Editorial, J Trauma Stress Disor Treat Vol: 0 Issue: 0
Emerging Directions in Traumatic Stress Disorders and Treatment
| Melanie D. Hetzel-Riggin* |
| 1Western Illinois University, USA |
| Corresponding author : Melanie D. Hetzel-Riggin Western Illinois University, USA E-mail: MD-Hetzel@wiu.edu |
| Received: June 21, 2012 Accepted: June 21, 2012 Published: June 23, 2012 |
| Citation: Hetzel-Riggin MD (2012) Emerging Directions in Traumatic Stress Disorders and Treatment. J Trauma Stress Disor Treat 1:1. doi:10.4172/2324-8947.1000e103 |
Abstract
Emerging Directions in Traumatic Stress Disorders and Treatment
Over the past 30 years, the field of traumatic stress disorders research and treatment has grown exponentially. A PsychINFO search on peer-reviewed research on “trauma treatment” identified 25 studies published in 1981; in 2011, there were 759. Numerous publication outlets for empirical and theoretical research now exist (to which the Journal of Traumatic Stress Disorders & Treatment is a helpful and desired addition). National and International centers and societies for the study of traumatic stress abound (i.e., the National Center for PTSD, the International Society for Traumatic Stress Studies, the International Society for the Study of Trauma and Dissociation, the Division of Trauma Psychology of the American Psychological Association). As we continue to grow and expand as a field of research and treatment, we must strive to address some of the remaining gaps in traumatic stress studies. Below are six important issues that I feel are areas of growth for the field of traumatology.
| Over the past 30 years, the field of traumatic stress disorders research and treatment has grown exponentially. A PsychINFO search on peer-reviewed research on “trauma treatment” identified 25 studies published in 1981; in 2011, there were 759. Numerous publication outlets for empirical and theoretical research now exist (to which the Journal of Traumatic Stress Disorders & Treatment is a helpful and desired addition). National and International centers and societies for the study of traumatic stress abound (i.e., the National Center for PTSD, the International Society for Traumatic Stress Studies, the International Society for the Study of Trauma and Dissociation, the Division of Trauma Psychology of the American Psychological Association). As we continue to grow and expand as a field of research and treatment, we must strive to address some of the remaining gaps in traumatic stress studies. Below are six important issues that I feel are areas of growth for the field of traumatology. | |
| Beyond the PTSD diagnosis: The upcoming publications of the DSM-5 and ICD-11 have sparked research and debate about our understanding of how traumatic stress disorders are theoretically related to each other, assessed, diagnosed, and treated [1]. Theoretical explanations of the effects of trauma frequently adopt a PTSD framework to explain the development of mental health consequences. What had become clear is that the diagnosis of posttraumatic stress disorder (PTSD), while an essential piece of our understanding of the emotional, cognitive, behavioral, and physiological consequences of trauma in many people, does not encompass the entirety of mental health consequences of trauma exposure. Not everyone who has a negative reaction to a potentially traumatic event (PTE) will develop PTSD; indeed, rates of depression, dissociation, anxiety disorders, eating disorders, somatoform disorders, and substance abuse and dependence are often higher after trauma exposure, even when PTSD symptoms are minimal or absent. A PsychINFO search on PTSD identified over 13,000 peer-reviewed studies over the past 30 years, while searches on reactive attachment disorder and other mental health outcomes and trauma found far fewer (< 150 over 30 years in some cases). As the field of traumatic stress studies matures, we need to continue to broaden our understanding of trauma reactions to encompass mental and physical health consequences beyond PTSD. | |
| Cultural competency: Cultural competency is an area of growth for the study of traumatic stress disorders and treatment. Organizations such as the International Society for Traumatic Stress Studies and the American Psychological Association have published multicultural and international practice guidelines when working with survivors of PTEs. Yet there still exists a paucity of research on the effects of these events on people from non-Western countries, people of color, members of a sexual minority, and other vulnerable populations. As a field, we need to be able to integrate a multicultural perspective into our assessment, diagnosis, and treatment understanding through cross-cultural research. We know that exposure to PTEs is common in impoverished or war-torn countries where terrorism is commonplace – how do we provide effective services to treat traumatic stress when the stressors are a part of one’s daily life? While a number of empirically supported treatments for PTSD and trauma have been identified (i.e., exposure therapy, cognitive processing therapy, trauma-focused CBT for children), there is little published research showing the effectiveness of these treatments cross-culturally. As a field, we need to make sure that the services we are providing are effective for everyone, no matter their background and living conditions. | |
| Dissemination: As is true of most clinically relevant research, we need to do a better job disseminating best practices for treating PTSD and other traumatic stress disorders to practioners in the field. As a scientist-practioner in a relatively rural area of the United States, local service providers, medical professionals, and legal professionals often call on me to provide education on the psychological effects of trauma on the victim as well as how to effectively treat victims. The International Society for Traumatic Stress Studies and the National Center for PTSD have begun providing online training modules for providers, yet we do not know how these online training modules translate to the actual provision of successful, trauma-focused treatment by the clinician-learner. Many front-line providers are unaware of these resources, do not have the financial resources to attend advanced trainings in the treatment of traumatic stress, or have caseloads so overloaded that taking time out of the workday to read or learn about advances in traumatic stress treatment is virtually impossible. We need to be more proactive in disseminating information on treating traumatic stress to front-line providers in a way that is easily accessible, effective, and flexible based on the needs of the clients. | |
| Resiliency: With the growth of the positive psychology movement, we have seen expansion in our understanding of how human beings are often able to handle PTEs with little to no ill effects and maintain a healthy pattern of functioning [2]. Continued research on resiliency is essential if we are to understand truly the nature of trauma within the human experience. If we can understand resiliency (how it develops and is maintained) within a biopsychosocial framework, we may be able to find ways to foster it in educational and health practices, community prevention work, and in our therapeutic activities. | |
| Individual differences in pre-trauma variables: As a field, we need to continue our investigation into what variables (such as personality, pre-trauma mental health issues, social support availability and accessibility, coping style, ethnicity and culture, etc.)influence the effects of PTEs. What variables increase someone’s risk for experiencing PTEs, or serve to minimize the likelihood of exposure? Researchers have identified some individual difference variables that serve as protective or risk factors for the development of mental health, physical health, or substance abuse problems after exposure to PTEs, but how do we integrate this information into best practices for community education and treatment decisions? How can we use pre-trauma individual difference variables to more effectively screen for elevated risk for the development of mental health disorders and integrate our understanding of personal individual differences into how we assess and treat survivors of trauma? | |
| Prevention education: As research and clinical practice has shown, pre-trauma mental health issues, coping style, and immediate responses to trauma exposure are extremely influential in the development of short- and long-term mental health outcomes and consequences. As traumatologists, we are often called upon during or after a PTE has occurred; in these cases, longitudinal, pre-trauma, and peri-trauma assessment and intervention is rarely possible. As is often said, “An ounce of prevention is worth a pound of cure”.The traumatic stress disorders field can work towards improving community educational practices to decrease the risk of exposure to PTEs, improve coping reactions during these events, and to minimize pre- and peri-trauma influences on the development of negative outcomes. Well-desgined and implemented program evaluation studies on the effectiveness of prevention education programs are greatly needed in the field of traumatic stress studies. | |
| While this is not an exhaustive list of the emerging directions in the study and practice of traumatic stress studies, they are areas in which we still need to grow. I look forward to reading the work of my colleagues on these topics in future issues of the Journal of Traumatic Stress Disorders & Treatment. | |
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