Cautions on the overgeneralized application of the NICE and CREST recommendations for the treatment of PTSD in the UK: a reflection from practice in Belfast, Northern Ireland

Abstract

The task of this paper is to present a message of caution regarding the overgeneralized reliance on the NICE (

Promoting mental health in Northern Ireland: addressing division, inequality and stigma

“…They found that 12% of their community sample met the criteria for post traumatic stress disorder (PTSD) and that this was also related to socio-economic status. Dorahy (2006) has made the important point that conventional treatment for PTSD may not be sufficient in Northern Ireland as the nature of Troubles-related trauma and the sociopolitical, ethno-cultural context may require a range of different responses. Tomlinson (2007) in his report, The Trouble with Suicide concluded that:…”

The Experience and Psychological Impact of ‘Troubles’ related Trauma in Northern Ireland

“…In the light of their investigations regarding the concept of "complex PTSD", Dorahy (2006) and Harrison and McGoran (2008) argue that the treatments recommended by NICE and the Clinical Resource Efficiency and Support Team (CREST), namely Trauma Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) may not be appropriate for the treatment of more complex presentations of PTSD from individuals who have experienced chronic and incessant violence or multiple traumatic events. Harrison and McGoran (2008), following results from an audit of cases in the Family Trauma Centre, suggest a phased approach to treatment of such cases which modifies the current NICE guidelines and addresses the "complex socio-political aspect".…”

“…It has also been noted, however, that the Northern The experience and psychological impact of 'Troubles' related trauma in Northern Ireland 101 Ireland "Troubles" present a complex array of incidents which in turn are set in a variety of social contexts. In recent years, a number of authors have questioned the homogeneity of PTSD presentations associated with the "Troubles" given these discrepancies (Dorahy, 2006;Harrison & McGoran, 2008;Dorahy et al, 2009). These authors have explored the concept of "complex PTSD" and whether this construct better characterises presentations of symptoms from individuals exposed to intense and sustained violence or multiple traumatic events.…”

“…Dorahy (2006) in fact argues that generalisations regarding the effects of the "Troubles" are fraught with inaccuracy, given the uneven spatial distribution and variation in social context surrounding traumatic events. Dorahy et al (2009) stress that the phenomenology of individuals who experience a single incident will vary from those who have been exposed to the chronic, repeated, relational trauma which characterised areas of North and West Belfast, for example.…”

“…Analysis of "Troubles-related" deaths reveals that the violence was overwhelmingly concentrated in Belfast with over 40% of deaths from political violence occurring in the Belfast district, and 75% of these deaths occurring in North and West Belfast (Smyth, Morrissey, & Hamilton, 2001). Dorahy (2006) describes the "repeated traumatisation" experienced by these communities with the often daily persistence and ongoing threat of political violence over many years. Despite the concentration of much of the violence within the Belfast area, it is important to also acknowledge the exposure to and impact of violence in other towns and rural areas which experienced violence and the threat of violence over many years.…”