promise with people hospitalized and diagnosed with schizophrenia who also have PTSD symptoms.2
* Alternative approaches emphasizing skills and support for managing trauma-related symptoms in the “here-and-now” are showing promise.2
* Dialectical Behavioral Treatment, though not designed specifically for treatment of PTSD, is a helpful treatment approach for some survivors.3
* Practitioners trained in evidence-based treatment, such as cognitive behavioral approaches, may be hard to find. Locating effective treatment for consumers with traumatic stress symptoms can be difficult, as many therapists have no training in treating stress disorders.1, 4, 5
* There is currently a shortage of health and mental health professionals who are educated and trained to work with trauma. Most clinical education programs lack formal courses or educational opportunities in trauma. American universities have been slow to contribute to advances in the study and treatment of trauma.1, 4, 5
* Research monies are being spent on techniques directed at symptom management of PTSD as well as other mental health categories. Managed care often overlooks trauma-focused relational psychotherapy. CBT, meds, and EMDR target symptoms and do not address the core of trauma work, which is relational.6
Recommendations:
* SAMHSA should integrate comprehensive trauma programs into the academic mainstream, and should require trauma education to be required for key professional groups (psychologists, nurses, social workers, neurobiologists, public health workers, medical researchers, etc.). SAMHSA should convene key professionals from universities, guilds, and licensing and accrediting bodies to organize practical programs in traumatology that draw from existing models and facilitate cross-fertilization between fieldwork, university research, and curricula.
* SAMHSA should encourage professional accrediting bodies to include some form of trauma training in their programs.
* Develop a “Certificate of Proficiency in the Treatment of Trauma Disorders.”
* Collaborate with the National Area Health and Education Center Program (AHEC) to bring trauma training programs and educational opportunities to professionals and communities served by AHEC Centers across the country.
* Foster and fund increased training in trauma theory and application to all service providers.
* Foster and fund treatment outcome research for existing models.
* Promote funding for trauma-specific psychotherapy, and trauma-informed services in general.
* Trauma survivors should be involved in every aspect of research design, development, practice, and analysis of trauma education programs.
* Assist evaluators in developing research practices that identify the relational components of trauma work in the assessment of interventions for trauma survivors.
Data and Evidence-Based Outcomes References
1. Goode, E. (November 20, 2001). Treatment can ease lingering trauma of September 11. Science Times, The New York Times.
2. J. Ford, Ph.D. (personal communication, April 2002).
3. S. Witterholt, M.D. (personal communication, August, 2002).
4. Marshall, S. (March 4, 2002). Mental health system failing 9/11 victims: Traumatized counselors lack skills, funds. Crain’s New York Business.
5. Strom, S. (July 22, 2002). Mending the hearts broken on September 11 is as difficult as explaining the cost. The New York Times.
6. R. Mazelis (personal communication, April 2002).