Tuesday, September 22, 2009

Prolonged Exposure Therapy, Is Reliving Past Trauma The Cure? – ELLE

In the latest issue of Elle, there is a terrific article on the cognitive behavioral therapy of prolonged exposure and its usefulness for treating Post Traumatic Stress Disorder "Prolonged Exposure Therapy, Is Reliving Past Trauma The Cure?" by Louisa Kamps. (I've blogged about prolonged exposure, and you can find that posting here.)

Kamps does a great service by informatively describing prolonged exposure, including the controversies about its use and its potential benefits for violence and trauma survivors. She also provides a brief, evidence-based explanation of why women are more likely to struggle with Post Traumatic Stress Disorder than men.

Kamps has wonderful quotes by leaders in the fields of prolonged exposure and Post Traumatic Stress Disorder, including Edna Foa, Stevan Hobfoll, and Patricia Resick.

Kamp's article is a terrific read for someone who does not know a lot about cognitive behavioral therapies, prolonged exposure or Post Traumatic Stress Disorder, but is interested in learning more.

Also, the article could be used when training sexual assault advocates and counselors. And therapists may find this article useful for educating survivors about prolonged exposure as a possible therapeutic strategy.

Wednesday, September 16, 2009

Violence Survivors Neglected in Health Care Debates

An important group of people who are often not mentioned in the health care debates (how health care should be delivered, who should receive it, and how it should be paid for) are violence survivors. As the controversy over health care increases, I worry about the lack of attention to survivors because research shows that women who have survived partner violence (also known as domestic violence) and sexual assault are far more likely to experience serious health problems than women who have not experienced violence.

(Note that the research shows that men who suffer violent victimization suffer fewer physical injuries than women. However, the research on the health effects of violence for men is limited. More research on this important topic is needed.)

For overviews of the research on the connections between health and violence, please see research by me and my colleagues, research by Dr. Jacquelyn Campbell, and this summary from the Centers of Disease Control and Prevention.

What are the health problems that survivors experience? Not surprisingly, partner and sexual violence often result in serious injuries, including broken bones, head trauma, and spinal cord injuries. Rape survivors are likely to have genital injuries. Even after such assault-related injuries have healed, survivors are likely to experience chronic pain disorders (migraines, pelvic pain, arthritis) and gastrointestinal disorders (stomach ulcers, spastic colon). Survivors also are likely to have reproductive health problems. And some research shows that survivors are at increased risk of hearing loss and heart disease. Survivors are also likely to have mental health problems, including depression, anxiety, posttraumatic stress disorder (PTSD), substance abuse, and suicidal ideations (thoughts about wanting to die or that life is not worth living).

With the many serious health problems survivors may experience, I'm concerned that so little attention is given to how survivors access health care and what types of health care are most helpful for survivors. For a research overview of the challenges that survivors face when they try to access health care see Dr. Stacey Plichta's excellent article. Plichta determined that partner violence survivors seek health care as much as other people, but survivors are less likely to receive the services that they need and more likely to have a poor relationship with their health care providers.

My worry about the neglect of survivors in the health care debate has been increased by a recent blog post reporting that domestic violence is a 'pre-existing condition' for insurers in some states (including my own state of North Carolina). Likewise, my colleague Dr. Sandy Martin and I have preliminary findings from a project to assess the needs of survivors who access domestic violence and sexual assault services. Our initial findings show that physical and/or mental health problems are a serious concern for nearly all the survivors. Further, these preliminary findings show that the majority of the survivors in this sample do not have health insurance.

Taken together, research shows that violence survivors are in need of health care but may not be able to access the services that they need because they lack the means and ways to pay for their health care. Personally, I find it outrageous that a person who experienced brutal violence may not be able to access needed health care. Beyond moral outrage, it seems to me that by not helping survivors with their health and safety, our society is likely incurring serious costs in the form of chronic health disabilities and lost productivity.

The Centers for Disease Control and Prevention report the costs associated with partner violence exceed 5.8 billion a year. I wonder how that number might be lowered if we were to ensure that every violence survivor received needed safety and health care services.