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Home > Public Resources > Trauma Blog > 2015 - October > Book Review: Evidence Based Treatments for Trauma-Related Psychological Disorders, A Practical Guide

Book Review: Evidence Based Treatments for Trauma-Related Psychological Disorders, A Practical Guide for Clinicians

October 27, 2015

This textbook is truly a practical guide for clinicians with contributions from traumatic stress experts from around the world, who succinctly summarize each subject to enable the reader to develop a knowledge base that can be enriched through cited references. Basic principles constitute the first section covering epidemiology, psychological and social theories, neurobiology, and pathways that lead to physical health problems. Each of these chapters provides a pithy précis of the current state of knowledge of these core principles that establishes a solid foundation for the chapters that follow. The next short section, Part II, examines the DSM-5 diagnostic criteria for the new section, Trauma-Related Disorders, and the ICD-11 diagnoses. The author contrasts the two diagnostic criteria systems, noting the increased complexity of the DSM-5 and the more streamlined ICD-1, as pertaining to PTSD.

Part III is the evidence based and clinical core of the text. The nine chapters broadly cover evidence based psychotherapies for Acute Stress Disorder (ASD), Post-traumatic Stress Disorder (PTSD), and prolonged grief disorder, which is currently a preliminary DSM-5 and ICD-11 condition. The challenge of applying the current evidence base for interventions in the immediate aftermath of a trauma compared to treating people with ASD is well formulated and thought provoking, identifying the need for more research. This section covers current evidence based psychotherapy treatments for PTSD with chapters by an international expert on Prolonged Exposure, Cognitive Therapy, Cognitive Processing Therapy, EMDR, Narrative Exposure Therapy, Brief Eclectic Therapy, and STAIR Narrative Therapy. Each author deftly describes the theoretical framework, outcomes based on the current evidence, and special challenges in conducting the treatment. The treatment methodology and clinical cases illuminate the treatment for the reader with additional references for further learning. The final chapter in the psychotherapy series addresses the same systematic approach to provide knowledge of Complicated Grief Treatment, noting the current conflicts in the diagnostic nomenclature, complete with multiple clinical vignettes to assist the reader.

While the numbers of co-morbid disorders for trauma related disorders are broad, this text elected to present three chronic and complex conditions and their treatment overview. Chapters are dedicated to the overlap of PTSD and substance use disorders (SUD), borderline personality disorder (BPD), and chronic pain. Each of these chapters is well written and based on the current state of research, which in some are limited and in need of further research. The most robust evidence base in this section is for the PTSD/SUD with one treatment significantly more researched than others. The authors review the knowledge base of treating BPD and PTSD accurately assessing the limitations and the need for additional research to replicate and expand treatment approaches for this common co-morbidity. The interface and overlap of trauma and pain is among the most difficult to parse and this was cogently presented, again with a clinical vignette as a focal point of discussion. The attention paid to these specific disorders focuses the reader to some of the most difficult clinical challenges for these disorders that alone are difficult to diagnose and treat, but are more so when complicated by PTSD.

The next two sections deal with special populations and special treatment modalities with authors noting where evidence exist and where clinical judgment in translating treatments from other disorders and populations are common, but at present lacking sufficient evidence for precise interventions. These are thought provoking sections that should challenge the field to research these areas. The special population section addresses trauma across the life span from the young to the old, refugees and immigrants, and veterans. The child and adolescent knowledge base is presented for ASD and PTSD divided into older and younger age children and includes psychotherapy and psychopharmacological reviews, with discussion of the strength and weakness of the current research base. The chapter on the older person with PTSD provides a view of aging and effective approaches to working with older patients, but accurately points out the paucity of research to define effective interventions. Translation of evidence from treating older persons with other disorders, such as depression, are discussed as potential clinical approaches to adapting adult evidence based treatments for PTSD in this special population. The diagnostic and treatment approaches for refugees and immigrants presents a great challenge to a succinct summary. The author anchors this chapter in a clinical case to highlight the core concepts in these complex cases. The psychological trauma, physical problems, legal issues, cultural issues and social disruption, as well as, a variety of issues around guilt and moral injury are adeptly addressed. The last chapter in this section is focused on issue related to veteran PTSD, examining issues related to combat trauma and military sexual trauma. The authors present concepts on military culture that non-veteran providers and those within veteran systems need to understand to help veterans deal with combat related issues, including grief, loss, and moral injury. Two cases are presented to demonstrate these two types of military trauma, core concepts, and evidence based treatments.

The section on special treatment modalities discusses common clinical approaches that are frequently helpful, but may have an insufficient evidence base. Methodological issues in group therapy research are discussed; an overview of group therapy with its potential benefits and complications is presented. The couple therapy chapter reveals the importance of impact of trauma on the relationship and promotes strong consideration for including the partner in treatment. A review of the evidence of several treatment approaches is organized for the reader with a discussion of the possible benefits to the person with trauma, the partner, and the relationship. The last chapter in this section explores the innovations in treatments through telemental health including Clinical Video-Teleconferencing, web-based interventions, mobile health that serve to increase access to care with the suggestion that these vehicles will permit use of other evidence based treatments.

Pharmacological treatments are the most researched and evidence based treatments, in particular for the selective serotonin reuptake inhibitors (SSRI) and the serotonin-norepinephrine reuptake inhibitors (SNRI). Other medications with weaker evidence are also reviewed. Several PTSD treatment guidelines are referenced with a summary of their commonalities, strengths, and limitations. This chapter will lead the clinician to read references and guidelines to determine evidence based effective dosing as few dose ranges are provided.

The final chapter by the book editors and a colleague asks the question, “What works for whom?” They explore some of the very fundamental questions that confront all behavioral health care providers across all types of disorders, including the therapeutic alliance, patient-therapist match, therapist characteristics, and patient characteristics. The chapter then focuses on issues related to trauma treatment selections out of the many options and often similar therapeutic interventions and combination approaches.

In summary, I strongly recommend this book for clinicians, advanced students of trauma stress, and educators across disciplines. This text provides a solid foundation that will prompt the reader to further exploration of the multiple treatment options and consider how to expand our personal and the field’s evidence base in treating trauma related disorders.
 

About the Authors


Janet E. Osterman MD, Vice Chair for Education and Training and Director of Psychiatry Residency Program at Boston University Medical Center and Associate Professor of Psychiatry at Boston University School of Medicine.