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How to move forward with loss, grief and PTSD linked to traumatic bereavement with Cognitive Therapy

Prof. Jennifer Wild & Dr Michael Duffy

Tuesday, 23 April 2024

Introduction

Sudden traumatic losses, such as death by suicide or violence or death by protracted illness, increase risk for post-traumatic stress (PTSD) and prolonged grief disorders. Whilst PTSD in such circumstances is characterised by persistent re-experiencing of the loss trauma, prolonged grief disorder is characterised by the experience of yearning for the deceased.  Cognitive therapy for PTSD (CT-PTSD; Ehlers et al., 2005) is a highly effective treatment for PTSD arising from a range of traumas including traumatic loss and is recommended as a first line treatment for the disorder by the National Institute for Health and Care Excellence guidelines (2018) as well as numerous international guidelines.  In this workshop, we will cover how to treat PTSD arising from traumatic bereavement, where the patient’s worst fears are likely to have happened resulting in the death of someone close to them.  A significant component of the treatment involves imagery transformation and this will be covered with the procedure of memory updating.


The event will be equivalent to 5.1/2hrs of CPD.

Content

We will apply the Ehlers and Clark (2000) cognitive model of PTSD to post-traumatic stress and grief reactions arising from traumatic bereavement. The workshop will demonstrate how to update trauma memories, how to interweave cognitive work with trauma memories, how to carry out trigger discrimination, how to plan rebuilding life activities that give a sense of purpose and meaning when the patient believes they have lost everything and how to address maintaining strategies, such as ruminating on what could have been done differently. We will demonstrate how to transform distressing loss images and how to link transformed images to the relevant moment in memory so that the patient may move forward with their loss.

Learning Objectives

By the end of the session, attendees will be able to:

1. Apply Ehlers and Clark’s (2000) cognitive model to PTSD arising from bereavement trauma
2. Recognise the differences between PTSD and prolonged grief disorders
3. Recognise how the core treatment components differ for PTSD associated with traumatic bereavement than for PTSD linked to trauma where there is no loss of life
4. Discover how to conduct imagery transformation to update traumatic loss memories
5. Identify core cognitive themes linked to loss trauma and ways of working with them
6. Describe steps in transforming images of loss and permanent change

Training Modalities

The presenter will use a range of teaching methods: slides, videos and experiential exercises.

Key References

Wild, J., Duffy, M., & Ehlers, A. (2023). Moving forward with the loss of a loved one: Treating PTSD following traumatic bereavement with cognitive therapy. The Cognitive Behaviour Therapist, 16, E12. doi:10.1017/S1754470X23000041

Duffy M, Wild J. Living with loss: a cognitive approach to prolonged grief disorder - incorporating complicated, enduring and traumatic grief - ADDENDUM. Behav Cogn Psychother. 2023 Jun 13:1. doi: 10.1017/S1352465823000279.

Duffy, M., & Wild, J. (2017). A cognitive approach to persistent complex bereavement disorder (PCBD). The Cognitive Behaviour Therapist, 10, e16. https://doi.org/10.1017/S1754470X17000034

Wild, J., Warnock-Parkes, E., Murray, H., Kerr, A., Thew, G., Grey, N., Clark, D.M. & Ehlers, A. (2020). Treating posttraumatic stress disorder remotely with Cognitive Therapy for PTSD. European Journal of Psychotraumatology, 11:1, 1785818 doi: 10.1080/20008198.2020.1785818

Ehlers, A. & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder, Behaviour Research and Therapy, 38, 319-345.

About the presenter

Jennifer Wild is Professor of Military Mental Health at Phoenix Australia, the University of Melbourne and the University of Oxford where she developed evidence-based interventions to prevent the onset and persistence of PTSD and major depression in first responders. Her area of expertise is in developing and evaluating evidence-based interventions for anxiety and stress disorders, and in developing preventative interventions for people at risk of trauma, such as emergency responders and military members.  She has worked in an advisory role to the Cabinet Office in the UK on best practice for developing preventative interventions for high risk occupations. She has written over 80 publications and two books, including a recently published popular science book on resilience, Be Extraordinary:  7 Key Skills to Transform Your Life from Ordinary to Extraordinary.  Professor Wild specialises in translating evidence into practice, has co-disseminated first-line interventions for anxiety and stress disorders to the UK’s National Health Service through the Improving Access to Psychological Therapies programme.  She is dedicated to improving treatments so they are more precise and effective and reach the people who need them most.  Professor Wild regularly appears in the media giving advice rooted in science for preventing the onset and persistence of trauma-related mental health problems. 

Michael Duffy is a Consultant Cognitive Psychotherapist and Senior Lecturer/Director of the Specialist MSc (Trauma) in Cognitive Behavioural Therapy at Queen’s University Belfast. He is Research/ & Clinical advisor to the Northern Ireland Regional Trauma Network and member of the UK Trauma Council. He is an acknowledged expert in PTSD, Complex PTSD and Prolonged Grief Disorder. He was team leader of the Trauma team established after the Omagh bombing in 1998 and team leader at the Northern Ireland Centre for Trauma (NICTT) where he helped to evaluate the application of cognitive therapy for PTSD (Ehlers & Clark 2000) in clinical trials. He has published several studies on the psychological effects of large scale traumatic events. During 2018-2021, he was Principal Investigator on a study funded by the ESRC and NSPCC, of PTSD in children and adolescents exposed to abuse or neglect. In 2022, as Co Chief Investigator with Prof Anke Ehlers, he commenced a multi-site RCT in England and Northern Ireland, funded by a £2 million NIHR grant, to test the effectiveness of Trauma-Focussed Cognitive Therapy for Complex PTSD. He is also currently studying Prolonged Grief Disorder and supervising PhD students exploring the maintenance factors associated with traumatic and complex grief presentations. His clinical studies have had a strong impact in the field securing invitations to present research and workshops at many international conferences and he has provided many workshops on PTSD after large scale traumatic incidents including: the 9/11 Twin Towers New York attack in 2004, the 7/11 London bombings in 2005; the Oslo bombing and Utoya Island shootings in 2012; the Manchester Concert bomb in 2017, the War in Ukraine, 22022/23. He has provided expert commentary in Television documentaries on PTSD screened on BBC, BBC Persia and Channel 4.
In NI he advised Health and Victims policy makers and commissioning agencies on trauma services. In 2015, he successfully presented a proposal for a new regional specialist trauma service to political leaders at the Northern Ireland Assembly; now developed into the NI Regional Trauma Network. During the Cocid-19 pandemic he was an Advisor to Dept. of Health group for the creation of a new psychological therapy service to support staff working in COVID-19 frontline services. He is a Fellow of the British Association for Behavioural and Cognitive Psychotherapies, a Fellow of the Senator George J Mitchell Institute for Global Peace, Security and Justice QUB and a Member of the Academy of Cognitive Behaviour Therapy (USA).

Who should attend

CBT practitioners who treat people with PTSD including IAPT High Intensity Therapists and clinicians interested in evidence-based interventions for post-traumatic stress linked to traumatic loss.

Details coming soon

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