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Trauma-focused art therapy in the treatment of posttraumatic stress disorder

Research showed that more than 30% of patients with Posttraumatic Stress Disorder (PTSD) do not benefit from evidence- based treatments: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Eye Movement Desensitization and Reprocessing (EMDR). These are patients with prolonged and multiple traumatization, with poor verbal memory, and patients with emotional over-modulation. Retelling traumatic experiences in detail is poorly tolerated by these patients and might be a reason for not starting or not completing the recommended treatments. Due to lack of evidence, no alternative treatments are recommended yet. Art therapy may offer an alternative and suitable treatment, because the nonverbal and experiential character of art therapy appears to be an appropriate approach to the often wordless and visual nature of traumatic memories. The objective of this pilot study was to test the acceptability, feasibility, and applicability of trauma-focused art therapy for adults with PTSD due to multiple and prolonged traumatization (patients with early childhood traumatization and refugees from different cultures). Another objective was to identify the preliminary effectiveness of art therapy. Results showed willingness to participate and adherence to treatment of patients. Therapists considered trauma-focused art therapy feasible and applicable and patients reported beneficial effects, such as more relaxation, externalization of memories and emotions into artwork, less intrusive thoughts of traumatic experiences and more confidence in the future. The preliminary findings on PTSD symptom severity showed a decrease of symptoms in some participants, and an increase of symptoms in other participants. Further research into the effectiveness of art therapy and PTSD is needed.

Trauma in Female Forensic Psychiatric Patients: A Mixed-Method Study into the Clinical Practice of Trauma-Focused Treatment

Research shows that victimization rates in forensic mental health care are high for both female and male patients. However, gender differences have been found in types and patterns of victimization (more sexual abuse and more complex trauma for women), cognitive appraisal, and response to traumatic events. Gender-responsive treatments focusing on trauma have been designed to adhere to these gender differences; however, despite promising research results, these interventions are yet to be introduced in many settings. This study examined how trauma is addressed in current clinical practice in Dutch forensic mental health care, whether professionals are knowledgeable of gender differences in trauma, and how gender-responsive factors such as self-esteem, self-efficacy, social relations, and coping skills are considered in treatment for female patients. We used a mixed-method design consisting of an online survey and 33 semi-structured interviews with professionals and patients. The results suggested that Dutch forensic mental health care could address trauma more structurally, and professionals could be more aware of gender differences and gender-responsive factors. Early start of trauma treatment was deemed important but was not current practice according to patients. Based on this study, guidelines were developed for gender-responsive, trauma-informed work in forensic mental health care.

Traumabehandeling bij kinderen met een licht verstandelijke beperking : Naar een methodiek voor de behandeling van getraumatiseerde kinderen en jongeren met een licht verstandelijke beperking.

Perspectives of underweight people with eating disorders on receiving Imagery Rescripting trauma treatment: a qualitative study of their experiences

"A proportion of those with eating disorders have also experienced traumatic events and ongoing symptoms of PTSD such as re-experiencing of the trauma and nightmares. We implemented an innovative trauma intervention called Imagery Rescripting (ImRs) to explore whether for those undergoing inpatient treatment for an eating disorder (in an underweight phase), it would be possible to treat the various trauma-related symptoms as well as the eating problems. Since this has not been investigated before, we asked the participants in this study to recount their experiences. Twelve participants who were underweight, reported a past history of trauma and were in an inpatient eating disordertreatment program participated in ImRs therapy intervention. One of these participant did not engage in the ImRs therapy because she discontinued the inpatient ED treatment. Analysis of interviews with these participants found that -although they were reluctant before the start of the treatment- the ImRs treatment during their inpatient admission had given them hope again. They added that it was important to have support from group members, sociotherapists and therapists. They shared a number of ways that the ImRs treatment could be adapted to people with eating disorders. Their experiences indicated that given these factors it was possible to treat PTSD during an underweight phase. This is important: until now, treatment for eating disorders has not specifically been trauma-focused and these tips have scope to improve the ImRs intervention and eating disorder treatment more broadly in the future."

Hoe gaat het nu met jongeren uit de JeugdzorgPlus?

De JeugdzorgPlus is gericht op jongeren niet bereikbaar zijn voor lichtere vormen van hulpverlening en die zonder behandeling een risico voor zichzelf en hun omgeving vormen. Het ministerie van VWS en betrokken instellingen wilden, nu de JeugdzorgPlus ruim tien jaar bestaat, een onderzoek laten uitvoeren onder een grote groep jongeren die ten minste vijf jaar geleden zijn uitgestroomd uit de JeugdzorgPlus. Het onderzoek is deel van de longitudinale effectmonitor JeugdzorgPlus gericht op het verkrijgen van inzicht in de mate waarin jongeren profiteren van de geboden hulp en welke factoren een relatie hebben met de gemeten effecten. Het Verwey-Jonker Instituut en de Hogeschool Utrecht hebben onderzocht hoe het jeugdigen die tussen 2008 en 2013 in de JeugdzorgPlus hebben gezeten is vergaan. Het doel van dit onderzoek was het verkrijgen van inzicht in het welzijn van de jongeren: hoe gaat het nu met de jongeren, hoe kijken zij terug op hun verblijf in de JeugdzorgPlus en wat kunnen we van hen leren? Tevens dient het onderzoek als verkenning voor hoe JeugdzorgPlus instellingen op de langere termijn vorm en inhoud kunnen geven aan follow up onderzoek, waarbij ook de mogelijkheid voor het gebruik van CBS-gegevens en gegevens van gemeenten wordt bestudeerd. In totaal zijn 46 jeugdigen betrokken in diepteinterviews met behulp van de tijdlijn-methode. Aanbevelingen zijn geformuleerd op grond van deze interviews en rekening houdend met ontwikkelingen in de JeugdzorgPlus.

Agreement between patients and mental healthcare providers on unmet care needs in child and adolescent psychiatry

Abstract Purpose In mental health care, patients and their care providers may conceptualize the nature of the disorder and appropriate action in profoundly diferent ways. This may lead to dropout and lack of compliance with the treatments being provided, in particular in young patients with more severe disorders. This study provides detailed information about patient–provider (dis)agreement regarding the care needs of children and adolescents. Methods We used the Camberwell Assessment of Need (CANSAS) to assess the met and unmet needs of 244 patients aged between 6 and 18 years. These needs were assessed from the perspectives of both patients and their care providers. Our primary outcome measure was agreement between the patient and care provider on unmet need. By comparing a general outpatient sample (n=123) with a youth-ACT sample (n=121), we were able to assess the infuence of severity of psychiatric and psychosocial problems on the extent of agreement on patient’s unmet care needs. Results In general, patients reported unmet care needs less often than care providers did. Patients and care providers had the lowest extents of agreement on unmet needs with regard to “mental health problems” (k=0.113) and “information regarding diagnosis/treatment” (k=0.171). Comparison of the two mental healthcare settings highlighted diferences for three-quarters of the unmet care needs that were examined. Agreement was lower in the youth-ACT setting. Conclusions Clarifcation of diferent views on patients’ unmet needs may help reduce nonattendance of appointments, noncompliance, or dropout. Routine assessment of patients’ and care providers’ perceptions of patients’ unmet care needs may also help provide information on areas of disagreement.