| Peer-Reviewed

Post Traumatic Stress Disorder: An Alternative Paradigm

Received: 6 January 2020    Accepted: 20 January 2020    Published: 3 February 2020
Views:       Downloads:
Abstract

Trauma focussed treatments for PTSD, have limited efficacy and utility. The purpose of this paper is to review a) the theoretical base of TFT’s, in particular the evidence that a flawed traumatic memory lies at the heart of the development of PTSD b) the evidence that a focus on the traumatic memory is a necessary part of the evidence based treatment of PTSD and c) to distil an alternative model of PTSD. The author reviews existing trauma focussed treatments to determine a) what may be the active ingredients for change and b) treatment acceptability. He suggests that it is not proven that the qualities of the traumatic memory are pivotal in the development and maintenance of PTSD. Psychogenic amnesia is not found to be significantly associated with outcome, compared to the bodily expressions of exaggerated startle response and hypervigilance. There appears no added value in re-living the traumatic event per se, rather the latter may prevent treatment compliance. The author suggests an alternative conceptualisation of PTSD, that does not appeal to a notion of arrested information processing but suggests instead that PTSD arises from a state of terrified surprise, (which is a combination of an exaggerated startle response and hypervigilance) which the person explains in terms of a hostile environment.

Published in American Journal of Applied Psychology (Volume 9, Issue 1)
DOI 10.11648/j.ajap.20200901.11
Page(s) 1-6
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Trauma-focussed Treatment, Arrested Information Processing, EMDR, Treatment Acceptability, Dropouts

References
[1] Horowitz, MJ.: Stress response syndromes, Jason Aronson, New York, 1976.
[2] American Psychiatric Association: (1980) Diagnostic and Statistical Manual of Mental Disorders (DSM-III). APA, Washington, DC, 1980.
[3] Shapiro, F. & Maxfield, L.: Eye Movement Desensitization and Reprocessing (EMDR): Information processing in the treatment of trauma. Journal of Clinical Psychology, 58, 2002.
[4] Resick, PA. & Schnicke, MK. Cognitive Processing Therapy for Rape Victims: A Treatment Manual, Sage, Newbury Park, CA, 1993.
[5] Foa, EB. Molnar, C. Cashman, L. Change in rape narratives during exposure therapy for post-traumatic stress disorder. Journal of Traumatic Stress, 8, 1995.
[6] American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. DSM-5. Washington, DC, 2013.
[7] Brewin, C. R. Gregory, J. D. Lipton, M. Burgess., N.: Intrusive images in psychological disorders: Characteristics, neural mechanisms, and treatment implications. Psychological Review, 117 (1), 2010.
[8] Ehlers, A. & Clark, DM. A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 2000.
[9] Brewin, CR.: Memory processes in post-traumatic stress disorder. International Review of Psychiatry, 13, (2001).
[10] Foa, EB. Hembree, E. Rothbaum, BO.: Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences.: Oxford University Press, New York, NY, 2007.
[11] Nijdam, MJ. Martens, IJM. Reitsma, JB. Gersons, BPR. Olff, M.: Neurocognitive functioning over the course of trauma-focused psychotherapy for PTSD changes in verbal memory and executive functioning. British Journal of Clinical Psychology, 57, 2018.
[12] Bernsten, D. Willert, M. Rubin, D.: Splintered memories or vivid landmarks? Qualities and organization of traumatic memories with and without PTSD. Applied Cognitive Psychology, 17, 2003.
[13] Bedard-Giliigan, M. Zoellner, LA. Feeny, NC.: Is trauma memory special? Trauma narrative fragmentation in PTSD: effect of treatment and response. Clinical Psychological Science, 5, (2017).
[14] Stein, DJ. Koenen, KC. Friedman, M. J. Hill, E. McLaughlin, KA. Petukhova, M.: Dissociation in posttraumatic stress disorder: Evidence from the World Mental Health Surveys. Biological Psychiatry, 73, 2013.
[15] Steuwe, C. Lanius, RA. Frewen, PA.: Evidence for a dissociative subtype of PTSD by latent profile and confirmatory factor analyses in a civilian sample. Depression and Anxiety, 29, 2012.
[16] Larsen, SE. Fleming, CJE. Resick, PA.: Residual symptoms following empitrically supported treatments for PTSD. Psychological trauma: Theory, Research, Practice and Policy, 11, 2019.
[17] Liberati, A. Altman, DG. Tetzlaff, J.: The PRISMA statement for reporting systematic reviews and meta-analyses of stuies that evaluate healthcare interventions: explanation and elaboration British Medical Journal, 339, 2009.
[18] Hoffman, V. Middleton, JC. Feltner, C. Gaynes, BN. Weber, RP. Bann, C. Viswanathan, M. Lohr, KN. Baker, C. Green, J.: Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update. Comparative Effectiveness Review No. 207. (Prepared by the RTI International-University of North Carolinaat Chapel Hill Evidence-based Practice Center under Contract No. 290-2015-00011-I for AHRQ and PCORI.) AHRQ Publication No. 18-EHC011-EF. PCORI Publication No. 2018-SR-01. Rockville, MD: Agency for Healthcare Research and Quality;. Posted final reports are located on the Effective Health Care Program search page. May 2018.
[19] Bradley, R. Greene, J. Russ, E. Dutra, L. Westen, D.: A multi-dimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 2005.
[20] Antune-Alves, S. Vukovic, B. Milyavskaya, M. Therapist interventions and patient outcome: addressing the common versus specific factor debate. Archives of Psychiatry and Psychotherapy 3, 2018.
[21] Zalta, A. K. Gillihan, SJ. Fisher, AJ. Mintz, J. McLean, CP. Yehuda, R. Foa, E. B.: Change in negative cognitions associated with PTSD predicts symptom reduction in prolonged exposure. Journal of Consulting and Clinical Psychology, 82, 2014.
[22] Larsen, SE. Wiltsey Stirman S. Smith, BN.: Symptom exacerbations in trauma-focused treatments: associations with treatment outcome and non-completion. Behaviour Research and Therapy, 77, 2016.
[23] Resick, PA. Galovski, TE. Uhlmansiek, MO. Scher, CD. Clum, GA, Young-Xu Y.: A randomized clinical trial to dismantle components of cognitive processing therapy for post-traumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 2008.
[24] Resick, PA. Monson, CM. Chard, KM.: Cognitve Processing Therapy for PTSD: A Comprehensive Manual. Guilford Publications, New York 2017.
[25] Gehrt, TB. Bernsten, D. Hoyle, RH. Rubin, DC.: Psychological and clinical correlates of the Centrality of Event Scale: A systematic review. Clinical Psychology Review, 65, 2018.
[26] Gillespie, K. Duffy, M. Hackmann, A. Clark, DM.: Community based cognitive therapy in the treatment of posttraumatic stress disorder following the Omagh bomb. Behaviour Research and Therapy, 40, 2002
[27] Schulz, PM. Resick, PA. Huber, LC. Griffin MG.: The effectiveness of cognitive processing therapy for PTSD with refugees in a community setting. Cognitive and Behavioral Practice. 13, 2006.
[28] Tuerk PW. Yoder, M. Grubaugh, A. Myrick, H. Hamner, M. Acierno R.: (2011) Prolonged exposure therapy for combat-related posttraumatic stress disorder: an examination of treatment effectiveness for veterans of the wars in Afghanistan and Iraq. Journal of Anxiety Disorder, 25, 2011.
[29] Tolin, DF. McKay, D. Forman, EM. Klonsky, ED. Thombs, BD.: Emprically supported treatment: recommendations for a new model. Clinical Psychology Science and Practice, 22, (2015).
[30] NICE Post-traumatic Stress Disorder (PTSD): The management of PTSD in Adults and Children in Primary and Secondary Care (Clinicval Guidance 26). National Institute for Clinical Excellence London 2005.
[31] Scott, MJ.: Improving Access to Psychological Therapies (IAPT) – The Need for Radical Reform. Journal of Health Psychology 9, 2018.
[32] Scott, MJ. Stradling, SG. Client compliance with exposure treatments for posttraumatic stress disorder. Journal of Traumatic Stress, 10, 1997.
[33] Foa, EB. Keane, TM. Friedman, MJ. Cohen, JA.: Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York: Guilford Press 2009.
[34] Holmes, SC. Johnson, CM. Suvak, MK. Sijercic, I. Monson, CM. Stirman, SW.: Examining patterns of dose response for clients who do and do not complete cognitive processing therapy. Journal of Anxiety Disorder, 68, 2019.
[35] Foa, EB. Rothbaum, BO. Riggs, D. Murdock, T.: Treatment of PTSD in rape victims: A comparison between cognitive-behavioral procedures and counselling. Journal of Consulting and Clinical Pychology, 59, 1991.
[36] Yehuda, R. Bierer, LM. Pratchett, LC.: Cortisol augmentation of psychological treatment for warfighters with posttraumatic stress disorder: Randomized trial showing improved treatment retention and outcome. Psychoneuroendocrinology, 51, 2015.
[37] Scott, M. J. CBT for Common Trauma Responses Sage Publications, London, 2013.
[38] Greene, T. Gelkopf, M. Epskamp, S. Fried, E.: (2018) Dynamic Networks of PTSD symptoms during conflict, Psychological Medicine, 48, 2018.
[39] McNally, RJ. Robinaugh, DJ. Wu, G. W. Wang, L. Clinical Psychological Science, 3, Mental disorders as causal systems: A network approach to posttraumatic stress disorder. Clinical Psychological Science, 3, 2015.
[40] Spiller T. R., Schic, M., Schnyder, U., & Bryant, R. A Symptoms of posttraumatic stress disorder in a clinical sample of refugees: a network analysis. European journal of Psychotraumatology, 8, 1318032.
[41] Weathers, FW. Blake, DD. Schnurr, PP.: The Clinician Administered PTSD Scale for DSM-5 (CAPS-5). National Centre for PTSD 2013.
[42] Latack, JA. Moyer, A. Simon, VA. Davila, J.: Attentional bias for sexual threat among sexual victimisation survivors: A meta-analytic review. Trauma Violence and Abuse, 18, 2015.
[43] Ito, M. Horikoshi, M. Resick, PA.:.(2017) Study protocol for a randomised controlled trial of cognitive processing therapy for post-traumatic stress disorder among Japanese patients: the Safety, Power, Intimacy, Esteem, Trust (SPINET) study. BMJ open 2017; 7: e014292. doi: 10.1136/ bmjopen-2016-014292.
Cite This Article
  • APA Style

    Michael James Scott. (2020). Post Traumatic Stress Disorder: An Alternative Paradigm. American Journal of Applied Psychology, 9(1), 1-6. https://doi.org/10.11648/j.ajap.20200901.11

    Copy | Download

    ACS Style

    Michael James Scott. Post Traumatic Stress Disorder: An Alternative Paradigm. Am. J. Appl. Psychol. 2020, 9(1), 1-6. doi: 10.11648/j.ajap.20200901.11

    Copy | Download

    AMA Style

    Michael James Scott. Post Traumatic Stress Disorder: An Alternative Paradigm. Am J Appl Psychol. 2020;9(1):1-6. doi: 10.11648/j.ajap.20200901.11

    Copy | Download

  • @article{10.11648/j.ajap.20200901.11,
      author = {Michael James Scott},
      title = {Post Traumatic Stress Disorder: An Alternative Paradigm},
      journal = {American Journal of Applied Psychology},
      volume = {9},
      number = {1},
      pages = {1-6},
      doi = {10.11648/j.ajap.20200901.11},
      url = {https://doi.org/10.11648/j.ajap.20200901.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajap.20200901.11},
      abstract = {Trauma focussed treatments for PTSD, have limited efficacy and utility. The purpose of this paper is to review a) the theoretical base of TFT’s, in particular the evidence that a flawed traumatic memory lies at the heart of the development of PTSD b) the evidence that a focus on the traumatic memory is a necessary part of the evidence based treatment of PTSD and c) to distil an alternative model of PTSD. The author reviews existing trauma focussed treatments to determine a) what may be the active ingredients for change and b) treatment acceptability. He suggests that it is not proven that the qualities of the traumatic memory are pivotal in the development and maintenance of PTSD. Psychogenic amnesia is not found to be significantly associated with outcome, compared to the bodily expressions of exaggerated startle response and hypervigilance. There appears no added value in re-living the traumatic event per se, rather the latter may prevent treatment compliance. The author suggests an alternative conceptualisation of PTSD, that does not appeal to a notion of arrested information processing but suggests instead that PTSD arises from a state of terrified surprise, (which is a combination of an exaggerated startle response and hypervigilance) which the person explains in terms of a hostile environment.},
     year = {2020}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Post Traumatic Stress Disorder: An Alternative Paradigm
    AU  - Michael James Scott
    Y1  - 2020/02/03
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ajap.20200901.11
    DO  - 10.11648/j.ajap.20200901.11
    T2  - American Journal of Applied Psychology
    JF  - American Journal of Applied Psychology
    JO  - American Journal of Applied Psychology
    SP  - 1
    EP  - 6
    PB  - Science Publishing Group
    SN  - 2328-5672
    UR  - https://doi.org/10.11648/j.ajap.20200901.11
    AB  - Trauma focussed treatments for PTSD, have limited efficacy and utility. The purpose of this paper is to review a) the theoretical base of TFT’s, in particular the evidence that a flawed traumatic memory lies at the heart of the development of PTSD b) the evidence that a focus on the traumatic memory is a necessary part of the evidence based treatment of PTSD and c) to distil an alternative model of PTSD. The author reviews existing trauma focussed treatments to determine a) what may be the active ingredients for change and b) treatment acceptability. He suggests that it is not proven that the qualities of the traumatic memory are pivotal in the development and maintenance of PTSD. Psychogenic amnesia is not found to be significantly associated with outcome, compared to the bodily expressions of exaggerated startle response and hypervigilance. There appears no added value in re-living the traumatic event per se, rather the latter may prevent treatment compliance. The author suggests an alternative conceptualisation of PTSD, that does not appeal to a notion of arrested information processing but suggests instead that PTSD arises from a state of terrified surprise, (which is a combination of an exaggerated startle response and hypervigilance) which the person explains in terms of a hostile environment.
    VL  - 9
    IS  - 1
    ER  - 

    Copy | Download

Author Information
  • Psychological Therapies Unit, Liverpool, United Kingdom

  • Sections