Delivering leading treatments for PTSD in emergency services

Prolonged Exposure (PE) therapy is a cognitive-behavioural therapy that focuses on the processing of trauma-related memories and developing a more realistic perspective of the experience and impact of past traumatic experiences.

Darryl Wade, Head of Policy and Practice at Phoenix Australia – Centre for Posttraumatic Mental Health and Associate Professor in the Department of Psychiatry at the University of Melbourne is an expert in PTSD treatment and research.

“In PE therapy, we help the patient to better understand PTSD, talk to them about the personal impact of trauma, and provide a rationale for therapy that makes sense to them,” explains Associate Professor Wade.

“We then support the patient to talk about and work through the memories of past traumatic experiences, which we call imaginal exposure. The other main component of therapy is in vivo exposure, which is assisting the patient to engage in more of the activities that they were previously doing. We know that patients with PTSD tend to avoid and withdraw from many social and other activities, so we work with them to progressively do more of the things that make for a fulfilling life.”

Associate Professor Wade has no doubt that PE therapy is one of the most effective treatments for PTSD. “PE and other trauma-focussed therapies such as EMDR are the gold standard for treatment of PTSD. I’ve been seeing patients with PTSD for many years,” he says. “It’s very rewarding work to witness the gains that patients can make with therapy,” says Associate Professor Wade.

“For many patients, they can start to reclaim their lives – to feel less distressed and more in control, do more day to day things they’ve stopped doing, improve their relationships and get back to work – it can be of enormous benefit.”

Associate Professor Wade recently saw a young police officer with PTSD who had moved from a frontline into a non-operational position to better manage his symptoms. “He found it very helpful to be able to talk to someone about his experiences and to put into perspective what happened during and in the aftermath of this particularly traumatic incident.” Therapy assisted the patient to feel less bothered by the incident, improved his relationship with his family, and helped him to progress towards achieving his goal of returning to operational duties. 

“While there is a strong evidence base for the effectiveness of PE therapy in reducing PTSD symptoms associated with various traumatic experiences, evidence for the effectiveness of a treatment does not necessarily result in wide-spread adoption by practitioners working in the field,” explains Associate Professor Wade. 

He attributes this to a range of factors, including concerns from practitioners that they lack the skills to deliver PE therapy or that their patient may get worse during the treatment. “We are asking a patient to confront and talk about their past traumatic experiences and this is definitely a perceived barrier among practitioners to using PE – the concern is that the person may be resistant or abandon therapy if they become distressed using this approach,” says Associate Professor Wade.

To help address these barriers, EML funded a training and consultation program in PE therapy for a select group of psychologists to improve the treatment offered to police officers and firefighters affected by PTSD.

The training program comprised a skills-based multi-day workshop followed by group telephone-based consultations over a six-month period.

Associate Professor Wade and colleagues from Phoenix Australia conducted an evaluation of the PE training and consultation program. The evaluation assessed the impact of the program on the practitioners’ self-efficacy and outcome expectations when using PE, as well as their actual use of PE with clients who have PTSD. “The purpose of this evaluation study was to see whether or not we can get psychologists to use PE therapy more often, and pleasingly we found that was the case,” says Associate Professor Wade.

The training had improved practitioners’ confidence in using PE, addressed attitudinal barriers to using the therapy, and increased the uptake and delivery of PE therapy to clients who have PTSD.

A clinical psychologist who completed the training said “Much appreciated that EML had the foresight to offer such training. I have spent 25 years in the work cover system and to see initiatives such as this is pleasing to say the least.”

Of the 45 psychologists who enrolled in the training, 33 attended the workshop plus at least 10 consultations. “Those who completed the program reported improved self-efficacy and confidence to deliver PE therapy,” says Associate Professor Wade.

The psychologists also reported improved perceptions of benefits for their patients. “They understood that if they provided this therapy to emergency services personnel, that their patients would get better at managing negative emotions, better at tolerating distress, and that the severity of patients’ PTSD symptoms would reduce over time,” he says.

Notably, the practitioners reported a reduction in their concerns about potential drawbacks, such as patients getting angry, dropping out, or their condition getting worse with therapy. They also reported reductions in their concerns that this sort of therapy would be a burden for them – that they might feel drained or uncomfortable providing the therapy.