Thanos Karatzias

A controlled comparison of the effectiveness and efficiency of two psychological therapies for posttraumatic stress disorder: eye movement desensitization and reprocessing vs. emotional freedom techniques.

The present study reports on the first ever controlled comparison between eye movement desensitization and reprocessing (EMDR) and emotional freedom techniques (EFT) for posttraumatic stress disorder. A total of 46 participants were randomized to either EMDR (n = 23) or EFT (n = 23). The participants were assessed at baseline and then reassessed after an 8-week waiting period. Two further blind assessments were conducted at posttreatment and 3-months follow-up. Overall, the results indicated that both interventions produced significant therapeutic gains at posttreatment and follow-up in an equal number of sessions. Similar treatment effect sizes were observed in both treatment groups. Regarding clinical significant changes, a slightly higher proportion of patients in the EMDR group produced substantial clinical changes compared with the EFT group. Given the speculative nature of the theoretical basis of EFT, a dismantling study on the active ingredients of EFT should be subject to future research.

Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ)

BACKGROUND The WHO International Classification of Diseases, 11th version (ICD-11), has proposed two related diagnoses following exposure to traumatic events; Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). We set out to explore whether the newly developed ICD-11 Trauma Questionnaire (ICD-TQ) can distinguish between classes of individuals according to the PTSD and CPTSD symptom profiles as per ICD-11 proposals based on latent class analysis. We also hypothesized that the CPTSD class would report more frequent and a greater number of different types of childhood trauma as well as higher levels of functional impairment. Methods Participants in this study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N=193). Participants completed the ICD-TQ as well as measures of life events and functioning. RESULTS Overall, results indicate that using the newly developed ICD-TQ, two subgroups of treatment-seeking individuals could be empirically distinguished based on different patterns of symptom endorsement; a small group high in PTSD symptoms only and a larger group high in CPTSD symptoms. In addition, CPTSD was more strongly associated with more frequent and a greater accumulation of different types of childhood traumatic experiences and poorer functional impairment. LIMITATIONS Sample predominantly consisted of people who had experienced childhood psychological trauma or been multiply traumatised in childhood and adulthood. CONCLUSIONS CPTSD is highly prevalent in treatment seeking populations who have been multiply traumatised in childhood and adulthood and appropriate interventions should now be developed to aid recovery from this debilitating condition.

An initial psychometric assessment of an ICD-11 based measure of PTSD and complex PTSD (ICD-TQ): Evidence of construct validity

Among the conditions following exposure to traumatic life events proposed by ICD-11 are Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). The primary aim of this study was to provide an assessment of the reliability and validity of a newly developed self-report measure of ICD-11 PTSD and CPTSD: the ICD-11 Trauma Questionnaire (ICD-TQ). Participants in this study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N=193). Participants completed the ICD-TQ and measures of traumatic life events, DSM-5 PTSD, emotion dysregulation, self-esteem, and interpersonal difficulties. Confirmatory factor analysis results supported the factorial validity of the ICD-TQ with results in line with ICD-11 proposals. The ICD-TQ demonstrated satisfactory internal reliability, and correlation results indicated that the scale exhibited convergent and discriminant validity. Current results provide initial support for the psychometric properties of this initial version of the ICD-TQ. Future theoretical and empirical work will be required to generate a final version of the ICD-TQ that will match the diagnostic structure of PTSD and CPTSD when ICD-11 is published.

A review of the literature relating to psychological interventions and people with intellectual disabilities: Issues for research, policy, education and clinical practice

The aim of this review is to identify and analyse the published evidence base and wider literature in relation to psychological interventions for adults with intellectual disabilities. The review suggests that the evidence base regarding psychological interventions is sparse yet growing, and if the therapeutic approaches are modified and adapted to meet the distinct needs of people with intellectual disabilities these may be life enhancing. The lack of access to psychotherapies for people with intellectual disabilities has led to their exclusion from mainstream research, thereby limiting the evidence base on effective interventions and treatment approaches. This has significant implications for research, policy, education and clinical practice and is an area requiring strategic and local attention and development in the future.

Vicarious traumatisation in practitioners who work with adult survivors of sexual violence and child sexual abuse: Literature review and directions for future research

Primary objective: The authors sought to summarise and evaluate evidence regarding vicarious traumatisation (VT) in practitioners working with adult survivors of sexual violence and/or child sexual abuse (CSA). Methods and selection criteria: Relevant publications were identified from systematic literature searches of PubMed and PsycINFO. Studies were selected for inclusion if they examined vicarious traumatisation resulting from sexual violence and/or CSA work and were published in English between January 1990 and June 2008. Critical analysis and results: Ten studies met the criteria of the present review. In summary, VT levels in the field of sexual violence/CSA are high with negative effects, but do not appear to exceed those reported by professionals working with non-sexual violence or with sexual offenders. Further investigation is needed into predisposing and mediating factors before clear conclusions can be drawn. Conclusions: Previous research has suffered a number of methodological limitations regarding definitions, sampling, comparison groups, support arrangements and measurement. These factors compromise not only the rigour and generalisability of findings but also our ability to define VT as a useful concept. These limitations are discussed and recommendations made for a future research agenda.

Talking Therapy Services for Adult Survivors of Childhood Sexual Abuse (CSA) in Scotland: Perspectives of Service Users and Professionals

This study aimed to elicit perceptions and experiences of talking therapy services for CSA survivors and professionals utilizing qualitative interviews and analyzing transcripts using Interpretative Phenomenological Analysis. Participants included 13 adult survivors and 31 professionals in statutory and voluntary services in Scotland. Main themes were benefits from and challenges of the therapeutic process. Benefits included a trusting therapeutic relationship, feeling safe to disclose, breaking isolation, enhancing self-esteem and self-worth, contextualizing the abuse, and moving toward recovery. Challenges included trauma-focused work, supportive contact, continuity and consistency of services, accessibility during acute episodes, hearing and managing disclosures, child protection issues, and availability and accessibility of services. The findings support a greater emphasis on relational models, supervision, and training.

The effectiveness of, and predictors of response to, inpatient treatment of anorexia nervosa

OBJECTIVE The inpatient treatment of anorexia nervosa lacks a clear evidence base. We sought to determine the effectiveness of, and predictors of response to, a specialist inpatient programme for adults with anorexia nervosa, and to survey satisfaction with the same. METHOD Demographic and clinical data were collected, at three time points, for 90 consecutive admission episodes over a three-year period. RESULTS Both a completers and an intention-to-treat analysis indicated the effectiveness of the programme. A longer length of hospital stay was associated with a greater degree of change in BMI, but no other predictors of treatment outcome were detected. Participants reported a high degree of satisfaction with the programme. CONCLUSION Adults suffering from anorexia nervosa improved significantly with a specialist programme delivered in an inpatient setting. Future research should investigate the potential role of factors other than obvious demographic and clinical history variables in determining treatment outcome.

Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire

The 11th version of the International Classification of Diseases (ICD‐11) has proposed two related trauma diagnoses: Post‐traumatic stress disorder (PTSD) and Complex PTSD (CPTSD). Using a newly developed, disorder‐specific measure of PTSD and CPTSD called the International Trauma Questionnaire (ITQ) the current study will (i) assess the factorial validity of ICD‐11 PTSD and CPTSD; (ii) provide the first test of the discriminant validity of these constructs; and (iii) provide the first comparison of ICD‐11, and Diagnostic and Statistical Manual, Fifth Edition (DSM‐5), PTSD diagnostic rates using disorder‐specific measures.

Alternative models of disorders of traumatic stress based on the new ICD-11 proposals

Although there is emerging evidence for the factorial validity of the distinction between post‐traumatic stress disorder (PTSD) and complex PTSD (CPTSD) proposed in ICD‐11, such evidence has been predominantly based on using selected items from individual scales that describe these factors. We have attempted to address this gap in the literature by testing a range of alternative models of disorders of traumatic stress using a broader range of symptoms and standardized measures.

General psychopathology in anorexia nervosa: The role of psychosocial factors

The aim of the present study was to investigate psychosocial correlates of comorbid psychopathology. Data were collected from a total of 90 female inpatients with anorexia nervosa (AN). Higher levels of general psychopathology were detected in depression, interpersonal sensitivity, obsessive-compulsive and anxiety subscales of the Symptom Checklist (SCL)-90. Regression analysis also revealed that higher levels of psychopathology across SCL-90 subscales in AN patients are significantly associated with an earlier age of onset of the condition, higher levels of anorectic psychopathology as measured by Eating Disorders Examination, lower self-esteem as measured by Multidimensional Self-Esteem Inventory and social support levels as measured by Quality of Social Network and Social Support Questionnaire. Considering the high levels of general psychopathology in people with AN, routine clinical practice should aim for a comprehensive assessment of such. Given the strong association between psychosocial factors such as self-esteem, social support and general psychopathology, psychological therapies could play an important role in facilitating emotional recovery.