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Creating effective therapy and prevention programmes for PTSD

Open hand holding wooden tiles with the letters P, T, S, D written in black

Post-Traumatic Stress Disorder (PTSD) is a disabling condition that may develop after traumatic events such as disaster, interpersonal violence, severe accidents or war zone experiences. Epidemiological studies and the 2007 Adult Psychiatric Morbidity Survey suggest that 2-3% of adults in the UK suffer from PTSD (1-1.5 million). PTSD can severely impact a person’s life, harming relationships with others and their ability to work. If untreated, it can lead to secondary mental health problems, substance misuse, and an increased risk of cardiovascular illness or suicide.

Research at the University of Oxford has changed the treatment and prevention of post-traumatic stress disorder (PTSD). Importantly, Professors Anke Ehlers and David M Clark’s group developed and validated a psychological model of the key cognitive processes that lead to PTSD. They then developed a new, highly-effective form of cognitive therapy (CT-PTSD) to specifically target these processes. In addition, the Oxford group’s research provided evidence for changes in diagnostic criteria for PTSD in the DSM-5 (American Psychiatric Association, 2013) and ICD-11 (World Health Organization, 2018).

The outstanding results obtained with CT-PTSD have led clinicians and health service commissioners from many countries to request training. Indeed, it received the highest recommendation as a first-line intervention in the revised NICE PTSD guidelines (2018), as well as in the clinical guidelines of the American Psychological Association (2016) and the International Society for Traumatic Stress Disorders (2019). This intervention has been made widely available in the NHS through the Improving Access to Psychological Therapies service (4,800 therapists trained and over 74,000 patients treated between 2013 and 2020) and secondary and tertiary care services. Therapy materials and therapist training videos are available free of charge at the Oxford Centre for Anxiety Disorders and Trauma (OxCADAT) resources website. Between January 2019 and June 2022, 28,572 therapists from 160 countries registered to receive training via this website.  

The Oxford team’s work continued during the COVID-19 pandemic. In the early stages of the pandemic, for example, they were asked to give webinars for NHS England on how to remotely deliver CT for PTSD and traumatic bereavement and were commissioned to provide a top-up training programme for IAPT therapists by Health Education England.

PTSD prevention and stress resilience training

The PTSD prevention programme developed by Dr Jennifer Wild from the Oxford group is a recommended intervention for emergency workers, disseminated through the Blue Light network to emergency services across England and Wales with a reach of up to 184,000 emergency responders. 500 newly recruited emergency workers have benefited from the programme. The evaluation showed that new recruits felt significantly more confident to manage their mental health once they start full-time work. Another 570 student paramedics at 15 universities across England have completed the programme evaluation showing favourable results. The programme is also being delivered to paramedics in Singapore following COVID and in Australia with firefighters and police officers.  The work forms the basis of SHAPE recovery, the team’s outreach programme for healthcare workers affected by COVID which has led to reliable rates of recovery of over 90% for PTSD.

The prevention programme has informed current resilience and wellbeing interventions, training and outreach programmes that the mental health charity, Mind, is delivering across England and Wales. The intervention is now routinely offered across 16 Local Minds in Wales following an evaluation with 350 older adults who demonstrated significant improvements in wellbeing and social connection with the intervention. The programme has reached over 1600 university students and a number of families of military veterans who have been exposed to stress.

Find out more and access the full range of PTSD resources