Recognition of the neurobiological insults imposed by complex trauma and the implications for psychotherapeutic interventions

Summary:

Considerable research has been conducted on particular approaches to
the psychotherapy of post-traumatic stress disorder (PTSD). However, the evidence
indicates that modalities tested in randomised controlled trials (RCTs) are far from
100% applicable and effective and the RCT model itself is inadequate for evaluating
treatments of conditions with complex presentations and frequently multiple
comorbidities. Evidence at levels 2 and 3 cannot be ignored. Expert-led interventions
consistent with the emerging understanding of affective neuroscience are needed and
not the unthinking application of a dominant therapeutic paradigm with evidence for
PTSD but not complex PTSD. The over-optimistic claims for the effectiveness of
cognitive-behavioural therapy (CBT) and misrepresentation of other approaches do
not best serve a group of patients greatly in need of help; excluding individuals with
such disorders as untreatable or treatment-resistant when viable alternatives exist is
not acceptable.

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