larissa meysner - peoplesense by altius
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Psychological Treatments for Traumatic Stress that Promote a Return to Work
Larissa Meysner
Clinical Psychologist
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
Post-traumatic Stress
• What is Post-traumatic stress disorder?• What is it not?
• Evidence based treatments• Trauma-focused cognitive behavioural therapy (TF-CBT)
• Eye movement desensitisation reprocessing (EMDR)
• First responders• How do they differ?
• What can we learn from them?
• The role of exposure in return to work
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
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Mental stress claims All accepted claims
Lost time (working weeks)
(Safe Work Australia, 2013)
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2000
4000
6000
8000
10000
12000
14000
Mental stress claims All accpeted claims
Direct cost ($)
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
Intrusion
Avoidance
Hyper-arousal
Negative thoughts or
mood
Criterion A
Exposure to actual or threatened death, serious injury, or sexual violence. This may be have been directly or as a witness.
Post-traumatic Stress Disorder (DSM-5)
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
Trauma-focused CBT
Key Elements - Behavioural
Psychoeducation
Relaxation and distress tolerance skills
Trauma narration
Exposure (visualisation, narrative and then in-vivo)
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
Virtual Reality - Exposure
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
Key Elements - Cognitive
Cognitive restructuring
Relapse management
Trauma-focused CBT
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
Trauma-focused CBT
Key Elements
Psychoeducation
Relaxation and distress tolerance skills
Cognitive restructuring
Trauma narration
Exposure (visualisation, narrative and then in-vivo)
Relapse management
• Involves homework• Skills learnt can be generalised to other areas/problems
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
EMDR
Meaning
e.g. I am not safe
Affect
e.g. fear
Sensory
e.g. Loud bangs,
flashing lights
A current trigger sets off the old memory network, activating behavioural (avoiding,
escaping) and cognitive (blocking, dissociating) responses
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
Memory
• Historical (vs. relived)
• Less vivid
• Faded
• Fragmented
Distress
• Emotional and bodily distress subsides
• Subjective units of distress (SUDS; 0-10 scale)
Belief about self
• Thoughts about self now and as they relate to old memory
• Strengthen positive thoughts
Reactivates memory networkEye movements facilitate processing of information
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
EMDR vs CBT
• Equally efficacious (about 80%)
• EMDR clients consistently demonstrated a more rapid rate of improvement recovery
• Compared with prolonged exposure, eclectic psychotherapy, CBT • (e.g. Nijdam et al., 2012;
Ironson et al., 2002)
Nijdam et al., 2012, British Journal of Psychiatry
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
EMDR – Scope of Improvement
• Treating the whole person
• Pre-existing trauma
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
EMDR – Scope of Improvement
• Treating the whole person
• Pre-existing trauma
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
Case example
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
Case example
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Intake Midpoint Final
Total
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35
Intake Midpoint Final
Depression
Anxiety
Stress
• Comprehensive assessment
• Three active sessions of EMDR
• Positive memory recall
• Increase in emotional reactivity
• Positive self-belief• “I don’t have
to be lonely, but I can be alone”
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
First Responders
Trauma world
Now world
• Each world has rules, assumptions, beliefs
• Aim of treatment is to help person come back into the ‘now world’
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
First Responders Guidelines
• Emergency workers will usually require 8 to 12 sessions of trauma-focused psychological treatment (either CBT or EMDR), each lasting between 60 and 120 minutes.
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
First Responders Guidelines
• Emergency workers will usually require 8 to 12 sessions of trauma-focused psychological treatment (either CBT or EMDR), each lasting between 60 and 120 minutes.
• However, non-trauma focused psychological interventions, such as relaxation or supportive counselling should not be used routinely for treatment of PTSD amongst emergency workers • …Unless trauma focused interventions treatments are not available or cannot
be tolerated by the worker.
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
First Responders Guidelines
• Emergency workers will usually require 8 to 12 sessions of trauma-focused psychological treatment (either CBT or EMDR), each lasting between 60 and 120 minutes.
• However, non-trauma focused psychological interventions, such as relaxation or supportive counselling should not be used routinely for treatment of PTSD amongst emergency workers • …Unless trauma focused interventions treatments are not available or cannot
be tolerated by the worker.
• Feared or avoided situations, including those in the workplace, should be systematically addressed through in vivo exposure with the view to optimise functioning.
• Occupational recovery should be considered from the very beginning of treatment. Remaining at, or returning to, work should be an aim of treatment and considered an important part of the recovery of emergency workers with PTSD.
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
PTSD prevents them from
working
Long term absence prevents
them from overcoming PTSD
Leadership, Learning & Life Enhancementwww.peoplesense.com.au
Any questions?
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