By Matthew J. Friedman,
M.D., Ph.D.
Many ISTSS members listed in the 1995/96 Membership Directory received a recent
mailing from the American Academy of Experts in Traumatic Stress (AAETS). The
stated mission of the Academy is to "increase awareness of the effects
of trauma and ultimately improve treatment for survivors." According to
this letter, the Academy offers "membership in a prestigious scientific
and professional association; a Code of Ethical and Professional Standards;
programs to achieve diplomat and fellow credentials; National Training Conferences;
the Academy Journal; and listing in The National Registry of Experts in Traumatic
Stress."
A membership application form was enclosed with instructions to include a check
for $125. Upon approval of application for membership, new members will receive
"an elegant membership certificate, suitable for framing." Members
will presumably be entitled to become diplomates and then fellows at some future
time, but the criteria for those designations were not specified. Finally, members,
diplomates and fellows will be entitled to display their Academy credentials
as a part of their signature.
This mailing raised a number of questions among ISTSS members that were directed
to me and ISTSS headquarters. Therefore, I would like to share with you what
we do and don't know about the Academy.
First, there is absolutely no connection between ISTSS and the Academy. Neither
I nor any member of the ISTSS Board has been approached by any of its representatives.
We have little more information about the Academy other than what was stated
in its letter and brochure.
On Feb. 22, Fred Lerner, director of the PTSD Resource Center at the National
Center for PTSD, searched three bibliographic databases (PILOTS, to date; PsychINFO,
1967 to date; and MEDLINE, 1990 to date). He was unable to find any publication
relevant to PTSD or traumatic stress written or co-authored by any officer or
advisory board member of the Academy listed on its letterhead.
Lerner phoned the Academy for more information and learned the following: the
first issue of the Academy's journal, Trauma Response, will appear in March;
it will be "practitioner oriented." The Academy had been recruiting
for about three months and had attracted over 200 members. The first annual
conference is tentatively scheduled for September in the New York City area.
We have been advised that it is not unlawful for an organization to establish
itself and to charge a membership fee as long as it accurately represents itself
and provides members with the benefits that have been promised. In this case,
Academy members should receive the journal, a membership certificate suitable
for framing, a listing in The National Registry of Experts in Traumatic Stress,
the right to cite the Academy credentials after their names and an opportunity
to attend certain conferences.
I received a number of inquiries about the basis for the Academy's "expertness" in
traumatic stress. ISTSS members may have personal beliefs about the proper meaning
of the term expert. Based on our own legal consultations, members must make
their own determinations on whether Academy membership makes someone an expert in
the area of traumatic stress.
This is all we know at present. We have been advised not to make specific recommendations
regarding the advisability of joining the Academy. However, we will try to keep
you informed as we learn more about the organization.
By Arthur S. Blank Jr.,
M.D.
As many readers will have noticed, StressPoints has entered a phase of growth
and development. Following the vision of the Board of Directors and many members,
we are adding features to the newsletter with the objective of boosting its
practical value.
The next issue of StresPoints will introduce a "Recently Published"
section, with citations for new articles and books not yet in the major databases.
I encourage ISTSS members to submit information about their newly published
articles for inclusion in this section; please send reprints to Elizabeth
Elliott at ISTSS headquarters. Authors of newly published books may send
pamphlets or announcements.
Much of the energy for the changes underway is coming from a group of contributing
editors, who regularly furnish or obtain reports in their specialized area.
As additional funds permit, the size of StressPoints may increase.
While contributing editors have a special role in the future of StressPoints,
all Society members can contribute to our professional communication by submitting
news and opinion items. These should be sent to Managing Editor Elizabeth
Elliott at ISTSS headquarters. We also welcome your suggestions for further
improvements.
ISTSS is seeking nominations
for its Lifetime Achievement, Robert S. Laufer and Sarah Haley awards. The nomination
deadline for these awards is May 15. The criteria for each award are described
below. Areas of particular interest are PTSD in children, sexual abuse and violence.
We encourage you to consider candidates from countries outside of North America.
Lifetime Achievement Award
The Lifetime Achievement Award is the highest honor given by ISTSS, recognizing
great contributions to the field of PTSD study over the course of a career.
Prior recipients include Robert Lifton, M.D., Ann Burgess, Chaim Shatan, M.D.,
and others. The recipient will receive $500. The award is presented at the Society's
Annual Meeting.
Robert S. Laufer Award
The purpose of the Robert S. Laufer, Ph.D., Memorial Award for Outstanding Scientific
Achievement is to recognize a specific accomplishment of outstanding merit in
the field of PTSD research. This award recognizes the excellence associated
with a particular study or series of related studies, rather than the collected
achievements of a career. All ISTSS members are eligible for this award. The
recipient will receive $1,000, which will be given by Ellen Frey-Wouters in
memory of her husband.
Sarah Haley Award
The Sarah Haley Memorial Award for Clinical Excellence was first given in 1993.
It recognizes people whose written and/or verbal contributions to the field
of traumatology exemplify the work of Sarah Haley. It is given to a clinician
in direct service to traumatized individuals. The recipient will receive $750.
Nomination Procedure
Nominations should be sent to Edna B. Foa, Ph.D., NCPHU, 3200 Henry Avenue,
Philadelphia, PA 19129 and should include a one-page statement summarizing the
major achievement of the nominee and a vitae.
By Harold Kudler, M.D.
At the Business Meeting of the 1995 ISTSS Annual Meeting, I suggested that the
Society consider developing practice guidelines for the treatment of PTSD. This
initiative does not stem from any desire to direct or constrain the practice
of clinicians in the field. Rather it represents concern about managed care
requirements for obtaining treatment. These include the ability to define the
necessity for treatment and to prescribe a professionally sanctioned course
of therapy.
The ISTSS is the logical body to develop practice guidelines for PTSD. This
is not a prerogative but a responsibility. Clinician-generated practice guidelines
would be preferable to those generated by insurance companies. If we fail to
take the lead, other professional societies will define the standard. ISTSS
action may also inform ongoing Veterans Affairs deliberations on the treatment
of PTSD. Our efforts may help alert primary care providers to PTSD and direct
their liaison with mental health professionals.
We have a clear opportunity to harness our expertise for the benefit of our
patients. ISTSS President Matthew Friedman asked me to head a task force of
interested ISTSS members to see whether it is possible to achieve a consensus
on recommended PTSD practice guidelines. He will present our recommendations
to the Board of Directors for further action. Those of you who have already
been working on such guidelines or who have an interest in joining this effort
are encouraged to contact me at 919/286-6933.
By David Read Johnson,
Ph.D., Contributing editor, creative arts therapies
Empirical research on creative approaches to PTSD treatment is sparse, but sorely
needed. Though many clinicians endorse the importance of artwork, role playing
and creative expression in the assessment and treatment of the disorder, very
little empirical evidence exists to support these claims.
A recent pilot study published in the journal Art Therapy in December 1995 by
Charles Morgan and David Johnson at the National Center for PTSD in West Haven,
Conn., provides an example of one model for the empirical study of treatment
for nightmares. The authors had two veterans with PTSD alternate each week between
two conditions: drawing a picture of, or writing in a journal about, their nightmares
each morning over the course of 12 weeks. Both veterans reported significant
decreases in the frequency and intensity of their nightmares during the art
condition, and increase during the journaling condition. The authors suggest
that "the isomorphism between visual imagery (in drawings) and the visual
modality of nightmares may provide a more effective means of transforming and
integrating the traumatic material into normal cognitive schemas."
If you would like to join the ISTSS Creative Art Therapies Interest Area Group,
simply write or fax chairperson David Read Johnson, Ph.D., c/o ISTSS headquarters.
Ideas for activities, research projects and presentations at the national conference
are welcome.
By Mary P. Koss, Ph.D.,
University of Arizona College of Medicine, Tucson, Ariz.
Sue Miller's protagonist in the novel For Love returns home, only to feel "mugged
by memory." Clinicians working with traumatic memories may feel mugged
nowadays. After reading hundreds of studies on emotional memory, I find a perspective
emerging. Those who seek to find in the literature evidence of memory's photographic
perfection conclude that the glass is empty. Those who have stopped magnifying
every memory flaw to disprove this extreme position have found substantial evidence
of the tenacity of memory.
Prior to the 1980s, 90 percent of the literature on eyewitness testimony was
laboratory simulation, which has limited application to real life. It is impossible
to recreate in a lab, within ethical guidelines, an experience that is as rich,
anxiety-provoking, personally affecting and consequential as a real-life trauma.
While field studies overcome many of these disadvantages, little of what has
been learned from them has surfaced in the memory debate.
The following principles are demonstrated in field studies: First, most of the
details that crime witnesses tell police are correct and remain correct for
several months. Second, investigators' attempts to suggest inaccurate details
do not intrude into recall, nor does wrong information published in the media
appear in witness statements. Third, among respondents recalling traumas suffered
in concentration camps 40 years earlier, the accuracy of memory for conditions,
mistreatment, daily routine, housing, food and main guards was remarkable.
Recently, I was the clinical discussant of a presentation by Elizabeth Loftus,
Ph.D., in Washington, D.C. I found myself in an odd position. Her slick address
was peppered with legal anecdotes and case material from newspapers and magazines.
Anyone who works clinically with trauma survivors could go head-to-head at that
level of evidence, but even if we wanted to, our professional audiences would
not let us get away with it. And so I responded with conclusions from cognitive
literature and empirical data from trauma survivors, most of which appeared
in the October 1995 special issue of Journal of Traumatic Stress. Some of the
audience comments referenced the problem that clinicians have not emphasized
third-party validation of memories.
Certainly, any applied profession has a practice forefront that is as yet unvalidated,
but I think that the field of trauma studies has amassed a very impressive body
of literature in its short history. And we can continue to do more. Intrusive
memory is one of the hallmarks of PTSD; however, we have focused too exclusively
on PTSD as an endpoint to be predicted by personal characteristics, or to be
evaluated with respect to the outcome of interventions. Descriptive data on
the phenomena of intrusion are lacking, and we have not paid sufficient attention
to whether our memory-focused interventions actually result in measurable changes
in intrusive memory, or whether they are effective by acting via reduction of
other symptoms of PTSD.
But overall, we are participating in the dialogue about memory productively,
marshalling data to rebut fundamental criticisms. Loftus recently resigned from
the American Psychological Association, writing a letter which attempts to further
polarize and politicize the issues by dismissing us as unscientific players
with whom she can no longer associate. No. The future belongs to those clinicians
and cognitive scientists who come together to share technical vocabulary, theoretical
formulations, objective approaches to measuring significant memory phenomena
and access to ethnically and developmentally diverse populations experiencing
real trauma.
For a detailed review, see Koss, M.P., Tromp, S. and Tharan, M. (1995). Traumatic
memories: empirical foundations, forensic and clinical implications. Clin. Psychol.:
Sci. and Pract., 1:111­p;132.
By Fahed Al Naser, Ph.D.,
Social Development Office, Kuwait
The Iraqi invasion of Kuwait in 1990 and the subsequent occupation caused many
psychological and social problems among the Kuwaiti citizens, whose traumatic
experiences included violence, abuses, torture and imprisonment, refugees, death
and bereavement and others. During the occupation, a country once known for
its harmony and prosperity was turned into a land of terror, distress and scarcity.
Kuwait's liberation left an ocean of traumatic stress related disorders, which
were aggravated by the problem of the prisoners of war and missing persons.
Preliminary studies showed that a considerable segment of the population developed
traumatic stress related disorders, including PTSD. It was at this juncture
in 1992 that the Amiri Diwan Social Development Office (SDO) was established.
Initially, the task of treatment was formidable because counseling and other
psychotherapies - due to their social and religious implications - were something
alien and unacceptable to the majority of citizens. SDO mobilized campaigns
to create awareness and recognition of the need of therapies for proper cure
and rehabilitation of the afflicted, with extreme care to safeguard the sanctity
and privacy of the individual, family and society. The tenacity of SDO, combined
with international cooperation and assistance, generated positive results.
The SDO sponsored a series of studies, as well as seminars, conferences and
training courses in which internationally known scholars shared their expertise
and experience in related fields. Modern therapies and methods were introduced
and Kuwaitis were enabled to face the present and future challenges.
By Didier Cremniter,
M.D., Contributing editor, ALFEST
The development of a medical and psychological care unit for immediate interventions
in cases of natural or accidental disasters, crowd accidents or bomb attacks
in France was based on our experience in dealing with the victims of the Islamist
bomb attacks during the summer of 1995.
The project was directed by Louis Crocq and supported by the political will
to define the practical modalities of immediate psychological care for all such
victims in France. While special centers for long-term treatment of victims
do exist in France, this new option provides an immediate psychological intervention
in emergency situations. The opportunity for specialized teams to provide psychological
care and debriefing at various locations is the result of a close collaboration
with the French SAMU (prehospital emergency medical service). We tested this
plan in suburbs of Paris during the summer 1995 bomb attacks by means of duty
teams. Every team included a psychiatrist, a psychologist and psychiatric nurse.
However, in case of a major disaster requiring more workers, the first line
team could be doubled. The team reached the site of the explosion by joining
the SAMU, which is well-equipped with ambulances and helicopters. In situ they
provided the first psychological debriefing. Those victims who were slightly
wounded (acoustic and chest trauma) were transported to the nearest hospital,
where psychiatric staff performed debriefings. In addition to the bomb attacks,
the unit provided psychological care for hostages in a school in the northern
suburbs of Paris and for victims of an accidental explosion in a building.
The role of this unit is to elaborate a rational French model of psychological
intervention in collaboration with every regional head psychiatrist and SAMU
coordinator. Members of this unit promote a training program not only for the
team workers but also for first-aid workers, medical teams and public institutions
(railway airport, electricity and gas employees). This mission is being carried
out in close collaboration with victim associations and legal authorities.
By Ellen Frey­p;Wouters,
Ph.D., ISTSS Representative to United Nations
Nearly 50,000 people - more than two-thirds of them women - travelled to China
from all over the world to participate in the United Nations Fourth World Conference
on Women, held in Beijing (Sept. 4­p;15, 1995), and the parallel NGO
Forum on Women held in Huairou (Aug. 30 through Sept. 8, 1995). They came carrying
the hopes and concerns of the 2.8 billion women and girls who constitute half
of humanity. The final document of the conference, the Beijing Declaration and
Platform for Action, was unanimously adopted by the 181 UN member states present,
and more than 100 countries and most UN organizations made specific commitments
to its implementation.
The world now has an ambitious blueprint to enhance the social, economic and
political empowerment of women; improve their health; advance their education
and training; promote their marital and sexual rights; and end gender-based
violence.
Mental health issues had unprecedented visibility at the UN Conference and NGO
Forum. In the first draft of the platform, in 1992, there was virtually no language
on mental health or provision for psychological counseling for women in distress.
NGO representatives in New York, especially in the World Federation for Mental
Health and ISTSS, had worked for three years leading up to this conference to
have mental health concerns included in relevant sections of the platform (all
forms of violence against women; impact of armed or other kinds of conflict
on women; international trafficking; burdens of poverty and programs for poor
women; needs of migrant, refugee and displaced women; special concerns of the
girl child). These issues were promoted through lobbying governments, recommending
new language on mental health for the platform and interacting with other nongovernmental
organizations. The efforts contributed to the inclusion of important language
on mental health issues in the final Platform for Action.
At the recent UN General Assembly meeting in the fall of 1995, many discussions
focused on effective follow-up. Secretary-General Boutros Boutros-Ghali appointed
Assistant Secretary-General Rosario Green to oversee the implementation of the
Beijing provisions concerning the UN.
During the 40th session of the Commission on the Status of Women, March 11­p;22,
1996, implementation of strategic objectives and action in the critical areas
of concern were again discussed. A preliminary report of government efforts
to implement the Platform for Action six months after Beijing shows progress.
For example, interministerial commissions are being established in many countries
and concrete national initiatives may be expected to follow.
Legislation is being introduced in a number of countries. In the United States,
Congresswomen endorsed a "Contract with Women in the USA," which summarizes
key parts of the Platform most relevant to women living in the United States.
An interagency Council to coordinate implementation was established, chaired
by Donna Shalala, head of the Department of Health and Human Services.
Yet, monitoring progress will be a difficult job. Change is likely to come only
incrementally, and only where advocates, in most cases nongovernmental organizations,
fight existing practices, laws and customs.
By Roderick Ørner, European
Conference Secretariat
SHEFFIELD, England - From March 17 to 20 - less than a week before the massacre
of Dunblane schoolchildren - 300 delegates from 30 countries gathered in Sheffield
for the First European Conference on Traumatic Stress in Emergency Services,
Peacekeeping Operations and Humanitarian Aid Organizations.
This watershed conference for the field of psychotraumatology, jointly sponsored
by the European Society for Traumatic Stress Studies and the Emergency Planning
Department of Trent NHS Executive in Sheffield, was the first regional meeting
to focus specifically on the needs of responders. More than 100 presentations
addressed risks, needs and care programs.
As pointed out by Berthold Gersons, M.D. (The Netherlands), the challenge presented
to individuals, professions and organizations is to maintain goal-directed action
in spite of complications arising from ambiguities of needs and role conflicts.
These all too often engender a sense of uncertainty, and their combined effects
for psychotraumatology in Europe has been to limit options for change. We may
have had our backs turned to the future for too long and the costs to responders
are manifest in compassion fatigue (C. Figley, Ph.D., USA) and a vast array
of somatic syndromes (W.S. de Loos, M.D., The Netherlands).
The conference bolstered the impression that Europe is reclaiming and reasserting
its own heritage with respect to conceptualizations of traumatic stress, its
sequelae and care provision for its victims. The days of uninformed "product
promotion" are numbered (J. Mitchell, Ph.D., USA). A previous focus on
techniques for intervention is being replaced by growing appreciation of the
value of process factors in critical incident stress management (A. Dyregrov,
Ph.D., Norway). Another point of regional divergence may be the extent of reliance
on professional staff groups for provision responder support. This may prove
to have been an impediment to defining specific standards for training and quality
of service provision (Dr. J. Kenardy, Australia).
Evidence was presented that education and realistic exercises that correctly
anticipate future incident scenarios are a powerful protector for responders
(L. Weisaeth, M.D., Norway). With respect to strengthening social support resources
and responder family networks, the challenge is to establish user-friendly information
systems backed by policies to minimize the effects of traumatic stress in the
workplace (Lt. Col. R. McLellan, Canada). Evidence suggests using systematically
gathered data to screen and select staff for particular duties (Col. M.W. de
Swart, The Netherlands).
While every responder's experience is invariably deeply personal and idiosyncratic
(Lt. Col. I. Palmer, U.K.), a prerequisite for truly turning our backs to the
past and achieving an enlightened future is the use of objective evidence as
the tool of our trade. In this respect humanitarian aid organizations appear
to lag behind other responder groups featured in the conference program. Ultimately,
all groups that respond to traumatic stress are developing a keen recognition
that interventions at an organizational level promise considerable longer-term
rewards (Dr. A. Ager, Scotland). All the more reason for all practice to be
informed by evidence (S. Turner, MRCP, U.K.).
StressPoints Staff
Elana Newman,
Ph.D.
Elizabeth Elliott, Managing Editor
Conferences | Membership | Publications | Leadership * Headquarters | Contact | Home Page