Authors: Roger Gurr, Maree Teesson, Kathy Mills, Jorge Aroche
Event: 2017 TheMHS Conference
Subject: symposium, trauma, therapy, substance use, comorbidity
Type of resource: Conference Presentations and Papers
Abstract: 1. Towards an Integrated Hierarchy of Treatments for Developmental Trauma & PTSD - A/Prof Roger Gurr
A high proportion of people with serious mental health disorders, have a history of trauma, whether developmental in childhood and adolescence, or from traumatic events in adulthood. Yet the effects of trauma persist unless effectively treated, they have serious consequences in mood disorders, psychosis, substance abuse, gambling, aggressive and violent behaviours, and personality disorders. The pain, suffering and economic cost to the individual, family and community are enormous. We talk about trauma informed care, but few people receive effective evidence based treatments for trauma - why is this so?
We will provide an overview of the current evidence base and give specific examples of research and experience in providing effective treatments across a range of needs. We will involve the audience in debating what should to be done to create and fund a hierarchy of care and treatments for this most important but neglected area of need.
2. Integrated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence: what have we learnt from the Australian research trials? - A/Prof Kath Mills & Prof Maree Teesson
In 2001-2002, 615 people with heroin dependence were invited to join the Australian Longitudinal Study of Heroin Dependence. Over 11 years these people have been telling their story and changing the way we provide support and treatment for people with heroin dependence. One of the first and most important findings was the extensive and complex histories of trauma exposure and PTSD among Australians with heroin dependence. High rates of trauma exposure (92%), particularly childhood trauma, and PTSD (41%) were reported, highlighting trauma and PTSD to be a major, but mostly hidden, issue for Australian heroin users. Individuals with PTSD presented with a more severe clinical profile, and continued to have poorer physical, mental health over time. 81% were exposed to further trauma over the 10-11yrs follow up and 25% attempted suicide. These findings led to an innovative NHMRC funded randomised controlled trial of an integrated treatment for PTSD and substance dependence. The findings of this world-first trial were published in JAMA, the world’s leading medical journal. The treatment manual was subsequently published by Oxford University Press as part of their “Treatments that Work” series and there is now further research conducted in the United States and Europe. Kath and Maree also received NHMRC funding in 2017 to undertake a further RCT examining an intervention for adolescents in response to the early age of onset of trauma and substance use. We will discuss the issues encountered in delivering integrated exposure based therapy, the findings and plans for the new study.
3. 28 years of Treating Trauma at STARTTS - Mr Jorge Aroche
This paper discusses the role of torture and trauma services in addressing the mental health needs of refugees, and the Bio-Psycho-Social Systemic approach utilized by STARTTS and a growing number of torture and trauma services in Australia and elsewhere to assist torture and trauma survivors overcome their psychological and psychosocial sequelae. The paper argues that T&T services play a pivotal role in enabling refugees to overcome the effect of traumatic experiences and resettle successfully to the point that they can integrate and contribute at all levels in societies such as Australia. It is proposed that the success of T&T services in this regard relies on the substantial depth of knowledge and experience they have developed over time in a complex area that is defined by the intersection of traumatology, cross cultural competence and the understanding of the impact of socio-political processes on individuals and communities. Particular reference is made of the exciting contribution to this approach derived from STARTTS adoption of an interpersonal neurobiology perspective, including the utilization of EEG and QEEG to inform treatment plans, as well as the utilization of Neurofeedback and related techniques in addressing cases resistant to other therapeutic approaches.
4. Panel discussion with dialogue from the floor on what can be done to progress the implementation of the evidence base across the wide range of needs - all presenters.
Learning Objective 1: Understand the evidence of what works in treating trauma across co-morbidities and across age groups.
Learning Objective 2: Understand the issues in trying to implement effective treatment of trauma in current service delivery systems and financial constraints.
Van Der Kolk, B (2015) The Body Keeps the Score: brain, mind, and body in the healing of trauma. New York: Penguin
Mills KL, Teesson M, Back SE, Brady KT, Baker A, Hopwood S, Sannibale C, Barrett E, Merz S, Rosenfeld J, Ewer PL. Integrated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence: A randomized controlled trial. JAMA. 2012; 308(7): 690-699.
Back S, Foa E, Killeen T, Mills K, Teesson M, Carroll K, Brady K (2014) Concurrent Treatment for PTSD and Substance Use using prolonged exposure (COPE): Therapist Manual, Oxford University Press.
Ewer, P. L., Teesson, M., Sannibale, C., Roche, A., & Mills, K. L. (2014). The prevalence and correlates of secondary traumatic stress among alcohol and other drug workers in Australia. Drug and Alcohol Review, 34(3), 252-258.
Fisher. S.F. (2014) Neurofeedback in the Treatment of Developmental Trauma. New York: W.W. Norton & Company
Van Der Kolk, B., Hodgdon, H., Gapen, M., Musicaro, R., Suvak, M.K., Hamlin, E., Spinazzola, J., (2016). A Randomized Controlled Study of Neurofeedback for Chronic PTSD. PLoS ONE 11(12): e0166752 doi:10.137