Hello everyone my name is Leanne Humphreys and today we’re speaking with Associate Professor Andrea Phelps who’s the Deputy Director of Phoenix Australia.
Today’s conversation relates to the topics of acute stress disorder and post-traumatic stress disorder and in particular Andrea will be talking with us about the issue of avoidance.
Hello Andrea how are you?
Andrea: Well Leanne thank you. How are you?
Leanne: I’m good thank you. Andrea why is avoidance such an important issue for us to understand?
Andrea: Look it’s really an important feature of dealing with trauma in so many ways and that starts from when the person first reaches out to a doctor or a counsellor, whoever it may be. Depending on the nature of their traumatic experience it can be very difficult for people to disclose to someone what’s happened to them.
The prime example of that is sexual assault but it can also be true for lots of different types of trauma.
It can also be difficult for people to disclose that they’re having problems after trauma and we often see that in people who are exposed to trauma in a work context.
So military or emergency services for example where some people feel embarrassed or ashamed about what they see as being a sign of personal weakness or failure so in both of those cases, whether it’s not wanting to talk about the traumatic experience or their responses to that experience, what we often see is that people will present with a range of other problems. Whether it’s physical complaints, sleep, anger, relationship issues. But not actually mention the traumatic experience and so that’s really important then for the psychologist or other health practitioner to actually be prepared to ask the person if they have had any particularly stressful or traumatic experiences that might be causing some of their distress.
Leanne: Okay, so you’re saying that when a range of different issues present even if the, the client or the patient isn’t volunteering that information that as practitioners we need to be kind of listening for that possibility and stepping in and asking those questions.
Andrea: Exactly, exactly. Because it can just break the ice if someone asks you that, you may be more prepared to talk about it. It can also be sometimes useful to have like a, a list of stressful or traumatic life events and if someone feels unable to say what’s happened to them they may even be prepared just to indicate on a checklist. Right. What they’ve had. And really that’s just a starting point to be able to talk about it.
Leanne: Okay so I guess you’re talking there about screening so whether it’s screening for just a simple list of items that somebody might endorse of in terms of experiences they’ve had but also I guess that leans into the idea of a primary care PTSD screen or a similar kind of screening tool.
Andrea: Yes absolutely, so we sort of think about screening in two ways. One is screening if you’ve had a traumatic exposure and then the second is screening to see if you might have PTSD. So the one you’ve mentioned, the primary key PTSD screen is really useful. It’s five brief questions so it’s a great place to start. Leanne: Okay and often that that start is as a primary care screen that’s with the GP isn’t it so GPs need to be kind of listening for that possibility and then kind of stepping in and conducting those screens as necessary.
Andrea: Yes absolutely, that’s right, and then if it is a GP the next step is really to help the person to overcome what is a natural avoidance about wanting to seek treatment.
Many people don’t want to talk about their traumatic experience and in fact they’re doing everything they can to avoid thinking and talking about it. So you have to have a compelling case for why they should do that and you know it’s just saying something simple like, you know,
‘I understand that it’s natural that you want to avoid talking about this but we do know there’s a lot of good evidence that the best way to recover from this sort of traumatic experience is to spend some time talking about it’.
Leanne: Okay. Yes, so does that.. that makes me think too that then having been alerted to that possibility and having had that conversation with the GP the choice of the right mental health practitioner is the next step?
Andrea: Yes, that’s absolutely spot on Leanne. We do know that supportive counselling doesn’t work for PTSD and we also need to be mindful that for some people, some psychologists and other mental health practitioners as well, it can also be tempting to avoid.
So actually making sure that the person is seeing someone who knows what the best practice approaches to treatment are and that’s generally trauma focused CBT or EMDR, eye movement desensitization reprocessing, which really do involve confronting that avoidance and that’s at the core of treatment.
Leanne: So those treatments that you’ve mentioned Andrea you know the most evidence-based treatments and they I guess, a commonality there is that really structured engagement with traumatic memories and I guess that directly works against avoidance doesn’t
Andrea: It’s about avoiding avoidance it’s not colluding with it. It’s avoiding it. That’s exactly right. It’s really about confronting the feared memories in the same way that you would, you know if you were phobic about spiders. The treatment is to confront the spiders. It’s really very much the same idea.
Leanne: Terrific, okay, look thank you very much Andrea that’s really thought provoking.
So for those who’d like to take a deeper dive into the topic and to understand more about avoidance and the evidence-based treatments for PTSD please feel free to explore the materials and the resources on this page, but also consider following the links to the recommended readings.
Andrea: Thank you.