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Terrorfied By Bomb Attacks
Victims of terrorists attack may suffer from post-traumatic stress disorder, living in terror of a further attack. Treatment needs to change to help victims deal with their state of ‘terrified surprise’ [ Scott (In submission) PTSD – An Alternative Paradigm and Scott (2013) CBT for Common Trauma Responses London; Sage Publications]. Clients should be encouraged to swap the glasses gifted by the extreme trauma and through which today is seen as a ‘war zone’, for the glasses they wore the day before the trauma. Here is a link to a handout to help terrorist attack victims gauge the actual personal threat level:
http://www.cbtwatch.com/terrorfied-by-bomb-attacks/
Life Beyond Trauma Focussed Therapy
I have just been preparing for a Workshop, I am delivering to the Merseyside Branch of BABCP, on October 4th 2018, titled ‘CBT for PTSD and Beyond’. At this Workshop I shall unveil my KISS Model of PTSD. KISS for the uninitiated stands for Keep It Simple Stupid. Unlike trauma focussed models of CBT and EMDR, it does not assume a flawed traumatic memory or arrested information processing.
As part of the presentation I will be saying that therapists should beware of questionnaires as they will overidentify symptoms because:
a) they don’t tease out whether a particular symptom is making a ‘Real World’ Difference e.g a respondent might indicate upsetting dreams, but if they are not woken by the dream and distressed this is not significant functional impairment and so would not count as a symptom that is ‘present’
b) in completing a questionnaire client’s are often not clear about the time frame under consideration, endorsing flashbacks/nightmares when they did have them initially but they are past, and also endorsing symptoms currently present such as poor sleep. For a diagnosis of disorder symptoms have to be simultaneously present and each must make a ‘real world’ difference. Only in an interview can you tease out both and request concrete examples of the extent to which a symptom is impairing functioning
Dr Mike Scott
SEE cbtwatch.com for discussion
In January 2018 I was due to make a presentation at an Improving Access to Psychological Therapies (IAPT) Conference, titled ‘Approaching Patients With Trauma – Can IAPT help patients with trauma?, but was overtaken by my own trauma of falling down the stairs at home! Here is the link to the presentation:
https://www.dropbox.com/s/21ye8ewczvmfamn/IAPT-January-23rd-2018-Birmingham-City-Football-Ground.pdf?dl=0
The good news is that I was able to specify how IAPT might change its’ practice, the bad news is that currently IAPT’s recovery rate with PTSD is 16%
Diary
Day Workshop Delivering Group CBT Friday June 14th 2018 at the Mechanics Institute, Manchester. Organised by the Manchester Branch of BABCP, see www.babcp.com
Special Issue of the Journal of Health Psychology, ‘IAPT Under the Microscope’ to be published end of July/ beginning of August 2018, Open Access, consisting of my paper ‘IAPT the Need for Radical Reform’ see link http://journals.sagepub.com/doi/full/10.1177/1359105318755264 , 3 commentaries on my paper, my response to the commentaries and an introductory Editorial by the Editor, Dr David Marks.
Day Workshop CBT for PTSD and Beyond Thursday October 4th 2018Organised by the Merseyside Branch of BABCP, at Crosby Lakeside Centre, Cambridge Road, Waterloo, Liverpool L22 1RR see babcp.com
Post Trauma Mapping – circumventing difficulties with trauma focussed cbt http://www.cbtwatch.com/post-trauma-mapping/
From an evolutionary perspective the problem with PTSD is not so much the traumatic memory but that the latter furnishes a maladaptive map, as if the sufferer is operating in a ‘war zone’. This suggests a different treatment focus to the often resisted trauma focussed CBT. The goal of treatment is to construct an adaptive map, this involves ‘scouting’ to ascertain where if anywhere the ‘real and present dangers’ are. PTSD sufferers are often operating like Tony Blair on the ‘dodgy dossier’, if the weapons of mass destruction are not found in one place there is a rush to somewhere else thinking ‘they must be here’.
For clients resistant to trauma focussed CBT (TFCBT), post trauma mapping readily enhances the therapeutic alliance. Alliance problems are a bigger problem in delivering trauma focussed cbt in routine practice than have ever been acknowledged in randomised controlled trials, resulting in therapists feeling deskilled. Steve Stradling and I found that in routine practice only just over half of clients comply, even loosely defined, with a trauma focussed CBT [ Journal of Traumatic Stress (1997)]. There is a gap between what the scientist practitioners in the randomised controlled trials find and what the routine clinician/ ‘engineer’ finds in routine practice. Such mapping can be insufficient to resolve the PTSD but in passing the person becomes so acquainted with talking about the trauma that shifting from the ‘shallow end’ to exercising in the ‘deep end’, trauma focussed CBT is seemless.
From an evolutionary perspective the only function of memory is to to help us better anticipate future events, there is no value in memory per se. It may transpire that trauma focussed CBT is not actually essential for recovery from PTSD, certainly we do know that TFCBT is not necessary and is often experienced as ‘toxic’ for those traumatised but not suffering from PTSD e.g simple phobia, depression. Making it very important to carefully delineate the psychological sequelae of trauma.
Dr Mike Scott
‘No Horror Has the Last Word’
this is the inscription to my book ‘Moving On After Trauma: A Guide for Survivors, Family and Friends’, Kindle Edition published by Taylor and Francis
it was first published in paperback in 2008 by Routledge and dedicated to my grandson Isaac, born on the day of the London bombings, July 7th 2005
on May 22nd 2017 yet another bombing, 22 dead, 59 injured and the psychological damage is likely to be incalcuable, more recently there has been the Grenfell Fire with at least 80 people dead, the numbers physically injured are unknown and the number of psychological casualties are likely to be vast
This book is for all those who have been traumatised and their relatives and friends. It offers a roadmap from preoccupation with the traumatic memory to reinvesting in life. With the aid of simple drawings, I have tried to explain the problems caused by the maintenance of an overactive alarm post trauma and, importantly, how it can be reset. If it is any help to anyone you can access, free of charge the PTSD Survival Manual by clicking the Resource button at cbtwatch.com
Let me know at cbtwatch.com:
what has happened in practice when you have tried to deliver trauma focussed CBT in practice?
how trauma groups have worked out?
whether you have used the concept of prolonged duress stress disorder (PDSD)?
A Failed Mental Health System
Mental Health undoubtedly needs to be better resourced but the clamour for equity with physical services masks that ‘the current mental health system is not fit for purpose’, see my just published book ‘Towards a Mental Health System that Works’ by Routledge. Further the UK Governments flagship Service, Improving Access to Psychological Therapies (IAPT) has not been independently evaluated using a ‘gold standard’ diagnostic interview. I argue that the best available data actually suggest a 15% recovery rate, no better than placebo. Case examples of the failings of current services are detailed together with ways forward. This week (mid July 2017) the National Audit Office announced an IAPT Performance Investigation and invited submissions re: IAPT to David.Raraty@nao.gsi.gov.uk or Jenny.George@nao.gsi.gov.ik
Dr Michael J Scott is a Consultant Psychologist, currently working in private practice in Liverpool. He has a particular interest in Post-traumatic Stress Disorder and Cognitive-Behavioural Therapy, he has been an Expert Witness for 20 years, and alongside providing individual treatment and workshops is the author of twelve books.
Published January 12th 2017 by London: Routledge
Research has established that there are efficacious psychological therapies for most common mental disorders. In Towards a Mental Health System That Works,psychologist Michael J Scott details the reforms necessary to ensure that consumers of services receive an evidence-based treatment.
This book examines:
- the social significance of interventions that target mental-wellbeing and psychological disorder
- why treatments are ‘lost in translation’ from research to routine practice
- steps that can be taken towards a translation that better recognises the complexity of research and ensures fidelity to an evidence-based treatment protocol
- the deleterious effects of current provision on clients and therapists.
Towards a Mental Health System that Works is a valuable resource for therapists, mental health practitioners, Clinical Commissioning Groups and politicians, enabling them to critically evaluate service provision, distil what constitutes cost-effective evidence-based mental health practice across the whole spectrum of disorders and client populations, and chart a new direction. It also serves as a guide to consumers of mental health services, as well as their friends and family, allowing them to understand what they are likely to experience and what they can demand.
Reviews
‘Mike Scott uncompromisingly asks the big questions and concludes the current mental health system is not fit for purpose. Crucially, many of the questions and solutions proffered are testable and act as helpful reminders of the pitfalls and challenges of service delivery. Clinicians, managers and practitioners who read this book with an open mind will experience many nudges to small as well as large service redesign. Prepare to be challenged. Readers won’t always agree with every assertion or argument. But readers will find a robust challenge to the status quo.’ – Chris Williams, Professor of Psychiatry University of Glasgow, President of the British Association of Behavioural and Cognitive Psychotherapies (BABCP)
‘Mental health and wellbeing is vitally important for individuals, families, communities, and societies. But traditionally health services have undervalued mental health and given the lion’s share of attention and resources to physical health. This situation makes no sense since it is now widely accepted that physical health is underpinned by mental health. The Cartesian divide is a delusion which, it appears from scrutiny of his writings, even Descartes did not subscribe to.
There are many ways in which mental health can be addressed. One of these is adequate provision of high quality clinical support for people who are currently suffering from mental health problems. In this interesting volume Michael Scott addresses the inadequacy of current services for the task in hand and makes a very strong case for doing something to improve the situation.’ – Sarah Stewart-Brown, Professor of Psychiatry, University of Warwick
One day workshops on Delivering Group CBT
Highlight Below, Then Right Click, Choose’Go To…’ For All Survival Manuals and Groupwork Materials
http://www.michaeljscottptsd.com/wp-content/uploads/2016/11/Simply-Effective-Group-CBT-All-Appendices-Copy.pdf
One day workshop on CBT Post Trauma
Thursday March 23rd 2017 University of Hull
One day workshops on Delivering Group CBT – discussion forum at cbtwatch.com
Beckenhan IAPT July 18th 2017
Ashworth Hospital for Merseycare February 5th 2017
Chester Rugby Club – Chester and North Wales BABCP March 10th 2017
Beckenham IAPT May 5th 2017
Bedford IAPT May 17th 2017
Recent events
At the EABCT Conference in Stockholm, on Thursday, September 1st 2016, BABCP President, Chris Williams, chaired a Clinical Roundtable, attended by about 300 delegates on ‘Why Can’t We Translate Research into Practice’. I was one of four contributors with a presentation titled ‘Reality Checking Psychological Services’ in which I made the case that independent evaluation of the UK, Government funded IAPT service, using the methodology used in controlled trials, has revealed that only the ‘tip of the iceberg’ recovered. The Rountable was filmed by the Swedish Television Service. The findings are in my forthcoming book ‘Towards a Mental Health System that Works: A Guide for Practitioners’. Below is a link to this presentation
reality-checking-psychological-services
40 min video on ‘Traumatic Stress’, Sage Publications, September 2015:
Letter published in Psychologist, August 2015, suggesting that the apparent decrease in CBT’s efficacy revealed in a meta-analysis is not real and the actual implications are that CBT is sub-optimal when a poorly defined population is targetted.
On July 21st 2015 I gave a one day workshop CBT for Common Trauma Responses at the University of Warwick and if you want to e-mail me at michaeljscott1@virginmedia.com I will be happy to let you have the presentation.
On July 22nd 2015 I presented a poster ‘Beyond IAPT -New Directions’ at the BABCP Annual Conference e-mail me at michaeljscott1@virginmedia.com if you want a copy.
On May 20th 2015 ‘Group CBT for Depression’ in Cognitive Behavioural Therapeutic Group Therapy Eds B. Larsen and T.H Nyland (In Danish) was published.
On May 6th 2015 I gave a one hour workshop Tailoring Traumatic Stress Treatments at the British Psychological Societies Annual conference.
I have edited a 4 volume Major Work, ‘Traumatic Stress’, (2015) Sage Publications and his 1989 work a ‘Cognitive-Behavioural Approach to Client’s Problems’ has just been re-issued as a Classic by Routledge. Currently he is writing ‘Pathways to Mental Health: A Professional Guide to Getting Psychological Help’ to be published by Routledge.
Traumatic Stress
This four-volume collection provides access to key papers which have formed our present-day understanding of the effects of extreme trauma. Traumatic stress is an important and diverse area of research and practice that crosses disciplines including psychology, psychiatry, and cognitive behavioural psychotherapy. The literature on the topic which has emerged over the last 50 years spans a large number of fields and journals. This major work performs the services of bringing together these disparate but vital strands of research into a single publication. Edited and introduced by esteemed Editor, Michael J. Scott, the literature is arranged into four thematic volumes, designed to guide the reader through key developments in the field and provide them with a comprehensive overview.
Volume One: Introduction, History, Context
Volume Two: Approaches to The Treatment of Trauma Related Disorders
Volume Three: The Management of Secondary Traumatisation and Comorbidity
Volume Four: Translating Evidence Based Treatment to Routine Practise
“This is an outstanding collection of papers on traumatic stress from which clinicians cannot fail to benefit. Articles have been very thoughtfully selected to provide breadth of coverage and depth of insight. There is a most welcome focus on critical areas that are often neglected, such as treatment of comorbid conditions and the translation of evidence into practice”
Chris R. Brewin, Professor of Clinical Psychology, University College London
“These volumes document a long and productive journey from Dr Rivers’ treatment of WW1 soldiers to the current diagnosis and treatment of traumatic stress reactions. A carefully selected mosaic of papers highlight advances in understanding, diagnosing and treating posttraumatic stress disorder (PTSD) and other reactions to trauma. The volumes also show that many important questions will still need to be investigated, such as how evidence-based therapies can be best implemented in clinical practice.”
Professor Anke Ehlers Wellcome Trust Principle Research Fellow, Department of Experimental Psychology, University of Oxford
Workshops
Supervision Workshop, London, September 10th 2014 Simply Effective CBT Supervision For Low and High August 9th 201
Tailoring Traumatic Stress Treatments, British Psychological Society Annual Conference, May 6th 2015, Liverpool
CBT for Common Trauma Responses, BABCP, Annual Conference July 21st 2015, University of Warwick
Paper given at the BABCP Annual Conference 2014 ‘Crystallising the Role of The Practitioner’ Crystallising The Role of Practitioners
Paper given at the BABCP Annual Conference, July 18th 2013 on ‘The Truculent Client’ and the presentation is below,
The Truculent Client July 16th 2013
Gave a two day workshop ‘Delivering Group CBT’ to the Danish Society for Behavioural and Cognitive Therapy, in Copenhagen June 21-22nd 2013 and here is the presentation if anyone wants to download click here Mike Scott Group CBT Copenhagen Workshop Mike Scott Group CBT Copenhagen Workshop
On June 8th 2013 I gave a talk ‘Crystallising Psychological Injury’ those of you interested in medico-legal work might like to download this here Crystallising Psychological Injury Psychologists June 8th 2013
Free
Post-traumatic Stress Disorder Survival Manual Word
CBT FOR COMMON TRAUMA RESPONSES London: 
Sage Publications
‘This book can be thoroughly recommended to those working with victims of trauma. Therapists will benefit enormously from the author’s wide experience of the many varieties of trauma response and the conditions that frequently accompany them’ – Chris Brewin, Professor of Clinical Psychology, University College London
This is the first book to show how to use cognitive behavioural therapy (CBT) with the full spectrum of post-traumatic responses; exploring how they affect and relate to one another. Focusing not only on co-morbidity with other anxiety disorders and depression, the book looks more widely at, for example, co-existing pain, substance abuse and head injury. After discussing how to tailor CBT practice to work most effectively with trauma responses in real-world settings,
Michael J Scott goes on to explore the step-by-step treatment of post-traumatic stress disorder, other commonly occurring disorders and, finally, secondary traumatisation. Those training to work with young people, or already doing so, will find the focus in Part Three on CBT with traumatized children invaluable.
TABLE OF CONTENTS
Introduction
The Real World Treatment of Common Adverse Trauma Responses
Identifying Distress and Tailoring CBT
PART ONE: POST-TRAUMATIC STRESS DISORDER
PTSD – Treatment Rationale
PTSD Treatment – Phase One Coping Skills
PTSD Treatment – Phase Two Trauma Focused CBT
PTSD Group Treatment – A Coping Skills Approach
PTSD and the Dual Treatment of Depression, Substance Abuse, Panic
Disorder and Borderline Personality Disorder
PART TWO: PRINCIPAL DISORDERS OTHER THAN PTSD
The CBT Treatment of Sub-Syndromal PTSD and Phobia
The CBT Treatment of Prolonged Duress Stress Disorder
The CBT Treatment of Chronic Adjustment Disorder
PART THREE: SPECIAL POPULATIONS
The CBT Treatment of Traumatised Children
The CBT Treatment of Traumatised Clients with a Severe Mental Illness
PART FOUR: SECONDARY TRAUMATISATION
The CBT Treatment of Pain and Disability
The CBT Treatment of Head Injury
The CBT Treatment of Disfigurement
For more information about this book, please visit:
www.uk.sagepub.com/books/Book237339
Further FREE SELF-HELP MANUALS:
Depression Survival Manual Word
Panic Disorder and Agoraphobia Survival Manual Word
Obsessive Compulsive Disorder Survival Manual Word
Generalised Anxiety Disorder Survival Manual Word
Obsessive Compulsive Disorder Survival Manual Word
The Manuals can form the content of a group CBT programme, alternatively a therapist can guide a person through an appropriate manual via telephone/e-mail or a therapist may use them as a hand out in individual therapy.
see page Guided Self-help for Moving On After Trauma