The therapy of combat-related post-traumatic stress disorder: A critical review of NICE guidelines and considerations on clinical implications
Description
Purpose: This poster will present results from a review of the NICE guidelines (2005) for PTSD. It will also consider the literature around psychotherapies for post-traumatic difficulties with military veterans.
Background: The guideline recommends Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) as first line treatment. Other psychotherapies are not recommended.
Method/Key Points: The debates surrounding the notion of superiority of TF-CBT and EMDR are explored. In particular, the arbitrary classification of psychotherapies under TF-CBT makes it difficult to ascertain what it entails. It appears that in practice, TF-CBT draws from Ehlers and Clark’s model (2000) which bears little resemblance to the studies cited in NICE. The validity issues of the comparisons made between psychological interventions cited and waiting list/ control are considered. It is argued that these factors undermined the conclusions made by NICE.
Conclusions: When psychotherapies are reclassified to bona fide (intended to be therapeutic), evidence converge to suggest that there does not appear to be a difference between various psychotherapies especially around reprocessing of trauma. Since the publication of the NICE guidelines in 2005, more studies have been conducted, examining relative efficacy. Various psychotherapies not previously considered by NICE have shown potential. Our review also identified a dearth of systematic bottom-up studies of individuals’ experience of what they found helpful and therapeutic. Furthermore, at present, NICE guidelines provide recommendations for general PTSD rather than CR-PTSD. The military is a unique organisation and carries a work culture that is different from civilians’. Thus, a case is made for research on a phenomenological approach towards working with CR-PTSD, which contextualises the military culture and encompasses a wider view of their problems.
Background: The guideline recommends Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) as first line treatment. Other psychotherapies are not recommended.
Method/Key Points: The debates surrounding the notion of superiority of TF-CBT and EMDR are explored. In particular, the arbitrary classification of psychotherapies under TF-CBT makes it difficult to ascertain what it entails. It appears that in practice, TF-CBT draws from Ehlers and Clark’s model (2000) which bears little resemblance to the studies cited in NICE. The validity issues of the comparisons made between psychological interventions cited and waiting list/ control are considered. It is argued that these factors undermined the conclusions made by NICE.
Conclusions: When psychotherapies are reclassified to bona fide (intended to be therapeutic), evidence converge to suggest that there does not appear to be a difference between various psychotherapies especially around reprocessing of trauma. Since the publication of the NICE guidelines in 2005, more studies have been conducted, examining relative efficacy. Various psychotherapies not previously considered by NICE have shown potential. Our review also identified a dearth of systematic bottom-up studies of individuals’ experience of what they found helpful and therapeutic. Furthermore, at present, NICE guidelines provide recommendations for general PTSD rather than CR-PTSD. The military is a unique organisation and carries a work culture that is different from civilians’. Thus, a case is made for research on a phenomenological approach towards working with CR-PTSD, which contextualises the military culture and encompasses a wider view of their problems.
Format
Conference
Language
English
Original Work Citation
Ishaq, M., & Draghi-Lorenz, R. (2013, July). The therapy of combat-related post-traumatic stress disorder: A critical review of NICE guidelines and considerations on clinical implications. Poster presented at the Division of Counselling Psychology Annual Conference, Cardiff, UK
Citation
“The therapy of combat-related post-traumatic stress disorder: A critical review of NICE guidelines and considerations on clinical implications,” Francine Shapiro Library, accessed May 11, 2024, https://francineshapirolibrary.omeka.net/items/show/22428.