Has anyone seen a good review or meta-analysis of ways to address childhood trauma and fostering resilience? One often sees mention of the importance of even one supportive relationship, but is this intuitive or evidence based?
thank you
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I think you're asking at least two different questions.
(i) what meta-analyses of treatment for "childhood trauma" have been done, and what have they shown
(ii) what evidence is there that a single supportive relationship will be sufficiently therapeutic in order for one to not need other forms of treatment
I think both of these are really great questions BUT one would need to define ones terms very clearly beforehand -- for example, childhood trauma is mentioned as if it was a single thing -- but it isn't, and herein lies a real problem -- what is "childhood trauma" -- not all people go through what has been called in the past a Criterion A Trauma, using DSM criteria for PTSD; and there have been changes to what is called PTSD -- and there will be further changes with the introduction next year as currently predicted, but it's been delayed before) of ICD 11, and then there will be different disorders, at least under ICD 11, called PTSD, and Complex PTSD. Yet people may, or may not, suffer either of these, depending on various combinations of genetic, physiological, and environmental/contextual factors.
But why stop with considerations of formal criteria for just these two disorders, when the research shows that sub-threshold stressors can result in lasting impairments of a range of different negative outcomes, including brain impairments. And therefore of what does "treatment" comprise -- treatments for fear responses (re-experiencing, avoidance, hypervigilance, etc), treatments for emotion and self dysregulation; treatments, treatments for relationship difficulties (relationship with self, and with others), etc etc. For which of these does a supportive relationship suffice to prevent problems -- unlikely to be effective with all problems.
Also, don't forget that something that is absolutely crucial for successful outcomes is the quality of interpersonal / professional relationships between the "client" and their principal and other "therapists", in relation to outcomes, and IMHO that is something that has not been adequately explored yet. I can give you some guidelines about this if you like, but there have been some really good contributions by others on this "list" -- see e.g., recent contributions by Marcia Hall.
But thanks for the question -- it'll make us think, and not just search the literature -- which I don't believe has reached this level of "maturity", yet, but may I bring to everyone's attention a recent interview with Marylene Cloitre, one of the foremost therapy researchers in the area (the actual url is VERY long, so I've used a shortener) https://goo.gl/zVjzXz It goes outside just ACEs but it's very consistent with the "whole of life" perspective in recent blog postings
Incidentally, if you're interested in exploring treatments at a more "molecular" level -- discrete areas of application -- then may I suggest accessing Cochrane Reviews www.cochrane.org/what-is-cochrane-evidence
Best wishes to you
Russell J. Wilson
B.Sc.(Hons), M.App.Psych (Clin) (UQueensland)
Retired Clinical Psychologist
Catherine Gutfreund posted:Has anyone seen a good review or meta-analysis of ways to address childhood trauma and fostering resilience? One often sees mention of the importance of even one supportive relationship, but is this intuitive or evidence based?
thank you
Hi Catherine. I know, there are just so many ideas out there, professionals with their own "this is best" and it can be difficult to decide what direction to pursue. I'm a child & adult trauma therapist and I of course have my own ideas about what works best. I don't know that there is a meta-analysis or a truly academic review of ALL the options out there. The importance of a trusting and connected relationship is backed by tons of studies though. Try TBRI from the Karyn Purvis Institute for Child Development at TCU. Some good research was done there on approaches from many backgrounds. I found it very helpful and evidence backed. They pull from neurology, occupational therapy, psychology, social work, functional medicine, etc. I hope this is helpful to you. Warm Regards, Laurie Belanger LCSWR
Mind you, being a (now retired) psychologist ("conservative"), there are some IMHO some ineffective approaches out there, with any success probably tied to the particular individual's capacity to develop a meaningful, client-validating therapeutic relationship. So, for a "quick" diagnosis-driven set of treatment guidelines there's always the guidelines from the International Society for Traumatic Stress Studies http://www.istss.org/
Mind you, that doesn't cover some really important treatment outcome studies, particularly from Europe --- you're welcome to private message me about those if you're interested -- who, together with van der Kolk cover the traumatising label of "personality disorder" pretty well.
Good thread! Thank you!
Catherine Gutfreund posted:Has anyone seen a good review or meta-analysis of ways to address childhood trauma and fostering resilience? One often sees mention of the importance of even one supportive relationship, but is this intuitive or evidence based?
thank you
Hi Catherine, picking up on the latter element of your question, about the benefit of a supportive relationship, you may be interested in the work around the "One Good Adult" concept, that has emerged from the "My World" research in Ireland. This comes from the Headstrong Programme (now called Jigsaw). While not exclusively focused on trauma, and focused on young people rather than early years of younger children, this was research explored risk and protective factors, with a powerful protective effect shown for having a trusted adult to turn to. See http://archive.headstrong.ie/w..._Emerging-Themes.pdf and for more on the One Good Adult approach see https://www.jigsaw.ie/what-we-...aigns/one-good-adult - there were statistically significant benefits around a range of measures of poor mental health and positive mental wellbeing
There is a good review of trauma treatments for children on the California Evidence-Based Clearinghouse for Child Welfare (http://www.cebc4cw.org/topic/t...ns-child-adolescent/) which provides information on the research evidence for each practice as well as the target population it was designed for. Lots of other information on related treatments as well (substance abuse, parent training etc). They don't compare the practices or give any advice on which to use, but it is good unbiased and easy to understand information.
Cambria
I notice it says Triple P is "well supported" by research evidence, but check Coyne's Mind the Brain for an alternative, probably sounder, perspective.
And what about programs for adults? Oh, sorry, there's Cochrane Reviews for those.
Russell - good point about Cochrane reviews but I dont think there are any Cochrane reviews addressing ACEs - do you know of any?
Not that I know of, but that's not wholly surprising. ACEs, after all, are "experiences", and one should be looking for therapies for "adaptations" (problematic responses to having had those experiences) - - for example, depending on one's theoretical orientation, substance use disorders as attempts to "self medicate" - - one example, "seeking safety" for people with co-mormid substance use and trauma disorders.
One imho can have more confidence in the "outcomes" reviewed by Cochrane than on most other sites, but that doesn't entirely remove the clinical responsibility to look into how those outcomes were obtained before applying the methods to a "new" (your) group
Although not meta-analyses the following two papers may provide some background/context for your question and information on some of the issues/complexities and limited evidence available ... (please note although I am listed as an author on the first paper I am not. Antonia Quadara is the sole author)
Cathryn Hunter posted:Although not meta-analyses the following two papers may provide some background/context for your question and information on some of the issues/complexities and limited evidence available ... (please note although I am listed as an author on the first paper I am not. Antonia Quadara is the sole author)
Have you examined the guidelines for authorship? You might be minimizing your contributions. Have you seen papers by, for example, John Reed --- he has a number of papers with survivors as co-authors, some of whom contributed to the writing by sharing their experiences -- of ACEs, and of sharing their experiences with other survivors.
IMHO there are probably not enough contributions by survivors to academic product --THEY after all are the experts of experiencing such things, even if, for some reason, they don't contribute to "the writing" -- did you see and comment the paper before it was "published".
Interesting article on Triple P, though that is not a program that was looked at for trauma treatment specifically because the population that is in the research has not been identified as experiencing trauma and it is not a clinical intervention, The only review of it on the CEBC in relation to child abuse is primary prevention. The definitions of each topic area give a clear picture of what was looked at for the rating in that area.
There are also adult trauma treatment resources on the CEBC http://www.cebc4cw.org/topic/trauma-treatment-adult/. You can delve deeper into the research that leads to the ratings on the website as well.
I would agree that all research needs to be taken with a grain of salt. I would also echo that it is not one size fits all, and that you need to look at individual client needs. There are a lot of complicating factors that surround research studies, but they certainly provide us with more information than simply using "treatment as usual"!
Cambria Walsh posted:Interesting article on Triple P, though that is not a program that was looked at for trauma treatment specifically because the population that is in the research has not been identified as experiencing trauma and it is not a clinical intervention, The only review of it on the CEBC in relation to child abuse is primary prevention. The definitions of each topic area give a clear picture of what was looked at for the rating in that area.
There are also adult trauma treatment resources on the CEBC http://www.cebc4cw.org/topic/trauma-treatment-adult/. You can delve deeper into the research that leads to the ratings on the website as well.
I would agree that all research needs to be taken with a grain of salt. I would also echo that it is not one size fits all, and that you need to look at individual client needs. There are a lot of complicating factors that surround research studies, but they certainly provide us with more information than simply using "treatment as usual"!
Take a look at how Seeking Safety is rated on Cochrane Reports -- one of the clearest endorsements of any program. Similarly there are some therapies not listed that are at least promising, such as Acceptance and Commitment Therapy, which has been used to help patients with the effects of childhood trauma. And I would argue that ratings on some therapies are out of date when viewed in terms of current publications -- like Ricky Greenwald's use of Progressive Counting. And internet / computer-assisted CBT isn't listed, yet it should be, again given recent research -- whether or not it's just not listed, being lumped in with other CBT -- not really the same IMHO, and the authors of some "recent" papers (its use, especially in European studies, has been around for several years, and its dynamics are different from face-to-face work).
Hi Russell,
On Seeking Safety,
I wouldnât call Cochrane a âclear endorsementâ â the effects didnât last post intervention. This is why it is rated as it was by the CEBC. They look at sustainment of effects and for trauma treatment it didn't meet the necessary length of sustainment to warrant a higher rating.
Acceptance and Commitment Therapy is on the CEBC, but under treatment for depression since that is its primary target: http://www.cebc4cw.org/program...ent-therapy/detailed .
Progressive counting is due for review this fall â research last reviewed September 2015. If the program representative or other users don't submit research as it is published, then it is caught when the CEBC does an independent review every two years.
If there are others with evidence that you would like them to add, they are always happy for suggestions! You can submit via the contact us form on the website. http://www.surveygizmo.com/s3/...CEBC-Contact-Us-copy
On-line treatments were only just recently added on the CEBC. At your suggestion, Computerized Cognitive Behavioral Therapy (cCBT) is now being added to the potential programs list. RAND Europe did a recent review, and there are a lot of different providers. If you have any particular versions in mind, they would welcome some suggestions.
I used to manage the CEBC so I do have some insider info and know that they are welcoming of suggestions and feedback!
Thanks for your suggestions!
Cambria
Cambria Walsh posted:Hi Russell,
On Seeking Safety,
I wouldnât call Cochrane a âclear endorsementâ â the effects didnât last post intervention. This is why it is rated as it was by the CEBC. They look at sustainment of effects and for trauma treatment it didn't meet the necessary length of sustainment to warrant a higher rating.
Acceptance and Commitment Therapy is on the CEBC, but under treatment for depression since that is it's primary target: http://www.cebc4cw.org/program...ent-therapy/detailed .
Progressive counting is due for review this fall â research last reviewed September 2015. If the program representative or other users don't submit research as it is published, then it is caught when the CEBC does an independent review every two years.
If there are others with evidence that you would like them to add, they are always happy for suggestions! You can submit via the contact us form on the website. http://www.surveygizmo.com/s3/...CEBC-Contact-Us-copy
On-line treatments were only just recently added on the CEBC. At your suggestion, Computerized Cognitive Behavioral Therapy (cCBT) is now being added to the potential programs list. RAND Europe did a recent review, and there are a lot of different providers. If you have any particular versions in mind, they would welcome some suggestions.
I used to manage the CEBC so I do have some insider info and know that they are welcoming of suggestions and feedback!
Thanks for your suggestions!
Cambria
Does it look at programs for those with Emotion Dysregulation? -- of course, a long established cornerstone of DBT, and with two separate programs developed "in recent times" (at least since 2010), and of course there's long been an argument for ERT as the first phase of a two-phase program for trauma (which European researchers have found (Dorrepaal's group, recently, isn't required in their programs.
As for ACT "depression (since that) is its primary target".... I suggest they look into Robyn Walser and what she does at the VA. She's been publishing on ACT for trauma for over 20 years. The ACT folk would probably be upset to hear that any particular disorder is their primary target -- transdiagnostic is one of their main tenets, they would probably say.
Just to clarify, all of the programs on the CEBC website provide information on what is in their entry, give input into what topic area they are posted in and review it before it is posted.
