Psychotraumatology - Medical Experts

Trauma therapy is an umbrella term for psychotherapeutic approaches used to treat trauma-related disorders following a traumatic event. The focus is on processing distressing memories of the experience. However, experiencing trauma does not necessarily lead to a condition requiring treatment. Therefore, not everyone needs immediate therapy following a traumatic experience.

The effects of trauma can manifest in various ways. These include, for example, sleep disorders or avoidance behaviour. In cases of dissociation, perception, memory or one’s sense of self may change temporarily.

Treatment may be appropriate if symptoms persist and significantly disrupt daily life. This applies to adults as well as to children and young people. For younger patients, trauma-focused cognitive behavioural therapy is the most widely studied approach. The extent to which parents or other caregivers are involved depends on the specific treatment programme.

If symptoms persist, PTSD may be present. Diagnostic assessment determines whether the symptoms are consistent with this or another condition. Even the presence of concurrent psychosis does not necessarily rule out trauma-focused cognitive behavioural therapy. Comorbid conditions are taken into account in the therapeutic planning.

Trauma therapy encompasses various psychotherapeutic approaches. These include trauma-focused cognitive behavioural therapy and EMDR. Both are distinct methods in which distressing memories are processed in different ways.

The prospects of success cannot be quantified by a universally applicable cure rate. The choice of therapy depends on the symptoms and the individual’s personal situation. A trusting therapeutic relationship is crucial for the treatment of trauma-related disorders, as it involves discussing very personal memories.

During the initial session of cognitive behavioural therapy, those affected describe their symptoms, wishes and expectations regarding the treatment. Before starting outpatient treatment, you can make use of trial sessions to get to know the therapist and assess how well you might work together.

There is no general evidence to suggest that a fixed stabilisation phase is a necessary prerequisite for trauma-focused treatment in adults. Stabilisation can involve developing skills for self-regulation and coping with stress. However, this does not imply a rigid sequence of phases that must precede every form of trauma treatment.

During the initial sessions, you can clarify the following points:

• Approach: Ask which method is offered.
• Approach: Clarify when distressing memories will be addressed.
• Collaboration: Check whether you feel taken seriously and in good hands.
• Expectations: Discuss which personal goals are realistic.

The exact process depends on the approach used, as there is no fixed sequence of stages that applies to every treatment. During confrontation – that is, the targeted examination of the experience – those affected talk about their memories.

Trauma-focused treatment may proceed as follows:

1. Traumatic experiences are recounted in detail or written down.
2. The strategies learnt are applied in everyday life and continued independently after the therapy has ended.

Treatment can usually take place on an outpatient basis. An outpatient individual session typically lasts 50 minutes. When specific memories are brought up in traumatised patients depends on the therapeutic approach and their personal situation.

An increase in symptoms does not necessarily occur. In a meta-analysis of randomised trials, in which treatments were allocated at random, recorded worsening of symptoms and adverse events occurred in psychological treatments at rates ranging from 0 to 5 per cent.

In the same systematic review, trauma-focused cognitive behavioural therapy was found to be at least as safe as the other psychological treatments examined. Another meta-analysis found no evidence of an average worsening of PTSD or depressive symptoms following trauma-focused therapies.

In people with PTSD and psychosis, a worsening of PTSD symptoms following the first trauma-focused session was uncommon in one study. In children and adolescents, however, adverse outcomes were only sporadically recorded in therapy studies. Exact frequencies are therefore uncertain.

Once trauma therapy has ended, those affected can continue to apply the strategies they have learnt independently. These include personal ways of coping with distressing memories and self-regulation.

Statutory health insurance may cover psychotherapy if post-traumatic stress disorder requires treatment. For adults, EMDR may also be covered as a supplementary treatment within the framework of systemic therapy, provided the method is integrated into a comprehensive treatment plan.

Whether private health insurance covers the treatment depends on the terms of the specific policy. You should therefore clarify before starting which therapeutic services are covered by your policy.

If you are paying for the sessions yourself, you should ask for the estimated costs to be provided in writing beforehand. It may also be worth comparing written quotes from different practices.

PTSD treatments are offered by medical and psychological psychotherapists. Some of them have undertaken additional specialist training in trauma therapy. Doctors may practise in fields such as psychiatry and psychotherapy, amongst others.

Specialists in psychosomatic medicine and psychotherapy are also suitable options. Their specialist medical training includes psychotrauma therapy using trauma-specific techniques such as EMDR.

The following questions, for example, are suitable for the initial consultation:

• What further training have you undertaken in trauma therapy?
• Which therapeutic approach do you use?
• What experience do you have with my specific condition?
• How do you proceed if the treatment becomes temporarily very stressful for me?

Trial sessions provide an opportunity to assess not only the therapist’s professional qualifications but also how well you work together on a personal level. You will find specialists in trauma therapy at the end of this text.