Traumatic stress service
Our Traumatic Stress Service (TSS) is national specialist service which works with people suffering from Post-Traumatic Stress Disorder (PTSD) and associated conditions.
We offer assessment, psychological treatment and consultation for people with PTSD. This can include victims of rape and sexual assault; victims of serious physical assaults; victims of serious road traffic accidents; and victims of other ‘single incident’ traumas.
Over the years our work has expanded to also include the needs of refugees and asylum seekers, many of whom have experienced multiple traumas including war, torture and violent bereavements. In addition, we treat service and ex-military personnel, as well as victims of terrorist attacks. We work with patients from a wide variety of ethnic groups and many of our clients do not speak English.
The service primarily covers five boroughs of London as well as taking some national referrals. We provide psychological assessment and treatment of PTSD on an outpatient basis. We do not have inpatient or community outreach facilities. Our clinicians work within a Cognitive-Behavioural Therapy (CBT) framework and can also offer Eye Movement Desensitisation and Reprocessing Therapy (EMDR). We offer appointments on Monday-Friday between 9am and 5pm.
As well as treatment, we provide teaching, training and supervision to colleagues working with PTSD. We also undertake and support a range of research activity in the areas of trauma and recovery.
Eligibility
This service is for adults who have experienced severe trauma and subsequently developed Post-Traumatic Stress Disorder (PTSD).
PTSD is an anxiety disorder caused by experiencing or witnessing life-threatening events. PTSD can develop immediately after someone experiences a traumatic event or it can occur weeks, months or even years later.
Inclusion criteria
- People over the age of 18 years. There is no upper age limit.
- People who have experienced one or more traumatic events in adulthood and have subsequently developed PTSD from those events.
Exclusion Criteria
Concurrent conditions requiring treatment in their own right:
- Active psychotic symptoms
- Alcohol, drug or medication abuse or dependence
- Severe depression and/or suicidality
- Other severe current risk to self or others
How to refer
The service accepts referrals from Community Mental Health Teams (CMHTs) and Improving Access to Psychological Therapy (IAPT) services within the Trust catchment area. Referrals from outside the Trust catchment area are also accepted where funding is agreed in advance.
Access to the TSS is via written referral, and should include an assessment letter that covers relevant background and personal history, trauma history and current symptoms. It should also include details of any previous treatment, a risk history and an up-to-date risk assessment.
Please Read more for our referral leaflet.
Treatment
The service’s treatment orientation is cognitive behaviour therapy (CBT), specifically trauma-focused CBT. Our main treatment models are Ehlers and Clark’s (2000) integrated cognitive model, and Judith Herman’s (1996) phased treatment model.
Treatments include anxiety management and emotion skills training, reliving and reprocessing of traumatic memories, cognitive restructuring outside and within reliving, imagery rescripting, behavioural experiments, in vivo (field) work, and schema-level work.
We offer treatment in the following formats: standard (12-16 sessions), extended (16-40 sessions) and intensive (18 hours over 5 days). Our clinicians also provide EMDR therapy for PTSD as a secondary or alternative evidence-based treatment.
Treatment is delivered by trained specialist staff using a phased treatment framework. All our treatments are compliant with NICE guidelines for PTSD, other anxiety disorders, depression, self-harm and personality disorders.
Treatment is always individually tailored to the patient based on a detailed assessment of their needs. Condition-specific outcome measures are used to evaluate the effectiveness of treatment and the service.
Training and Supervision
We offer teaching and training on PTSD at four levels:
- Introductory courses for professional groups at increased risk of developing PTSD (such as aid workers and paramedics)
- Teaching sessions for clinicians likely to encounter PTSD in the course of their work (victim liaison officers and medical staff);
- Multi-sessions training packages for clinical psychologists and CBT therapists in the identification and treatment of people with PTSD
- Combined supervision and training packages to whole psychological services to help them improve their outcomes for people with PTSD.
Tailored training programmes can be developed and delivered to services to meet their requirements. For example, a training package in TF-CBT comprising face-to-face workshops, webinars and supervision was recently delivered to therapists across 10 IAPT services. Evaluation of the programme revealed large improvements in therapist knowledge, skills and self-efficacy in treating PTSD.
We also offer CPD placements to clinicians inside and outside the Trust, who already have a foundation in CBT skills and wish to develop their competencies working with PTSD and trauma. Please read more for our training leaflet.
Staff
Our core team is made up of three full-time clinical psychologists and a team administrator. We also have an assistant psychologist who works part-time on our research and training projects.
Our core team is:
- Dr Sharif El-Leithy, Consultant Clinical Psychologist
- Dr Eleanor Cross, Principal Clinical Psychologist
- Dr Abigail Pain, Highly Specialist Clinical Psychologist
- Dr Jenny Rahemtulla, Highly Specialist Clinical Psychologist
- Elizabeth Hardcastle, Assistant Psychologist
- Bartholomew Tenerowicz, Team Administrator
A number of other psychologists and psychiatrists work in the service part-time, undertaking specialist continuing professional development (CPD). We also offer clinical and counselling psychology trainee placements on a national basis.
Outcomes
The Traumatic Stress Service routinely collects information to help us monitor the effectiveness of the treatments we offer. We use a number of standardised symptom questionnaires to do this.
Every patient completes the Post Traumatic Stress Diagnostic Scale (PDS) and the Beck Depression Inventory (BDI-II) at their assessment and then at the end of their treatment. The PDS questionnaire measures the severity of their PTSD symptoms. The BDI-II measures the severity of their depression symptoms.
Our results show that, in terms of PTSD symptoms, 74% of our patients report a significant improvement after treatment, with 51% making a recovery. In terms of depression symptoms, 60% of our patients report a significant improvement after treatment, with 47% making a recovery.
Testimonials
Some things our patients have told us after treatment:
“The Traumatic Stress Service has helped me to achieve many things in my life, and also with my family. When my friends see me now they see the change in me.”
“That was the hardest part for me…admitting that I had a problem. Since then, it has been difficult getting through the treatment but the end result is my life has become more manageable”.
“The doctor asked me several times to recall the incident which happened. It was really difficult to confront this memory. It was so distressing talking about the past that I wanted to leave, but after a few sessions, I started to use the treatment techniques at home and I realised that what the doctor had told me was helping me to deal with my memories of the incident”.
“When the doctor said that he wanted me to talk about what happened in the past, I was not willing to do it. But after he explained that it would help to talk about the past, I agreed. I told the doctor I would only talk about what I was able to. It was very difficult in the beginning but it got easier”.
“My advice would be to continue coming to the treatment sessions and not to stop. It will be difficult at first, but they will get results and feel much better in themselves if they finish the whole course of treatment, and they need to have patience”.
“It’s hard getting it out of you, and bearing your soul so to speak, but it is definitely worth it”.
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