What I have changed my mind about and why: public health and technology perspectives in the field of trauma studies

Abstract

Background: This paper is based on a panel discussion at the 32nd annual meeting of the International Society for Traumatic Stress Studies in Dallas, Texas, in November 2016. Objective: Paula Schnurr convened a panel of experts in the fields of public health and technology to address the topic: ‘What I have changed my mind about and why.’ Method: The panel included Richard Bryant, Lucy Berliner, Dean Kilpatrick, Albert (‘Skip’) Rizzo, and Josef Ruzek. Results: Panellists discussed innovative strategies for the dissemination of scientific knowledge and evidence-based treatment. Conclusions: Although there are effective treatments, there is a need to enhance the effectiveness of these treatments. There also is a need to develop simpler, low-cost strategies to disseminate effective treatments. However, technology approaches also offer pathways to increased dissemination. Researchers must communicate scientific findings more effectively to impact public opinion and public policy.

Complementary and integrative interventions for PTSD

“…Also, in low and middle income countries with less specialized health care these types of interventions may be more feasible (Bröcker et al, 2022 ). In the Schnurr et al ( 2017 ) paper that identified evolving perspectives in the field, Bryant noted ‘One public health approach is to try to implement evidence-based interventions that can be delivered to large numbers of affected people by non-specialist providers, even if it means that the effect size of treatment may not be as large as we would expect to see in a trauma-focused therapy delivered by expert specialists’ (p. 3). Answering the need for broad dissemination by evaluating internet-based trainings or peer-led interventions is another issue that we ask scientists in this area to address.…”

“…To reduce the risk that individuals are sidetracked from seeking effective treatment, integrating CIH approaches in comprehensive treatment plans is recommended. As Rizzo commented ‘I have come to think that we need to spend more time offering a variety of treatment options to patients, some in the complementary and alternative medicine domain that, while not rock-solid in terms of multiple independent randomized clinical trials, may connect individuals to the concept of healing’ (Schnurr et al, 2017 , p. 4). Approachable and appealing CIH treatments may promote personal agency and engage individuals in the ‘ritual of the therapeutic act’ (Benedetti et al, 2018 ).…”

“…Given the potential contribution of CIH to improving functioning and wellbeing for people exposed to trauma, it is critical that researchers focus on conducting methodologically rigorous studies. By assessing complements and adjuncts to known effective therapies, continued rigorous research of CIH interventions can contribute to answering the call from Schnurr et al ( 2017 ) to enhance existing treatments to ‘make more people more better’ (p. 2). Longitudinal studies that track constructs such as some that were examined in this series of papers (e.g.…”

“…However, these are not a panacea. For populations in poorly resourced countries with limited health care infrastructure, these treatments cannot be scaled up easily to respond to the many in need (Bröcker et al, 2022 ; Kaminer et al, 2023 ; Schnurr et al, 2017 ). Even among those privileged to attain these treatments, success rates are modest and a substantial proportion of individuals either drop out, do not attain clinically significant gains, or are left with notable residual symptoms (Miles et al, 2022 ; Niles et al, 2018 ; Schottenbauer et al, 2008 ; Steenkamp et al, 2015 ; Thimm et al, 2020 ).…”

Interdisciplinary approaches to understand traumatic stress as a public health problem

“…Rizzo and Shilling (2018) Yehuda et al, 2016) to gather experts together for a frank discussion about approaches that have stood the test of time, in other words tried and true evidence-based practices (EBPs), in comparison with others approaches that can by now be considered more or less tried and failed. In the final paper in this special issue, Schnurr, Bryant, Berliner, Kilpatrick, Rizzo, and Ruzek (2017) continue this line of discussion, describing some of the things they have changed their mind about over the course of their careers, primarily from the perspectives of EBPs, public health and technology.…”