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DEVELOPING PEOPLE | 31
Overcoming trauma
Maternal gain
Survivors of the 7/7 London terrorist bombings have benefited from
psychological treatments for post-traumatic stress disorder.
François Nosten’s groundbreaking
malaria research is recognised by
the Institut de France.
1 2 3
Distressing sensations such as
flashbacks, sleep problems and
strong emotions including anxiety,
shame, guilt or anger are common
after any traumatic event. Most
people recover within a few weeks but
a significant proportion – around a
quarter – continue to experience
disturbing and disabling symptoms
collectively known as post-traumatic
stress disorder (PTSD). Anke Ehlers’s
team at the Institute of Psychiatry and
the University of Oxford has
developed a highly effective form of
cognitive therapy that has helped
survivors of terrorist attacks and
other traumatic experiences.
With David Clark, Professor Ehlers has
proposed a model of PTSD based on the
notion that PTSD develops when trauma
survivors continue to perceive the past
trauma as a current threat. This leads to a
variety of ways thinking (and behaving)
that, although intended as coping
strategies, actually serve to maintain the
condition.
In several studies, cognitive factors
specified in this model have been found to
be the strongest predictors of chronic
PTSD symptoms. The validity of this
model has underpinned a PTSD-specific
form of cognitive therapy shown to be
highly effective in several clinical trials. It is
superior to alternative psychotherapies
and achieves better outcomes than drug
treatments.
One group to benefit significantly has
been survivors of terrorist attacks,
including survivors of the Omagh
bombing. This led to the creation of the
Northern Ireland Centre for Trauma and
Transformation, which has achieved
positive results even in patients with
severe terrorism-related PTSD.
Tragically, the London bombings of 7 July
2005 provided another opportunity to
apply trauma-focused cognitive
therapies. Professor Ehlers has been part
of a collaborative effort to identify and
treat people directly exposed to the
bombings. About 150 people have been
treated to date and, encouragingly, the
treatment effects have been as great as
those seen after Omagh.
Ehring T et al. Do cognitive models help in predicting the
severity of posttraumatic stress disorder, phobia and
depression after motor vehicle accidents? A prospective
longitudinal study. J Consult Clin Psychol
2008:76(2);219–30.
Bisson JI et al. Psychological treatments for chronic
post-traumatic stress disorder. Systematic review and
meta-analysis. Br J Psychiatry 2007;190:97–104.
Brewin CR et al. Promoting mental health following
the London bombings: a screen and treat approach.
J Trauma Stress 2008;21(1):3–8.
Professor Ehlers’s Principal Research
Fellowship was renewed in 2008.
In June 2008 François Nosten,
Director of the Wellcome Trustfunded
Shoklo Malaria Research Unit
in Thailand, received the Christophe &
Rodolphe Merieux Foundation Prize,
a €400 000 (£366 000) honour
bestowed by the Institut de France on
a researcher or team studying
infectious diseases in developing
countries.
Although malaria therapies exist, until
recently little was known about how to
treat pregnant women. Ironically,
pregnant women are routinely excluded
from clinical trials because of the fear of
harming an unborn baby. In a deadly
‘catch-22’ scenario, pregnant women
may then not be given the best available
treatment because little is known about
how they or their child might be affected.
Working with Nick White, Chairman of
the Wellcome Trust’s South-east Asia
Programme, Professor Nosten’s work on
maternal malaria on the Thai–Myanmar
border cut the number of pregnant
women dying from malaria from one per
hundred live births to zero.
Clinical trials showed that pregnancy
alters the efficacy of antimalarials and
that the doses of medicines given to
pregnant women were too low – findings
that led to a revision of WHO guidelines.
Images
Left Participant in a study of brain activity relating
to sign language use. See page 33.
1 The aftermath of the 2005 London terrorist bombings.
2 Professor Anke Ehlers of the Institute of Psychiatry.
3 Professor François Nosten.