ISTSS Conference, Day 1: Best Practices and Refugees
Once a year, you can find the world's trauma experts, the Dart Center's staff and the journalists who won Dart's annual Ochberg Fellowships in one place: the annual meeting of the International Society for Traumatic Stress Studies. This year the place is Chicago, and while the fellows are bonding in their fourth day of seminars, I'm wandering in and out of panels learning about the cutting edge of trauma research from psychiatrists, psychologists, social workers, nurses, counselors, administrators, advocates, journalists, and even clergy. Today through Sunday, I'll be blogging their nuggets of wisdom here.
At a morning symposium on Gathering and Implementing Evidence on Psychological Interventions to Prevent and Treat Post-Traumatic Stress Disorder, researchers from the United Kingdom and Australia shared thorough meta-analyses of the latest evidence for various treatment practices. Taken together, their three presentations (email required) confirmed earlier results showing that two therapies are at the head of the pack, with clear results in treating PTSD: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Non-trauma-focused "stress management" fared worse, though it was better than nothing. "Other therapies" evaluated didn't share this distinction, and still lack evidence demonstrating they are any more effective than remaining on a treatment waiting list.
At a second panel, on the Nature and Extent of Traumatic Stress in Refugees, the insights were more unconventional. Panelists had studied the experience of refugees (email required) from Cambodia, Darfur, Burundi and Iraq, assessing the effectiveness of the Western diagnosis of post-traumatic stress disorder--a constellation of avoidance, intrusion, and hyperarousal symptoms--and Western treatments akin to those described above. The differences between communities were striking. For example, Harvard's Devon Hinton related how Cambodian survivors of the Pol Pot genocide who might be diagnosed with "anxiety" by Western doctors believe they suffer from “wind attacks,” air traveling through blood vessels from the extremities to the head, and treat themselves by scoring their bodies with oiled coins in a process called "scratching wind." To oversimplify greatly, the upshot of such radically different conceptualizations of trauma is that local idioms and local concepts make not only for what a journalist would call a better story, but what a clinician or researcher would call a demonstrably more effective way of diagnosing and treating trauma's psychological aftermath. Also important to keep in mind when dealing with refugees: for many, the trauma isn't over. If there's an ongoing threat to them or their families back home (like, say, Iraqi refugees in Australia with relatives back in Baghdad), the re-exposure to a past traumatic experience that is a part of therapy (not to mention journalism) may also be visiting a real, possible future trauma, and so requires especial sensitivity.