Professor Mark Creamer Post-Traumatic Stress Disorder Interview

Professor Mark Creamer Post-Traumatic Stress Disorder Interview

A million Australians are suffering post-traumatic stress disorder (PTSD), but a lack of adequately trained mental health workers means that many are not receiving the specialised treatment they need, according to clinical psychologist Professor Mark Creamer, a keynote speaker at the APS Clinical Psychology Conference in Sydney.

APS Fellow and trauma expert Professor Creamer, a former director of the Australian Centre for Posttraumatic Mental Health, said, "We have high rates of PTSD in our community but worryingly only around 30% of people seek help; however, even if they do seek help most won't be able to access best-practice treatment."

PTSD is caused by significant traumatic events such as major disasters, war, sexual or physical assault, motor-vehicle accidents and torture.

Prof Creamer said there was now international consensus that psychological interventions that involve people confronting their traumatic memories were the most effective. Of these trauma-focussed therapies, exposure therapy has the largest body of evidence to support it.

"Unfortunately, there aren't enough services or trained clinicians to deliver exposure therapy to those in need," he said.

Exposure treatment involves confronting the traumatic memory in a safe and controlled way, and dealing with thoughts and beliefs associated with the experience until the memory no longer creates high levels of distress.

"Because memories can cause intense fear, anxiety and distress, people often want to escape or avoid anything associated with the event. Although this provides temporary relief, it is one of the main reasons people don't recover," Professor Creamer said.

Failure to treat post- traumatic stress disorder can cause ongoing difficulties in people's lives: relationship problems; poor sleep; withdrawal from places, thoughts and feelings; irritability and physical complaints such as fatigue and headaches. Many people will also suffer disorders such as depression, substance use and anxiety.

Professor Creamer said: "It is vital that we train more psychologists to better recognise and treat this complex condition if we are to meet the needs of the community."

Professor Creamer's presentation on Friday 29th June at the Conference aims to upskill clinical psychologists to implement exposure treatment in clinical practice.
For more information see www.psychology.org.au

Interview with Professor Mark Creamer

Professor Mark Creamer is internationally recognised for his work in posttraumatic mental health. He was Director of the Australian Centre for Posttraumatic Mental Health for 15 years and is currently a Professorial Fellow in the Psychiatry Department at Melbourne University. His research record includes over 130 journal articles, three books, and many book chapters. Over the last 25 years, he has worked with individuals, communities, and organisations following traumatic events of natural and human origin. Mark now provides clinical, policy, teaching, and research advice to government and non-government organisations, as well as to health professionals, on issues relating to traumatic stress. In 2012, he was awarded the prestigious Lifetime Achievement Award by the International Society for Traumatic Stress Studies.


Question: What is post-traumatic stress disorder (PTSD)?

Professor Mark Creamer: Post-traumatic stress disorder or PTSD is a mental health condition that develops in a minority of people when they have been exposed to trauma.

Question: How is post-traumatic stress disorder diagnosed?

Professor Mark Creamer: Post-traumatic stress disorder is characterised by a number of symptoms.
The three main groups are:
The person is haunted by memories of what happened such as images, pictures or nightmares.
The second group of symptoms are efforts to stop those memories coming back such as the person avoiding any reminders of what or where it happened or in more severe cases they will emotionally shut down and then become withdrawn.
The third group of symptoms are being constantly on the verge or lookout for danger and being tense, jumpy and uptight.
When we see these groups of symptoms occurring together we call it post-traumatic stress disorder.

Post-traumatic stress disorder can be diagnosed by a mental health professional which is usually a clinical psychologist or a psychiatrist. Although sometimes other professions can diagnose this condition and we have put a lot of work into training General Practitioners.


Question: What events cause post-traumatic stress disorder (PTSD)?

Professor Mark Creamer: Any event where the person's life, physical health or wellbeing is under significant threat. Sometimes being exposed to the death or suffering of another person such as seeing someone who is significantly injured. The events, which we know about a lot, are military combat and sexual assault but there are a whole range of other events that are life threating such as natural disasters (bushfires, earthquake, floods) or severe car accidents where people are seriously injured. Certainty if the person believes they are going to die, that's an indicator of an event that could cause post-traumatic stress disorder.

Most people are very resilient and with the help of family and friends bounce back from these incidents without developing any kind of problems. 80-95% of people who experience trauma do recover without the help of a mental health professional.


Question: What type of treatment is required to help those with post-traumatic stress disorder?

Professor Mark Creamer: The treatment of choice is called Trauma Focused Psychological treatment which is also called Cognitive Behaviour Therapy and it helps the person to confront what happened in a safe and controlled way. Usually the person will want to block our memories and not think about it but they rumble around in the background and keep popping up through dreams and images. We help the person confront what happened and go through it in a controlled and safe way.

We also teach a range of skills to deal with the very unpleasant feelings that they have got. We teach ways to manage anxiety and depression which go along with post-traumatic stress disorder.

These kinds of psychological treatments are the best treatments but we also use medication in many cases such as anti-depressants that are known as SSRI which are a new generation of anti-depressants such as Prozac, which was the first, although there are many more sophisticated drugs available now. Cognitive Behaviour Therapy or psychological treatments are the first choice and medication is the second choice.

Question: How long does it take the average Australian to overcome post-traumatic stress disorder?

Professor Mark Creamer: Treatment time varies enormously; with some people it can be as little as six to ten sessions over a couple of months. Of course with others, if they have many repeated exposures to trauma or they have a lot of other things going on in their lives and a lot of other problems it can take much longer.


Question: How can we improve post-traumatic stress disorder training for mental health professionals?

Professor Mark Creamer: Although mental health professionals are trained to treat depression and anxiety in their training very few of them are trained to treat the mental health effects of trauma. We need to be running training for clinical psychologist and psychiatrists as well as general practitioners.


Question: If post-traumatic stress disorder is not treated can other issues occur?

Professor Mark Creamer: Yes, very much so and the classic example is with our veterans who have come back from overseas deployment and wars and have not sought treatment and often those who do have problems, gradually get worse and worse; this can result in drinking heavily as a way of managing the symptoms and this may cause alcohol problems. Other issues include developing relationship problems with family and loved ones and it then becomes more difficult to work. In time, with more severe cases, their whole life can be affected, and it becomes very disabling.


Question: What will your presentation at the APS Clinical Psychology Conference focus on?

Professor Mark Creamer: I am presenting a couple of presentations and I am focusing on how to treat post-traumatic stress disorder. I am running a one-day workshop with very experienced physicians to teach them how to do the Trauma Focused Psychological treatment in particular. The other workshop group is for experienced physicians who are seeing very complex cases and we talk about managing complex and difficult cases.


Interview by Brooke Hunter