Traumatology

A literature review was conducted to examine whether EMDR should be considered an empirically-supported treatment for PTSD. Relying largely but not exclusively on electronic data bases such as Medline and PsychInfo, journal articles published through April 2003 were identified which reported a randomized experimental evaluation of the effectiveness of EMDR in treating PTSD. EMDR appears to be an empirically supported treatment for adults with single-trauma civilian PTSD. However, the evidence supporting the effectiveness of EMDR is much less compelling when we focus on children, combat PTSD, multiple-trauma PTSD, and whether EMDR is more effective than exposure therapies. Proponents of EMDR hotly debate proponents of exposure therapy regarding methodological issues, with each side in the debate frequently employing a double standard. Clinicians are advised to use either EMDR, exposure therapy, or stress-inoculation therapy when treating civilian adults with single-trauma PTSD. They may also want to employ EMDR when treating children with PTSD or clients with multiple-trauma or chronic PTSD. But if they do, they should do so in light of the inadequate evidence base, be guided by future evaluations of EMDR with these populations, and recognize that many more sessions of EMDR, with less robust effects, may be required than what they might currently expect.

Volunteer clinical experiences as part of the New York Police Department’s Police Organization Providing Peer Assistance (POPPA) program are described in providing critical incident stress debriefings (CISD) to NYC emergency rescue personnel. Also, there is a discussion of distinctive aspects of September 11^th that both characterize and confound a successful post-9/11 recovery, to include the intertwining of personal and national reactions to global terrorism and socio-political forces. Such factors, along with concerns about the efficacy of “one-shot clinical interventions,” form the rationale for a “Phase 2 CISD intervention model” that is described.

Departing from a deprivation approach to the study of trauma, a small body of literature has recently emerged that examines positive, rather than negative, post-trauma changes. Studies to date have focused on individuals’ positive reactions to a personally endured traumatic event for example, as bereaved parents, living with HIV/AIDS, or surviving cancer. Negative symptoms following a traumatic event that is experienced during the course of fulfilling professional obligations (e.g., in ambulance, fire and police services), are reported to be akin to the negative post-trauma symptoms found in direct survivors of a traumatic event. In this study, we investigated the prevalence of self-reported positive changes (posttraumatic growth) in emergency ambulance personnel, a population that are readily exposed to potentially traumatic incidents. Results indicated that a large proportion of both seasoned ambulance personnel and new recruits to the service, perceived positive changes in themselves that they attributed to having experienced a traumatic event at work. A significant mean difference was also detected between personnel who had endured a personal trauma in addition to a work-related trauma (n = 281) and personnel who had endured trauma only in the course of their employment responsibilities (n = 217). The study supports theoretical and clinical expectations that the experience of occupational trauma can act as a catalyst for significant positive post-trauma changes.