Trauma-focused cognitive therapies
9 February 2009
Distressing sensations such as flashbacks, sleep problems and strong emotions including anxiety, shame, guilt or anger are common after any traumatic event. Most people recover within a few weeks but a significant proportion - around a quarter - continue to experience disturbing and disabling symptoms collectively known as post-traumatic stress disorder (PTSD). Anke Ehlers’s team at the Institute of Psychiatry and the University of Oxford has developed a highly effective form of cognitive therapy that has helped survivors of terrorist attacks and other traumatic experiences.
With David Clark, Professor Ehlers has proposed a model of PTSD based on the notion that PTSD develops when trauma survivors continue to perceive the past trauma as a current threat. This leads to a variety of ways thinking (and behaving) that, although intended as coping strategies, actually serve to maintain the condition.
In several studies, cognitive factors specified in this model have been found to be the strongest predictors of chronic PTSD symptoms. The validity of this model has underpinned a PTSD-specific form of cognitive therapy shown to be highly effective in several clinical trials. It is superior to alternative psychotherapies and achieves better outcomes than drug treatments.
One group to benefit significantly has been survivors of terrorist attacks, including survivors of the Omagh bombing. This led to the creation of the Northern Ireland Centre for Trauma and Transformation, which has achieved positive results even in patients with severe terrorism-related PTSD.
Tragically, the London bombings of 7 July 2005 provided another opportunity to apply trauma-focused cognitive therapies. Professor Ehlers has been part of a collaborative effort to identify and treat people directly exposed to the bombings. About 150 people have been treated to date and, encouragingly, the treatment effects have been as great as those seen after Omagh.
Professor Ehlers's Principal Research Fellowship was renewed in 2008.
Image: Professor Anke Ehlers of the Institute of Psychiatry.
References
Ehring T et al. Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia and depression after motor vehicle accidents? A prospective longitudinal study. J Consult Clin Psychol 2008:76(2);219-30.
Bisson JI et al. Psychological treatments for chronic post-traumatic stress disorder. Systematic review and meta-analysis. Br J Psychiatry 2007;190:97-104.
Brewin CR et al. Promoting mental health following the London bombings: a screen and treat approach. J Trauma Stress 2008;21(1):3-8.