PTSD Resolution & HGI

Transcription

1 PTSD Resolution & HGI outcomes of therapy Bill Andrews Pragmatic Research Network 1

2 Bill Andrews Research Coordinator Pragmatic Research Network 2

3 Bill Andrews Senior advisor ICCE 3

4 Andrews, W. P., Wislocki, A. P., Short, F., Chow, D., Minami, T. (2013) "A 5-year evaluation of the Human Givens therapy using a Practice Research Network", Mental Health Review Journal, Vol. 18 Issue: 3 Dropbox link to post-publication version of article (exactly as published but without the journal logo and format) 4 The official abstract is now available here: This link can be provided to anyone. The official citation for the article is:

5 (n = 130) CORE 10 CORE 34 mean=post mean=post CORE 10 CORE 34 mean pre mean pre ORS IES E mean=post mean=post ORS IES E mean pre mean pre Unpublished data on 130 cases treated with HG approach clearly demonstrates the effectiveness of the treatment regardless of measures used. 5

6 (n = 130) effect size CORE 34 ORS IES E effect size CORE Any effect size ( a way of measuring the magnitude of change) that is greater than 1 is a very LARGE effect. 6

7 Bill Andrews Research Coordinator Pragmatic Research Network Well, there is work to be done now to get published on Trauma results within HG treatment. 7

8 Results 1/10/2010 to present Independent report complied by Bill Andrews This report will consider recent results. It has been independently analysed based on data gathered through a practice research network and has been provided by PTSD Resolution 8

9 Latest PTSD Resolution data 150 cases assessed since 1/10/2010 CORE10 and IES-E measures both used 4 females, 146 males Mean age 43, range Mean no. of treatment sessions between 5 and 6 While 150 cases are included, as will be seen in following slides, for 1 reason or another there are some cases without either or both of the measures available. This is most likely due to cases being entered in the database but not progressing into treatment for 1 reason or another. 9

10 No. of treatment sessions 14" 12" 10" 8" 6" 4" 2" 0" 1" 7" 13" 19" 25" 31" 37" 43" 49" 55" 61" 67" 73" 79" 85" 91" 97" 103" 109" 115" 121" 127" 133" 139" 145" 151" While a small number of cases had in excess of 8 sessions the vast majority were treated in 6 sessions or less 10

11 Latest PTSD Resolution data 150 cases treated by 51 therapists The measures used were the CORE10 and the IES-E. 51 therapists saw the cases. However, the vast majority saw 4 clients or less. Only 6 therapists saw 6 or more cases 17 therapists saw only 1 case. 11

12 No. of therapists and No. of cases 51 therapists saw 150 cases Majority saw 4 or less 17 therapists saw only 1 case 6 therapists saw 6 or more cases The remarkable achievement of the treatment is that it was largely successful regardless of which therapist saw the client. 12

13 Changes in average scores pre- and post- treatment CORE10 23 to 10.4 IES-E 54 to 24 Getting a birds-eye view of the data one can see that the magnitude of change on both measures is substantial 13

14 Effect size (>1 is a large effect) Magnitude of the treatment effect IES-E 1.81 CORE Magnitude of effect size on both measures is also substantial. The more disorder specific IES- E shows more substantial changes as opposed to the more generic CORE10. This is a typical finding of the more disorder-specific measures and is one that might be expected considering the treatment is specifically focused on psychological trauma. 14

15 Levels of distress at start of treatment Average CORE10 score was 23 (typical primary care score is 18 to 19) Of the 111 cases with a pre-treatment CORE10 measure 107 were above the clinical cutoff score of 11 Average IES-E score was 54 Of the 131 cases with a valid IES-E pre-treatment score available, 86 (66%) were above 50 and 108 (82%) were above 40 This client population was very distressed. Typical CORE10 scores in primary care are between a 18 and 19. A cutoff of 50 on the IES-E is regarded of highly indicative of PTSD. That of course does not mean a lower score shows no PTSD and in fact over 80% of cases had a score over

16 Effect of treatment CORE of 111 cases were above the cutoff of of those 107 had a post treatment measure (98% - excellent data capture) 87 of these 105 cases (83%) had an improvement in their scores of 6 points or more and so can be deemed to have improved RELIABLY 60 of these 105 cases were below the cutoff posttreatment This represents a moving to recovery rate of 56% (IAPT revised target 40% using GAD7 and PHQ9 as measures) The achievement of 83% reliable improvement (likely to be due to treatment and not just a random improvement) is remarkable, particularly when one can have confidence in it as 98% data capture is so high. 16 IAPT moving to recovery targets were revised down from 50% to 40% as it seems too hard to reach the 50% target. Remember though that this was using a different set of measures.

17 Effect of treatment IES-E 131 cases had a valid pre-treatment score 122 had a valid post-treatment score (93% data capture) For these 122 cases, pre-treatment average score was 54 and post-treatment average score was of these 122 cases were above 50 pre-treatment 66 of these 79 (83%) were below 50 post-treatment 59 of these 79 cases (75%) had improved by 20 points or more Once again data capture is excellent (93% time 2 measures available). The average movement in scores was from 54 to 24 and, just as 83% of CORE10 scores above the cutoff had improved reliably, here we see that 75% of clients who scored in the very distressed area of above 50 improved in treatment by 20 or more points. The same sort of cut-off information is not available for IES-E as it is difficult to establish cut-offs for trauma measures but a 20 point improvement is large by any stretch of the imagination. 17

18 but but but but but but... Does it work????? 18

19 W Andrews (Feb. 2009) Hymm... the naysayers will simply say... it s not an rct? 19

20 NICE Guidelines Evidence hierarchy RCT Meta-analysis of RCT studies 20

21 PTSD treatment NICE Guideline recommendations Trauma- focused CBT EMDR Only 2 treatments are approved? 21

22 Trauma Focused Treatment CBT Trauma focused treatment is a term that describes a wide range of treatments and some of these treatments vary enormously from each other. 22

23 Meta-analysis of PTSD treatments Common focus on the patient s traumatic memories of the traumatic event & personal meaning of the trauma NO DIFFERENCE between ANY of these trauma-focused treatments Look closer at Duffy et al and you will see that it is simply a random allocation to a 12 week waiting list Agreement of no difference between trauma focused treatments and debate as to whether this is indeed accurate itself. Please go to: 23 for much more detail about this issue and links to all relevant papers

24 The New Frontier Using a treatment that works on soothing the ANS and works on the right hemisphere is likely to be a good idea 24

25 Treatment through PTSD Resolution IS......a treatment that works on soothing the ANS and works on the right hemisphere and so it is likely to be a good idea 25 The significant advantage of the rewind treatment typically used by HG therapists is that it maintains a relatively low level of emotional arousal and so is less distressing for the client and the therapist does not need to necessarily hear much about the detail of the trauma, thus further reducing arousal in both client and therapist and reducing the risk of vicarious traumatisation.

26 THE END 26