Retraumatisation during Trauma-Focused Interventions for Post-Traumatic Stress Disorder

Purnell, Lucy (2024) Retraumatisation during Trauma-Focused Interventions for Post-Traumatic Stress Disorder. Doctoral thesis, University of East Anglia.

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Abstract

Background: Trauma-focused psychological interventions for post-traumatic stress disorder (PTSD) have a large evidence base and are recommended by clinical guidelines. A recognised barrier to delivering trauma-focused interventions is a fear of symptom exacerbation or “retraumatisation.” However, available evidence supporting these concerns is limited.

Methods: First, a systematic review and meta-analysis is presented, which aims to examine mid-treatment PTSD symptoms in randomised controlled trials of trauma-focused psychological treatments for adult PTSD compared to control groups (non-trauma-focused psychological treatments or passive conditions). Second, an empirical study is presented that used a survey to investigate clinicians’ understanding of retraumatisation, estimate its prevalence and relate this to clinicians’ confidence in trauma-focused interventions and fear of retraumatisation.

Results: The systematic review included 23 studies, and there was no evidence of PTSD symptom exacerbation at mid-treatment in trauma-focused interventions compared to control groups (g=-.16; [95% CI -.34, .03]). Further, there was some evidence of symptom relief at mid-treatment in high quality studies (g=-.25; [95% CI -.48, -.03]). Surveys were completed by 348 clinicians. There was high variation in the endorsement of signs of retraumatisation. Trauma-focused therapy was reported by clinicians as harmful or leading to a worsening of PTSD symptoms in 3.4% of patients, with this outcome being reported by 12.1% of participants; these participants reported significantly higher total endorsement of signs of retraumatisation (p<.001, d=.69), using a significantly greater number of non-trauma-focused therapies (p<.001, d=.90) and greater fear of retraumatisation (p<.001, d=.94).

Conclusion: The results question whether retraumatisation is a valid construct, as there was no evidence of PTSD symptom exacerbation at mid-treatment and little agreement in defining the term. This thesis highlights the need for a better working definition of retraumatisation.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	11 Nov 2024 09:44
Last Modified:	11 Nov 2024 09:44
URI:	https://ueaeprints.uea.ac.uk/id/eprint/97601
DOI:

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