Training Course in
BRIEF ECLECTIC PSYCHOTHERAPY FOR PTSD
Bucharest, September, 2014
organised by the Psychological Services Unit of the Romanian Gendarmerie and
endorsed by the Institute of Philosophy and Psychology of Romanian Academy
and the Institute for the Study and Treatment of Trauma
Course trainer:
Co-trainers: |
Prof.dr. Berthold Gersons is emeritus Distinguished professor of Psychiatry AMC, University of Amsterdam and Senior Scientific Advisor Centrum ’45, Netherlands, [email protected]
dr. Mariel Meewisse studied clinical psychology at the Free University of Amsterdam and works at the mental health institute GGZ-Noord-Holland Noord.She trains and supervises clinicians in Brief Eclectic Psychotherapy (BEPP) since 2005. Andreea Liţă works as psychologist for Romanian Police and has been trained in Brief Eclectic Psychotherapy by prof. Gersons, in 2011. |
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Short biographical sketchIn 1980, dr. Berthold Gersons started research on trauma and PTSD in the police force and established the first self-help-team in Dutch police force. He developed the Brief Eclectic Psychotherapy (BEPP) protocol consisting of 16-sessions for police officers and other trauma victims and showed the effectiveness in randomised trials. BEPP has been recognized in the NICE Guidelines (2005).
He is a member of the Board of the Dutch Veterans Institute and was an advisor for the Ministry of Defence. He is adviser to the National Coordinator for Counterterrorism to help politicians under threat to cope. He has also been advisor for the Dutch Government after major disasters in the Netherlands, like the El Al air crash in 1992 and the Enschede firework disaster in 2000. His group with dr. Miranda Olff is active in research on treatment and biological factors. He was president of the European Society of Traumatic Stress Studies, and served in the Board of the ISTSS and ESTSS. He has been member of the Board of the Journal of Traumatic Stress, has published over 200 papers in scientific journals and books and has lectured around 500 in his home country and in various countries all over the world. |
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Course objective
To understand the framework of this effective treatment for PTSD;
To understand and become familiarized with the different modules of this treatment-protocol;
To be able to start practicing BEPP with supervision;
To understand and become familiarized with the different modules of this treatment-protocol;
To be able to start practicing BEPP with supervision;
Course contents
Brief eclectic psychotherapy for PTSD (BEPP) has specifically been developed for the treatment of PTSD. It is an evidence based treatment as effective as CBT and EMDR. Clients and therapists choose BEPP when they want to diminish the symptoms of PTSD but also favour to pay attention to the emotions, the story of the traumatic experience(s) and about how the event(s) changed their lives. Therapists therefore often call BEPP a complete treatment because the elements of the treatment protocol are in line with a natural process of working through and learning from trauma.
The 16-sessions Brief Eclectic Psychotherapy for PTSD Protocol (BEPP) was originally developed for police officers with PTSD and proved to be effective also for other PTSD-patients in randomized controlled trials (RCT). The effectiveness has also been proofed with neuroimaging and a significant decrease of the heart rate. The treatment starts with psychoeducation on PTSD. The patient and his or her partner learn to understand the symptoms of PTSD as dysfunctional, and caused by the traumatic event. The patient will then receive 4-6 sessions of relaxation and imaginary exposure, focused on the suppressed intense emotions of sorrow. Memorabilia are used to stimulate remembrances of the traumatic event and a writing task to write a letter to someone or an institution blamed for the traumatic incident. The letter is specifically used to help to express the aggressive feelings. Most symptoms will then disappear and the patient is able to concentrate on what the impact of the trauma has been on his view of him or herself and on their world. During BEPP there should be considerable change and a new equilibrium should be reached. This is called the ‘domain of meaning phase’. The treatment will end by a farewell ritual with the partner in whom the letter and or mementos are burned to leave the traumatic incident behind, as a way to turn and face life and the future, at the same time never to forget, but not hindering the individual anymore in their daily life.
The 16-sessions Brief Eclectic Psychotherapy for PTSD Protocol (BEPP) was originally developed for police officers with PTSD and proved to be effective also for other PTSD-patients in randomized controlled trials (RCT). The effectiveness has also been proofed with neuroimaging and a significant decrease of the heart rate. The treatment starts with psychoeducation on PTSD. The patient and his or her partner learn to understand the symptoms of PTSD as dysfunctional, and caused by the traumatic event. The patient will then receive 4-6 sessions of relaxation and imaginary exposure, focused on the suppressed intense emotions of sorrow. Memorabilia are used to stimulate remembrances of the traumatic event and a writing task to write a letter to someone or an institution blamed for the traumatic incident. The letter is specifically used to help to express the aggressive feelings. Most symptoms will then disappear and the patient is able to concentrate on what the impact of the trauma has been on his view of him or herself and on their world. During BEPP there should be considerable change and a new equilibrium should be reached. This is called the ‘domain of meaning phase’. The treatment will end by a farewell ritual with the partner in whom the letter and or mementos are burned to leave the traumatic incident behind, as a way to turn and face life and the future, at the same time never to forget, but not hindering the individual anymore in their daily life.
Time Frame
Day 1:
9:30 – 10:30: Introduction Welcome and Learning to know each other and presentation of expectations Theoretical background of BEPP; similarities and differences with other trauma-therapies Overview of the BEPP-protocol 11:00 – 12:30: Psychoeducation I Introduction DVD Discussion 12.30 – 13.30 Lunch 13:30 – 15:00: Psychoeducation II: role playing (3 x 20 minutes) Discussion of experiences 15:30 – 16.30: Imaginary exposure I Introduction Relaxation training DVD Discussion Work for next day (memorabilia) |
Day 2:
9:30 – 11:00: Imaginary exposure II: role playing (3 x 20 minutes) Discussion of experiences 11:30 – 12:30: Use of memorabilia and letter writing; Memorabilia (from participants) Exercise letter writing 12.30 – 13.30 Lunch 13:30 – 15:00: Domain of meaning Introduction DVD Role playing 15.30 -16.30: Introduction Farewell ritual Theory and examples DVD Farewell ritual Discussion |
Day 3:
9.30 – 10.30: Case presentations of participants 11.00 – 12.00: Other issues Indications and Contra-Indications BEPP, CBT, EMDR; common aspects and differences Comorbidity Cultural Context Transference and Countertransference 12.30 – 13.00: Evaluation Certification Farewell |
Literature to be studied
Protocol ‘Brief eclectic psychotherapy for posttraumatic stress disorder’, English version 2010
References
Bisson, J.A., Ehlers, A., Matthews, R.,Pilling, S.,Richards, D.,Turner,S., (2007) Psychological treatments for chronic post-traumatic stress disorder Systematic review and meta-analysis The British J of Psychiatry 190: 97-104
Gersons, B.P.R., Carlier, I.V.E., (1992), Post-traumatic stress disorder; the history of a recent concept, British J. of Psychiatry 161, 742-748, 1992
Gersons BP, Olff M., (2005), Coping with the aftermath of trauma. British Medical Journal 330(7499):1038-9
Gersons, B.P.R., Carlier, I.V.E., Lamberts, R.D., van der Kolk, B., (2000), A randomized clinical trial of brief eclectic psychotherapy in police officers with posttraumatic stress disorder, Journal of Traumatic Stress 13 (2):333-347
Lindauer, R.J.L, Booij J, Habraken JB, Uylings HB, Olff M, Carlier IV, den Heeten GJ, van Eck-Smit BL, Gersons BPR, (2004), Cerebral blood flow changes during script-driven imagery in police officers with posttraumatic stress disorder. Biological Psychiatry 56:5;356-363, 2004
Lindauer, R.J.L, Vlieger, E.J., Jalink, M., Olff, M., Carlier, I.V.E., Majoie, C.B.M.L., den Heeten, G.J., Gersons, B.P.R., (2005), Effects of psychotherapy on hippocampal volume in out-patients with post-traumatic stress disorder: a MRI investigation, Psychological Medicine 35, 1-11
Lindauer, R.J.L.,Olff, M., van Meijel, E.P.M., Carlier, I.V.E., Gersons, B.P.R., (2006), Cortisol, learning, memory, and attention in relation to smaller hippocampal volume in police officers with posttraumatic stress disorder, Biol Psychiatry 15;59(2):171-7
Lindauer RT, van Meijel EP, Jalink M, Olff M, Carlier IV, Gersons BP., (2006), Heart rate responsivity to script-driven imagery in posttraumatic stress disorder: specificity of response and effects of psychotherapy. Psychosom Med. 68(1):33-40.
Lindauer RJ, Booij J, Habraken JB, van Meijel EP, Uylings HB, Olff M, Carlier IV,den Heeten GJ, van Eck-Smit BL, Gersons BP. (2007), Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post-traumatic stress disorder: a randomized clinical trial. Psychol Med 6;1-12
Lindauer, R.J.L., Gersons, B.P.R.,van Meijel, E.P.M., Blom, K., Carlier, I.V.E., Vrijlandt, I., Olff, M., (2005), Effects of Brief Eclectic Psychotherapy in patients with posttraumatic stress disorder: randomized clinical trial, Journal of Traumatic Stress 18:205-212
NICE-Guidelines Posttraumatic stress disorder, March 2005
Nijdam, M.J., Gersons, B.P.R., Reitsma, J.B., de Jongh, A., Olff, M., (2012), Brief eclectic psychotherapy versus eye movement desensitization and reprocessing therapy in the treatment of posttraumatic stress disorder: randomized controlled. Br J Psychiatry 200, 1-8
Olff M, Lindauer RJL, Gersons BPR, (2004),The effect of psychotherapy on psychophysiological responses to trauma imagery in patients with posttraumatic stress disorder. International Journal of Psychophysiology 54 (1-2):176-177
Olff M, Langeland W, Gersons BP., (2005), The psychobiology of PTSD: coping with trauma. Psychoneuroendocrinology 30(10):974-82
Schnyder, U., Müller, J., Maercker, J., Wittmann, L., (2011), Brief eclectic psychotherapy for PTSD: a randomized controlled trial. J Clin Psychiatry 72:4, 565-566
References
Bisson, J.A., Ehlers, A., Matthews, R.,Pilling, S.,Richards, D.,Turner,S., (2007) Psychological treatments for chronic post-traumatic stress disorder Systematic review and meta-analysis The British J of Psychiatry 190: 97-104
Gersons, B.P.R., Carlier, I.V.E., (1992), Post-traumatic stress disorder; the history of a recent concept, British J. of Psychiatry 161, 742-748, 1992
Gersons BP, Olff M., (2005), Coping with the aftermath of trauma. British Medical Journal 330(7499):1038-9
Gersons, B.P.R., Carlier, I.V.E., Lamberts, R.D., van der Kolk, B., (2000), A randomized clinical trial of brief eclectic psychotherapy in police officers with posttraumatic stress disorder, Journal of Traumatic Stress 13 (2):333-347
Lindauer, R.J.L, Booij J, Habraken JB, Uylings HB, Olff M, Carlier IV, den Heeten GJ, van Eck-Smit BL, Gersons BPR, (2004), Cerebral blood flow changes during script-driven imagery in police officers with posttraumatic stress disorder. Biological Psychiatry 56:5;356-363, 2004
Lindauer, R.J.L, Vlieger, E.J., Jalink, M., Olff, M., Carlier, I.V.E., Majoie, C.B.M.L., den Heeten, G.J., Gersons, B.P.R., (2005), Effects of psychotherapy on hippocampal volume in out-patients with post-traumatic stress disorder: a MRI investigation, Psychological Medicine 35, 1-11
Lindauer, R.J.L.,Olff, M., van Meijel, E.P.M., Carlier, I.V.E., Gersons, B.P.R., (2006), Cortisol, learning, memory, and attention in relation to smaller hippocampal volume in police officers with posttraumatic stress disorder, Biol Psychiatry 15;59(2):171-7
Lindauer RT, van Meijel EP, Jalink M, Olff M, Carlier IV, Gersons BP., (2006), Heart rate responsivity to script-driven imagery in posttraumatic stress disorder: specificity of response and effects of psychotherapy. Psychosom Med. 68(1):33-40.
Lindauer RJ, Booij J, Habraken JB, van Meijel EP, Uylings HB, Olff M, Carlier IV,den Heeten GJ, van Eck-Smit BL, Gersons BP. (2007), Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post-traumatic stress disorder: a randomized clinical trial. Psychol Med 6;1-12
Lindauer, R.J.L., Gersons, B.P.R.,van Meijel, E.P.M., Blom, K., Carlier, I.V.E., Vrijlandt, I., Olff, M., (2005), Effects of Brief Eclectic Psychotherapy in patients with posttraumatic stress disorder: randomized clinical trial, Journal of Traumatic Stress 18:205-212
NICE-Guidelines Posttraumatic stress disorder, March 2005
Nijdam, M.J., Gersons, B.P.R., Reitsma, J.B., de Jongh, A., Olff, M., (2012), Brief eclectic psychotherapy versus eye movement desensitization and reprocessing therapy in the treatment of posttraumatic stress disorder: randomized controlled. Br J Psychiatry 200, 1-8
Olff M, Lindauer RJL, Gersons BPR, (2004),The effect of psychotherapy on psychophysiological responses to trauma imagery in patients with posttraumatic stress disorder. International Journal of Psychophysiology 54 (1-2):176-177
Olff M, Langeland W, Gersons BP., (2005), The psychobiology of PTSD: coping with trauma. Psychoneuroendocrinology 30(10):974-82
Schnyder, U., Müller, J., Maercker, J., Wittmann, L., (2011), Brief eclectic psychotherapy for PTSD: a randomized controlled trial. J Clin Psychiatry 72:4, 565-566