Trauma-focused CBT and EMDR

Meet the patient

A 34-year-old paramedic comes to clinic eight months after a child died in her arms at a road crash. She has not driven past the intersection since. She replays the monitor flat-lining when she tries to sleep, drinks three glasses of wine to fall asleep, and told her last clinician she is "not ready" to talk about it. Her PCL-5 is 51.[1][10]

The registrar heard "not ready" and booked six sessions of supportive counselling plus a benzodiazepine. The examiner wants the move you make next: which trauma-focused protocol, on what evidence, and what does readiness actually mean?[10][16]

References18Show ledgerHide ledger

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2. [2]Ehlers A, Clark DM, Hackmann A, et al. Cognitive therapy for post-traumatic stress disorder: development and evaluation Behav Res Ther, 2005.PMID 15701354
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10. [10]Lewis C, Roberts NP, Andrew M, Starling E, Bisson JI Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis Eur J Psychotraumatol, 2020.PMID 32284821
11. [11]Shapiro F The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences Perm J, 2014.PMID 24626074
12. [12]Lee CW, Cuijpers P A meta-analysis of the contribution of eye movements in processing emotional memories J Behav Ther Exp Psychiatry, 2013.PMID 23266601
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17. [17]Bisson JI, Berliner L, Cloitre M, Forbes D, et al. The International Society for Traumatic Stress Studies New Guidelines for the Prevention and Treatment of Posttraumatic Stress Disorder: Methodology and Development Process J Trauma Stress, 2019.PMID 31283056
18. [18]Brady K, Pearlstein T, Asnis GM, Baker D, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial JAMA, 2000.PMID 10770145