Trauma doesn’t discriminate.
It can affect anyone, anywhere throughout the world and, unfortunately . . .
. . . not everyone has similar access to resources for treating trauma or PTSD.
So, what can we do to reach survivors of trauma who have limited access to treatment options?
Paul Bolton, MBBS and a team of researchers from the Johns Hopkins University Bloomberg School of Public Health, wanted to test the effects of PTSD treatment provided by workers who had access to few resources and little training opportunities.
To complete this study, Bolton coordinated 20 community health workers in Iraq. The workers were randomly assigned to two different treatment groups – Behavioral Activation Treatment for Depression (BADT) and Cognitive Processing Therapy (CPT).
BADT is designed to allow patients to recognize their depression, and then engage in positive activities to overcome it.
CPT helps patients focus on the traumatic event and initially works to change the inaccurate details of what happened. The purpose of the treatment is to allow survivors to talk about their trauma in flexible terms to reduce PTSD symptoms.
For two weeks, these community workers were trained in one of two treatment interventions that were being evaluated.
Next, the researchers gathered a sample of 732 survivors of systematic violence (torture or other severe violent trauma). The survivors were screened, and 281 were enrolled in the trial.
The researchers assembled a waitlist control group of 66 patients. The remaining participants were randomly placed into one of the two treatment groups.
The researchers found moderate, positive correlations between each of the treatment interventions and decreased PTSD symptoms.
Now, the purpose of this study was not to see which intervention was more effective, but rather to see if it was possible to decrease PTSD symptoms for trauma survivors when there are limited resources and training opportunities available for treatment.
On one hand, it is hard to generalize these results to a large group – would the treatments be effective in other areas that have restricted resources?
But, this study does indicate that even limited trauma interventions can be effective in helping people who are suffering from PTSD.
In Dohuk, Iraq, where the study was completed, many of the patients lack language proficiency and live in extreme poverty, and these can make treatment even more difficult.
But it’s astonishing to see results when the community workers in this study had received a mere two weeks of training.
You see, studies like this reinforce my commitment to provide ongoing training for practitioners in health and mental health fields.
It’s always encouraging for me to read emails from professionals all around the world who have used our programs. Our goal at NICABM is to spread awareness about effective interventions to as many people as possible in order to treat as many people as possible.
I’m hopeful that some of our programs may even be reaching people who don’t have access to adequate resources.
It’s crucial to remember that trauma happens everywhere and that, even for people who are living in extreme poverty with limited resources, basic treatments can have a major impact on trauma survivors.
Have you ever worked in an area where those suffering from trauma or PTSD have limited resources? What do you think we can do to make treatment options more accessible all around the world? Please leave a comment below.
There three trauma resolution techniques I know of that resolve symptoms. All of them have been used for many years — one in refugee campus– with great results in the resolution of trauma symptoms! And they are easily Learned by lay people.
I don’t understand why they are not more well known.
Hi Ruth, I am so grateful that you have opened this topic for discussion and that there are so many different responses. i work with iraqi refugees and their children and have used both Lifesapn Integration and Sensorimotor Psychotherapy in treating PTDS. I know that we are touching the tip of the iceberg when we treat refugees from Iraq. there are so many traumatized people suffering in Syria and iraq and are not getting the opportunity to come over as refugees. These people are the future of the Middle East – a dismal thought. I agree that besides getting funding to help them, it would be a great idea if therapists would donate a month of their year to go to the refugee camps and treat them where they are at.
Thank you to all of you for helping this population,
Blessings,
Mona El-Masry
What does “moderate positive correlations” mean here?
A therapy that is already in use at Fort Bliss for PTSD is HeartMath…… I become concerned that our industry continues to attempt various forms of talk therapy another off shoot of CBT and assign new meanings of “viable evidenced based treatments “. HeartMath is part of the protocol being used in a sponsored recovery program at Fort Bliss, Texas and heals the heart from the inside out for PTSD streams from Vietnam and Iraq wars….
The use of HeartMath is revolutionary and not in the mainstream of our profession enough..,
The heart has its own, more powerful central nervous system…. Combined with healthy supplemental therapies, such as mindfulness meditation, etc then results can and may be lasting…. I have not seen any “talk therapy ” be the end all of the therapies to heal PTSD…..
I agree that biofeedback techniques amplify and quantify recovery in PTSD. HeartMath is a leader in the heart coherence protocols. Many D.O.D. and V.A. facilities are using biofeedback (also Wild Divine IOM systems such as Relaxing Rhythms and Somatic Vision’s Alive) to enhance treatment for our returning military personel.
I humbly suggest that it is the combination of CBT, CPT, etc.. with a visual, quanitative mind-body awareness vehicle which creates the greatest value to our valued PTSD veterans.
May I also add: the premise of this study and this article is for application of a treatment in resource poor environments. Therefore, when we have nothing but our mind and our mouths, talk therapy’s application being proven ‘to be moderately positive’ is encouraging.
Thanks!
I created a protocol for working with children (with help of generous colleagues) in the streets, schools and orphanages of Kabul after the Taliban retreated. We worked with finger puppets resembling an Afghan boy and girl who we explained were having bad dreams and we wondered if any of the children shared this difficulty. using very little language, drawings and close attention to each of the children in the group we had them draw and then destroy the bad drawings using bilateral ripping and stomping. we then encouraged them to create new hopeful (hope is an important word in the Afghan culture) drawings. Pleasant Afghan music played in the background. they were invited to keep the new drawings and we went to each child and pressed a small puppet into the palm of their hand and asked if they would please care for it. they were delighted and excited to promise they would care for their new friend.
we adjusted the protocol for age and situation but always included creating a small community, a way to tell their stories, music bilateral stimulation and our attention and caring in the interaction.
How about some resources on PTG, post-traumatic growth? So much less known than PTSD, yet said to be much more common.
Also, please share info on understand the crucial difference between typical responses to trauma versus PTSD. According to Martin E.P. Seligman in his book Flourish, “merely knowing that bursting into tears is not a symptom of PTSD but a symptom of normal grief and mouring, usually followed by resilience, helps to put the brakes on the downward spiral.” Seligman outlines 5 elements that contribute to PTG:
1: understanding the response to trauma itself
2: anxiety reduction
3: constructive self-disclosure
4: creating a trauma narrative
5: articulating life principles and stances that are more robust to challenge
When I was in Rwanda, I listened to Tutsi survivors. It took basic listening skills, a welcoming attitude toward release of painful feelings, utmost respect for the integrity, intelligence, and capacities of the survivor, an ability to lighten things up (not by distraction or irrelevant humor but modeling scornful attitudes toward terror or putting the memory more safely into the past) when the person started to shut down or become flooded. There is a huge need and people are eager to be listened to. I’d love to form networks of Rwandans who have basic training and then have resources to process what they have heard.
Hi Ruth,
Thanks so much for all your articles you have offered to help with PTSD victims…you are to be commended! One of the major concerns i have is with the V.A. And their outdated policy of permitting ONLY Psychologists with an approved APA internship to work with them. I, and many of my STATE LICENSED colleagues who for many reasons completed internships with other agencies cannot work with That system. I am licensed in California and Washington state, have worked with vets in different treatment centers for over 40 years…but am denied this service… A loss for so many vets who need our skills (CBT and MBSR) trained as well in several other therapies.
Wish there were options… Alas, so far, no response from the VA. Anyway, that s change that really is long overdue.
I might add thati have used mindfulness, hypnosis, tai chi and psychodrama as relevent models to assist returning vets with PTSD symptomology, all with positive outcomes.
Thanks again for all you do.
Roger I. Bailey, Ph.D. FACAPP
CISM-D approved instructor,
Kitsap
I would love to see a study done on the effectiveness of a more somatic based therapy or as Bessel Van der Kolk says,” Limbic System” focused– to unload from the bottom up instead of top down.
TRE – Trauma Release Exercise System has been used in over 30 countries around the world — check out Dr. David Berceli for more information if you are not yet familiar with this system.
Dr. Berceli is currently conducting a 5 year study with the Vets Hospital in Phoenix, AZ. Looking forward to seeing the results!
Dear Ruth –
I am very interested in the study you talk about. Can you send me more information? I am beginning research with a group of women veterans who have returned from the Middle East, all with various issues from their experience. I am putting together training for veterans, volunteers and health service professionals who have little to no background in these issues, so I think this may be a valuable piece of research.
Thanks,
Jim Smith
Hi Jim,
The article was published December, 2014 in BMC (BioMed Central) Psychiatry. You can find it on their website.
Dear Ruth –
I am very interested in the study you talk about. Can you send me more information? I have been helping set up psychosocial programs in Jordan for young refugee children, especially Syrian and Iraqi children, where there are very few services available. As a former teacher I have spent the last few years working with teachers and other child care givers on how they can help the children in their classrooms who have experienced disasters, either natural or man-made.
I am also working, long distance, with a couple of people in northern Syria who are doing play therapy with children, as well as working with their families and the schools. There is tremendous need out there for psychological help for young children – and as you indicate – trained resources just aren’t available. Anything you can do to put me in touch with new resources (people, funding, training, whatever) would be really helpful.
Not only is there need for training for people we might call paraprofessionals but also for parents who don’t know how to help their kids as well as older siblings who often are the caregivers and have even less idea of what to do with their younger siblings.
It is so very sad to realize that we are losing generations of kids because of the effects of war and violence. So whatever resources you can suggest, please let me know.
Thank you.
Beryl Cheal
Teacher/trainer/consultant
disastertraining@gmail.com
Good morning. I know Teresa’s work and I also trained in TIR, Narrative Exposure Therapy,and I use EFT so people can continue their own work. I also like One Eye Movement and other iterations of EMDR but not EMDR.There are a few others of what Harvard calls the power therapies and some have been around for thirty or forty years and with solid studies now to back up their efficacy. Any of these techniques can be taught in DAYS to lay people and are immediately applied. We work in and with community people around the world to train and collaborate with them to assure how and what we/teach is culturally relevant. The western mode of one on one work is laughable to those in tribal cultures. I think we have to watch our ethnocentricity, Community people must be taughtIF we are to address the millions of traumatized who will not get care under the current policies and the belief that only professionals can offer trauma resolution. Additionally, it is very empowering that people work within their own communities and teach others so the good work spreads.
Good Morning Ruth,
My experience with trauma training began in the 90’s with Teresa Descilo at the Miami-Dade-Victim Service Center. She gave a presentation on traumatology for St. Thomas University’s Loss & Healing Certificate Program’s Crisis and Trauma course, before we ever knew there was such an “olpgy” or knew about a Dr. Figley. Teresa sent me and a classmate to Seattle WA for Criminal Death Support training with a Dr Rynerson. When we returned we gave trauma treatment training to the staff and other health and social service departments in Miami. Miami-Dade county helps fund the Center @ 17587 So Dixie Hywy which services individuals intake, and for continued support groups @ Coral House, 900 Perrine. Teresa and her trained staff contribute greatly to the community with support activities for the those recovering from trauma and for the community’s education of trauma resolution.
Thank you for your continued education and support. Teresa can be reached at the following addresses for more information on the Miami Trauma Connection. Be blessed, Joan
Teresa Descilo, MSW, MCT
Executive Director
The Trauma Resolution Center
17567 So. Dixie Hwy
Miami, FL 33157
305-374-9990 fax 9995
Dear Joan –
Oh, my goodness, I just posted a request for help for working with Syrian and Iraqi refugee kids and then I read your post and your mentioning your work with Dr. Rynerson, here in Seattle! Thanks so much for the reminder. I met him several years ago, but had forgotten about his being a great possible resource! I’ll call him right away. That is a terrific idea.
Thank you –
Beryl Cheal
disastertraining@gmail.com
Dear Beryl,
You never know if you’re going to add beneficial information in a blog situation. I’m so pleased that my posting reminded you of Dr Rynerson. Such a sensitive and delightful man. He and his staff even came to Miami to help us with a conference we held at St Thomas U, I think in 2001, on trauma. It was an exciting time.
Blessings on your work with the children. What a noble and needed use of your talents.
Let me know how it goes 🙂
Hello Ruth,
It’s good to hear of all the compassionate and effective work going on in ravaged parts of the world to heal trauma.
As well as the above approaches EFT (Emotional Freedom Technique) has been shown to be extremely effective in the healing and neutralising of trauma – such as with soldiers returning from Iraq; soldiers in Rwanda; trauma relief and humanitarian aid in areas traumatised by earthquakes – such as in Indonesia and the Philipines; the families of those massacred in the school at Newtown CT; etc
It is also cost-effective – as it can be taught to people and children as a self-regulation tool, (although it helps to work with a skilled and conscious practitioner).
Here are some useful resources: Eric Hurre has made a film called The Answer – of Gary Craig’s work (the founder of EFT) with traumatised US vets returning from Iraq – and he can be contacted on eric@skywriter.ca
Project Light – Dr. Lori Leyden’s work with Rwandan genocide survivors and boy soldiers (she also helped with the Newtown CT Project).
Google Deepak Mostert’s Trauma Relief programme in Indonesia;
There’s enough researched evidence now of the beneficial and neutralising effects of EFT on health and trauma – though more needs to be done of course. Doctors in the UK NHS are beginning to respond (some with bemused surprise) at the results being achieved on patients. Prof. Tony Stewart’s work with alternative tapping techniques.
I could go on!
Thank you for all the good work you put out!
Warmly,
Viv Fogel UKCP MBACP AAMET
Senior Training Psychotherapist & Supervisor,
at the Psychosynthesis Trust, London Bridge, SE1
Master Accredited EFT Practitioner & Trainer
Integrative Psycho-energetic Psychotherapist
If, as you say, two weeks is sufficient to train in the basics of PTSD Treatment, I believe many health care providers and nutrition counsellors would be willing to train, and to volunteer their services for a month or more, which would minimize the costs involved in such a program. I favor enlisting volunteers in preference to fund-raising for these services, which we can hope would be unnecessary in coming years.
Hi there, I’m one of the directors of the Canadian Hypnosis Assoc and I
Have found using hypnosis to heal the brain and yoga/meditation for ongoing
Skill development in affect regulation has been very helpful. Re-patterning the mind
And clearly years of trauma can be accomplished so quickly using the hypnosis. I have begun
Doing my hypnosis work in groups with great results. I just returned from several months in India and used my approach in groups there and in Canada. Let me know if I can offer additional info. Thanks for the blog and ongoing information- Ruth- great work!
Heather Good
Change for the Good