In recent years, our knowledge of traumatic stress related disorders has advanced considerably. To ensure the right care is provided, it is important to stay up-to-date on the latest peer-reviewed research and treatment options – especially for those working in trauma-exposed organisations such as the police, emergency services or the military.
The Phoenix Centre in Melbourne provides Australia’s national guidelines on the management of PTSD which includes established treatment modalities such as Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Yet despite a series of important advances in recent years, the diagnosis and treatment of traumatic stress-related disorders remains a relatively young area in mental healthcare, which is itself a young area of medicine as a whole.
In coming years, I expect the field to make substantial progress – there is great potential to leverage new technology and treatment innovations to better care for sufferers of mental trauma, many of whom undertake profoundly difficult work to protect the broader community.
PTSD is part of a range of disorders
When it comes to traumatic stress-related disorders and mental illness, Post-Traumatic Stress Disorder (PTSD) tends to dominate the debate. However, traumatic events may cause a range of disorders, not just PTSD.
Trauma exposure can lead to clinical depression, or a whole spectrum of “adjustment disorders” – that are still devastating to the professional and personal lives of sufferers. Whatever the nature of the disorder, understanding the symptoms and how best to manage them is very important.
PTSD itself consists of a range of symptoms including ongoing distress, changes to thought patterns and intrusive memories of traumatic events. However, two core features of the disorder are avoidance and impairment of function. PTSD can only be diagnosed where someone takes active steps to avoid trauma-related stimuli and has significant symptom-related difficulties in fulfilling their daily or professional obligations.
Two types of traumatic stress
The symptoms of PTSD generally come on in one of two ways. In the case of type one trauma, a singular incident sparks an extreme traumatic response in the stricken person. Type two trauma refers to a much slower and drawn out onset period as the result of multiple traumatic events which are often, although not always, occupationally-related.
Over the course of a long career in the emergency services, for instance, you would expect to witness a number of traumatic events. While many people will find adaptive ways of coping, such as talking about the incidents with people they trust, others find it increasingly difficult to deal with each subsequent incident and their symptom burden eventually rises to the level that it warrants the label of a PTSD diagnosis.
In both conditions the symptoms are similar –avoidance and impairment of function, among other things – but with type two trauma, it is often the case that at the time of diagnosis someone’s lifetime ‘dose’ of trauma can be very high. But early detection of impending problems should allow employers to intervene at an earlier point and limit the damage.
Detection and intervention for prevention
We know that many people who suffer with mental health problems, including PTSD, do not seek any help at all. However, research has found that pro-active and informal peer support networks are very effective in identifying people who are developing problems and getting them the help they need.
One such peer support framework pioneered in the British Royal Marines in the 1990’s is known as TRiM (Trauma Risk Management). Would-be TRiM practitioners receive training in the identification and initial management of traumatic stress, and pro-actively reach out to at-risk colleagues after potentially traumatising events to begin informal conversations.
Now, 20 years later, TRiM is now in use across trauma-exposed organisations such as emergency services, media professionals, diplomats, healthcare workers and train drivers all over the world, and its effectiveness has been confirmed by scientific research.
Once people are identified as having a trauma-related health problem, positive actions by their organisation – such as temporarily moving the person into a less trauma-prone role or ensuring they have access to good support from their work-buddies and managers – can assist recovery. Some people suffering from persistent difficulties will require professional assessment and treatment by appropriately experienced professionals.
For such courses of treatment, the Phoenix Centre in Melbourne advocates a range of programmes such as CBT and EMDR. EMDR appears to be infrequently used in Australia despite being an evidence-backed treatment programme that has been proven to make serious and positive change in the lives of those suffering from excessive traumatic stress. And while trauma-focused CBT is more commonly understood, recent innovations have radically changed the ways in which it can be delivered.
Traditionally, CBT programmes involve one session a week for 12-20 weeks. But interesting new studies suggest that 16-20 hours of CBT can be delivered in just one week, enabling a traumatised man or woman to have one week of treatment and be ready for a graded return to his or her duties.
New advances in treatment options
Over the next 20 years, there will be further advances in treatment options of this kind. One promising area is the delivery of remote therapy over Skype or instant messaging applications – there is now strong evidence that it can be as effective as face-to-face therapy. This method can allow sufferers to communicate with a professional without having to travel long distances or even, in some cases, to reveal who they are which may help navigate around the social stigma of mental illness.
Also in its infancy is Virtual Reality technology. Because EMDR and CBT both incorporate trauma therapy – where people are safely exposed to the cause of their trauma so they can learn to manage their fear response in a controlled manner – the use of Virtual Reality could be an effective method of treatment. There are also novel approaches to the way therapy is delivered: for instance, accelerated resolution therapy (ART) is a modified approach to EMDR, and early research suggests it may be more rapidly effective than standard EMDR protocols.
Alongside these technological advancements will come, I hope, a better understanding of mental illness and some measure of “parity of esteem” – that is, equal treatment of mental and physical health problems. When a person suffering from an adjustment disorder receives the same due care and day-to-day professionalism in treatment as a person suffering from a knee injury, we will have reached this point!
Of course, we are some way from that moment. But we owe it to sufferers of traumatic stress – whether a result of their employment or otherwise – to improve our efforts and stay on top of new research, treating them in the most effective way possible and so allowing them to remain healthy and productive members of society.