2008 Research Award Recipients
Trauma-Focused Cognitive Behavioural Therapy for Abused Children with Posttraumatic Stress Disorder: A Pilot Study
Jacqueline Susan Feather
Department of Behavioural and Social Sciences, Faculty of Science, Engineering and Health Building 32/2.26, Central Queensland University, Bruce Highway, Rockhampton
A manualised trauma-focused cognitive behavioural therapy (TF-CBT) programme was developed for multiply-abused children diagnosed with posttraumatic stress disorder (PTSD; Feather & Ronan, 2004). It was piloted with 4 children (aged 9-14 years) referred to a specialist clinic of the statutory child protection agency. The locally developed programme built on efficacious treatments for childhood anxiety and PTSD as a result of sexual abuse. It comprises psychosocial strengthening, coping skills training, gradual exposure using creative media, and special issues relevant to trauma and abuse. A multiple baseline design was used to demonstrate the controlling effects of the treatment. The results indicate a good deal of promise. PTSD symptoms generally decreased and child coping increased. Gains improved over 3, 6, and 12 month follow-ups. Results are discussed in terms of the value of clinicians engaging in local research aimed at increasing outcomes for their clients.
The influence of data-driven processing on perceptions of memory quality and intrusive symptoms in children following traumatic events
Department of Psychology, Flinders University of South Australia
Ehlers and Clark (2000). A cognitive model of post-traumatic stress disorder. Behaviour Research and Therapy, 38, [319-345] cognitive model of post-traumatic stress disorder (PTSD) has been relatively untested with children. Seventy-fivechildren (7-16 years) were interviewed within 4 weeks of an injury that led to hospital treatment to examine whether peritraumatic processing strategies (data-driven processing and fear) were associated with perceptions of memory quality and intrusive memories. Perceptions of memory quality mediated the relationship between data-driven processing and intrusive reactions but not avoidance, arousal or depressive reactions. Finally, the relationship between peri-event fear and intrusion reactions was mediated by perceptions of memory quality even after data-driven processing was controlled. The implications of these findings are discussed in the context of a cognitive developmental model of PTSD in children.
Clinicians’ Understanding of ICD-10 Diagnostic Criteria: F62.0 Enduring Personality Change After Catastrophic Experience
Ruth O. Beltran
Occupational Therapy, Faculty of Health Sciences, The University of Sydney
ICD-10 has included a diagnostic category of “enduring personality change after catastrophic experience” (EPCACE). Preliminary investigation suggests there is considerable endorsement in principle for this new category amongst experts in the field of intentional human trauma, yet many aspects of the diagnosis remain contentious. Criticisms leveled at EPCACE raised issues that question the reliability, validity and clinical utility of this diagnostic category. ICD-10 has two sets of documents describing EPCACE criteria. These are diagnostic criteria for research (DCR) and clinical description and diagnostic guidelines (CDDG). This study examines how clinicians described the symptoms which conform to or exceed the criteria of EPCACE that they observed in their clients. No other published research has yet emerged examining the descriptive validity of this category.
A qualitative approach from a social phenomenology and applied policy research perspectives was used to gather the views and experiences of clinicians. Twenty four clinicians working in the area of torture and refugee trauma, war trauma and sexual assault trauma were interviewed in depth.
Using the CDDG, clinicians were able to typify the characteristic symptom criteria of EPCACE. Hostile or mistrustful attitude was identified as a prominent symptom. Somatization, self injurious behaviours, sexual dysfunction and enduring guilt are suggested additional features that are not encompassed by current EPCACE criteria.
This study contributes to the descriptive validity of EPCACE. It demonstrates the utility of a qualitative approach to descriptive validation of diagnostic criteria. Participation of clinicians as members of working parties in the development and review of diagnostic criteria is recommended. The symptom descriptors generated from this study could be used to enhance the CDDG.