Treatment programme

This module is designed to help gain a clear understanding of your particular difficulties and concerns. It will involve a detailed assessment and the development of a shared way of making sense of your difficulties (we call this a formulation). This assessment will cover current psychological difficulties and also offer you a chance to review your current health and use of medication.

Following on from your assessment there will be an early opportunity to discuss options regarding pharmacological treatment. This might involve leaving things as they are at the moment, changing or even stopping medications. We will want to work with you to ensure that if medication is part of the overall plan – you are taking the right dose of the right medication to produce the best effects possible.

This module will cover a wide range of areas. We will want to discuss the ways in which you can regain a sense of control over your life, how you can help yourself feel safe and how you can manage your feelings. We will also want to actively encourage you to ‘reclaim’ a life that gives you a sense of meaning, purpose, hope and direction. So often it is the case after a trauma individuals stop doing the very things that enrich their lives.

We will also want to provide you with some good opportunities to understand what might have happened at the time of the trauma in terms of encoding and storing memories. We call this psychoeducation.

Many individuals who attend the trauma service have often serious difficulties with sleeping and experience frequent nightmares. If this applies in your case we will invite you to get involved in a behavioural sleep management programme and, where appropriate, we will collaborate with you in the development of potentially effective ways of managing nightmares using Imagery Rehearsal Therapy (IRT) and, where appropriate, the use of Prazosin.

Clear progress on the above modules will help to make it appropriate to now focus directly on the traumatic event or events that brought you to our service. We will offer you treatment for your trauma difficulties in line with the guidance produced by the National Institute for Health and Care Excellence (Clinical Guideline 26). This guidance suggests that Trauma Focused Cognitive Behavioural Therapy (TF-CBT), Eye Movement Desensitisation and Reprocessing (EMDR) and where appropriate, medication, are the appropriate treatment approaches.

• Trauma focussed CBT – this is a psychological treatment approach for PTSD and trauma based on the principles of Cognitive Behaviour Therapy (CBT). CBT considers carefully the important relationships between how we think, how we feel, and what we do. In trauma it is particularly important to identify both what happened and how we felt and thought about the events that took place. Understanding the meaning we give to the events that happen to us is at the heart of TF- CBT. Telling your story, describing in some detail the events that happened to you will be an important part of the assessment process. It will then be possible to agree with your therapist which issues will be a priority for treatment. Treatment in TF-CBT is not something that is done to you, it is a collaboration between you and your therapist and only works if you are fully engaged in the process.
• Eye Movement Desensitization and Reprocessing (EMDR) – this is another treatment approach that is seen to be effective in trauma and PTSD. Like TF-CBT it follows from a careful and detailed understanding of the way in which the trauma has left you thinking about yourself. Sometimes the way in which we think about ourselves may have become “stuck” in the past at the time of the trauma and might not be a reasonable, fair or compassionate view of ourselves. EMDR treatment aims to help you to relook at the event that happened and to consider whether there are alternative ways of thinking about yourself that are more fair, reasonable and less self attacking.
• Medication management - as a part of the assessment process there will be a review of both your current and past medication including any medication that you may be buying over the counter. Where appropriate physical health monitoring may be done in line with current guidance for certain prescribed medications. We may also ask for information regarding your physical health before prescribing any medication for you. Where treatment with medication is indicated it will be prescribed in line with the guidance given by the National Institute for Health and Care Excellence for the treatment of PTSD. It is not always helpful to take medication whilst receiving psychological therapy for PTSD or trauma and this will be discussed with you and the person delivering the therapy as a part of the assessment and ongoing therapy. Any medication prescribed will be reviewed on a regular basis and you may expect treatment to be given short term in many cases.

There may be times when, following assessment, we might consider that treatment is not indicated and the reasons for this will be discussed with you.

How will I feel? Working on emotional difficulties in therapy can be difficult as it involves discussing issues that might be distressing for you to talk about. It is common for people to feel a bit worse for a while as they are facing up to issues they have, perhaps, avoided. However, usually this results in an improvement in how you feel.

What benefits can I expect? CBT and EMDR have both been found to be effective forms of treatment for PTSD. In research trials, they have been found to be more effective than medication alone. Therapy can potentially help to alleviate distress and teach you coping strategies for future use. If your symptoms have meant that you have had to stop work for a while, you may be able to return to work.

Are there any risks with therapy? There are no physical health risks to engaging in therapy, as the treatment is non-invasive. Psychological therapies may bring up bad memories or strong emotions that may be challenging to deal with at first. It is certainly not unusual to feel worse before you feel better. Therapy can sometimes affect your relationships with your friends in a negative as well as a positive way.

At the end of the Module 5 we will have further discussions with you regarding how to continue with the progress you have made – what to look out for and how to manage times which might be difficult for you.

By this point (and sometimes earlier) – you may also be in a position to identify ways in which your experiences have led you to review and to perhaps reconsider a number of attitudes, values or ideas ou had about yourself, about others or about your world. This can often be an important process.