From the Guidelines
Treating clients with a history of big T trauma requires a comprehensive approach that prioritizes morbidity, mortality, and quality of life, and should follow the European guideline on management of major bleeding and coagulopathy following trauma, which recommends a systematic diagnostic and therapeutic approach to reduce preventable deaths attributable to traumatic injury 1.
Key Considerations
- Establishing a secure therapeutic environment where the client feels physically and emotionally safe is crucial, as premature exposure to trauma work can retraumatize clients.
- Developing a strong therapeutic alliance before delving into trauma work is essential, and evidence-based psychotherapies such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), or Prolonged Exposure therapy should be considered, tailoring the approach to the client's specific needs and readiness.
- For clients with PTSD symptoms, medication may be beneficial as an adjunct to therapy, with first-line pharmacological options including SSRIs like sertraline or paroxetine, or SNRIs like venlafaxine, typically continued for at least 6-12 months after symptom improvement 1.
Important Elements
- A trauma-informed approach toward another person involves provision of the following core interpersonal principles: safety, trustworthiness, choice, collaboration, and empowerment.
- Cultural, linguistic, and gender competence and the availability of peer support are also important elements in treating clients with a history of big T trauma.
- Specific services to treat severe trauma, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Child and Family Traumatic Stress Intervention (CFTSI), Child Parent Psychotherapy (CPP), and Parent Child Interaction Therapy (PCIT), should be considered for clients whose level of trauma exposure requires intensive clinical interventions 1.
Imaging and Treatment
- Imaging, in particular CT, plays a critical role in the management of patients with major blunt trauma or polytrauma, and a number of indications are discussed in the ACR Appropriateness Criteria, including patients who are hemodynamically stable or unstable, and patients with additional injuries to the face, extremities, chest, bowel, or urinary system 1.
- The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel, and provide recommendations for imaging and treatment procedures for specific clinical scenarios.
From the Research
Treatment Approaches for Clients with a History of Big T Trauma
- Trauma-focused cognitive behavioral therapy (TFCBT) and eye movement desensitization and reprocessing (EMDR) are effective treatments for post-traumatic stress disorder (PTSD) 2, 3
- TFCBT and EMDR have been shown to be more effective than non-trauma-focused treatments in reducing PTSD symptoms 2
- EMDR has been found to be better than cognitive behavioral therapy (CBT) in reducing post-traumatic symptoms and anxiety 3
- Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and trauma-focused CBT are strongly recommended by treatment guidelines for PTSD 4
Key Components of Effective Treatment
- Trauma-focused treatments that directly address memories of the traumatic event or thoughts and feelings related to the traumatic event are essential 4
- Parental participation in treatment can significantly enhance the beneficial impact of TF-CBT for traumatized children 5
- A trauma-informed approach to care can help resist re-traumatization in healthcare settings 6
Considerations for Treatment
- The quality of evidence for each comparison made in studies is often assessed as very low, and findings should be interpreted with caution 2
- Sample sizes in studies are often small, and many studies are underpowered 2
- Limited follow-up data can compromise conclusions regarding the long-term effects of psychological treatment 2