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Post-Traumatic Stress Disorder

2021 Year in Review of Trauma and PTSD Research

Seven studies that highlight helpful versus unhelpful trauma research.

Key points

  • Knowing which psychological research studies to trust is difficult because behavior is complicated and papers are shrouded in jargon.
  • Three helpful studies are described that provide meaningful new knowledge and can be immediately useful.
  • Four unhelpful studies are described that have impressive jargon or appealing concepts, but are useless or misleading.
Emerson Lima/Unsplash
Source: Emerson Lima/Unsplash

At the end of each year, I pick research studies on posttraumatic stress disorder (PTSD) that I think represent the most and least helpful examples of research in this field.

I believe the best types of studies are ones that are actually helpful for real patients, and that’s usually around prediction:

  1. Prediction of who is going to develop problems so that the problems may be prevented.
  2. Prediction of treatment response in controlled settings.

The unhelpful studies in psychological research tend to be of no use in one of three ways:

  1. Attempts to confirm ideological biases that the authors appear only dimly aware of.
  2. Poorly-conceived studies that provide no important new information but are dressed up in fancy jargon to sound momentous.
  3. Samples of convenience that lack controls and/or quality control.

With that introduction, here is the good and the bad of 2021.

The Helpful

1. A voice of reason against the tide of COVID hysteria

Roel van Overmeire, of Vrije University Brussel in Belgium, makes the list for the second year in a row. He wrote a critical commentary on a study published by other authors that claimed journalists were getting PTSD by covering the COVID-19 pandemic. Van Overmeire pointed out several major flaws in the study, but the main one he astutely noted was that researchers never clearly ascertained whether the journalists covering stories about other people experienced the most basic criterion of PTSD, which is exposure to events where someone was threatened with death, serious injury or sexual violence. Thus, the journalists’ responses on the PTSD measure are invalid. Van Overmeire concluded that diagnosing journalists with PTSD who don’t really have PTSD was “problematizing possibly normal behavior.” I call it false positives and politicized research.

2. Another notch for evidence-based practices (EBP)

Brian Shiner and colleagues wanted to examine how the culture shift at the Veterans Administration to implement EBP has played out. Their study tells at least two interesting stories. First, while it’s positive that the percentage of patients with PTSD who received any EBP increased from 0.7 percent in fiscal year 2004-2005 to 14 percent in 2012-2013, it is unfortunately conceivable that 86 percent of veterans with PTSD are still not receiving treatment based on EBPs. Second, they classified patients into three levels on the quality of delivery of services:

  1. Lowest quality received psychotherapy of eight or more sessions
  2. Middle quality received eight sessions or more delivered by the same therapist
  3. Highest quality received these within a 14-week period. The group that received the highest quality delivery of services improved the most. These data are useful for the VA’s continuing attempts to set the bar for where a quality standard should exist for the delivery of psychotherapy for PTSD.

3. One small step back from mother-blaming

Ellisa Brown plus the two founders of trauma-focused cognitive behavioral therapy (TF-CBT), Judith Cohen and Anthony Mannarino, reviewed the literature in regards to whether involving parents in the work of TF-CBT impacts children’s outcomes. Their conclusion was that “Including non-offending caregivers in TF-CBT can improve youth outcomes.” But that’s not what I found noteworthy. What I think is noteworthy is that, thankfully, they didn’t try to frame the review around blaming parents for causing their children’s PTSD. Crafting a literature review that was not about the worn-out myth of parent-blaming probably took enormous self-restraint. It is so rare it is worth mentioning. I think they still vastly overestimated the impact of parenting behaviors, but it was a baby step away from the traditional mother-bashing in our field.

The Unhelpful

4. The myth of trauma-informed approach makes the best-seller list

Child psychiatrist Bruce Perry and talk show host Oprah Winfrey wrote a book titled What Happened to You? Conversations on Trauma and Resilience and Healing. This book was full-throttle marketing of the myth of toxic stress in a book-length treatment with the high-gloss spin of talk show-style anecdotes but none of the research. Among their many unsupported claims, the key one is that if you received love and affection during the first two months of life, your neural development protects you with resilience. If you didn’t, your brain was permanently altered in many maladaptive ways which affect literally everything in your life because this allegedly shapes the very core of our selves. As I and others have written before, none of this is close to being proven, but this narrative has been leveraged to support ideological-based social agendas.

5. A complex PTSD study by (fill in the blank)

The so-called complex PTSD syndrome is unproven by any measure of diagnostic validation, as I and many other researchers have noted, yet it seems to only increase in popularity. It’s been one of the most counterfactual developments in the history of the trauma field. There are too many studies published on it every year to be able to cite one study as more egregious than the others, so I picked one example authored by three of the biggest stokers of this phenomenon. Joseph Spinazzola, Bessel van der Kolk, and Julian Ford showed that children diagnosed with developmental trauma disorder (DTD), which is essentially the childhood version of complex PTSD, had experienced more emotional abuse and separations from caregivers compared to children diagnosed with regular PTSD. Since DTD includes emotional abuse and separations from caregivers in the criteria, and regular PTSD does not, this was entirely circular reasoning, which the authors, reviewers, and editor seemed blissfully unaware of.

6. Towards the vanishing promise of machine learning

Research using the number-crunching function of machine learning started appearing in psychology journals around 2010, and scholars are already noting the inability to produce useful results. Like so many other promises from new technology that never materialized, machine learning has captured scant meaningful new knowledge about human behavior. In one typical example, Jiang and colleagues applied a machine learning technique to diagnosing PTSD. Their conclusion was that instead of using an interview with all 20 PTSD symptoms, you could achieve good, but not perfect, diagnostic accuracy with 16 items for males and 14 items for females. Obviously, this would not shorten the time spent interviewing very much.

7. Towards the vanishing promise of network analysis

Take everything I wrote about machine learning above, and apply it to network analysis, except that network analysis has been around longer. Network analysis was supposed to be a promising new statistical methodology to optimize tasks too complicated for the human brain. In the social sciences, this was supposed to discern how large sets of variables associate with each other, which would somehow enlighten us on how to help individuals better. As the typical example I’ve chosen shows next, we’re still waiting for that to occur. In a study by Zhu and colleagues, they applied network analysis to resting functional magnetic resonance imaging. Using profiles of functional connectivity, they could accurately distinguish individuals with PTSD from non-PTSD with 89 percent accuracy. When a simple diagnostic interview can achieve near 100 percent accuracy more rapidly and less expensively, one wonders how network analysis is a meaningful advance.

References

Brown EJ; Cohen JA; Mannarino AP (2020). Trauma-Focused Cognitive-Behavioral Therapy: The role of caregivers. [Review] Journal of Affective Disorders. 277:39-45.

Jiang T; Dutra S; Lee DJ; Rosellini AJ; Gauthier GM; Keane TM; Gradus JL; Marx BP (2021). Toward Reduced Burden in Evidence-Based Assessment of PTSD: A Machine Learning Study. Assessment. 28(8):1971-1982.

Perry P; Winfrey 0 (2021). What Happened to You? Conversations on Trauma and Resilience and Healing. New York: Flatiron Books.

Shiner B; Westgate CL; Gui J; Cornelius S; Maguen SE; Watts BV; Schnurr PP (2020). Measurement Strategies for Evidence-Based Psychotherapy for Posttraumatic Stress Disorder Delivery: Trends and Associations with Patient-Reported Outcomes. Administration & Policy in Mental Health. 47(3):451-467.

Spinazzola; van der Kolk B; Ford JD (2021 online ahead of print). Developmental Trauma Disorder: A Legacy of Attachment Trauma in Victimized Children. J Trauma Stress 2021 May 28.

Van Overmeire R (2021). Comment on Tyson, G.; Wild, J. Post-Traumatic Stress Disorder Symptoms among Journalists Repeatedly Covering COVID-19 News. Int. J. Environ. Res. Public Health 18, 8536

Zhu H; Yuan M; Qiu C; Ren Z; Li Y; Wang J; Huang X; Lui S; Gong Q; Zhang W; Zhang Y (2020). Multivariate classification of earthquake survivors with post-traumatic stress disorder based on large-scale brain networks. Acta Psychiatrica Scandinavica. 141(3):285-298.

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