title: Recognition of the neurobiological insults imposed by complex trauma and the implications for psychotherapeutic interventions.
abstract: Considerable research has been conducted on particular approaches to the psychotherapy of post-traumatic stress disorder (PTSD). However, the evidence indicates that modalities tested in randomised controlled trials (RCTs) are far from 100% applicable and effective and the RCT model itself is inadequate for evaluating treatments of conditions with complex presentations and frequently multiple comorbidities. Evidence at levels 2 and 3 cannot be ignored. Expert-led interventions consistent with the emerging understanding of affective neuroscience are needed and not the unthinking application of a dominant therapeutic paradigm with evidence for PTSD but not complex PTSD. The over-optimistic claims for the effectiveness of cognitive-behavioural therapy (CBT) and misrepresentation of other approaches do not best serve a group of patients greatly in need of help; excluding individuals with such disorders as untreatable or treatment-resistant when viable alternatives exist is not acceptable.
authors.affiliation: Argyll & Bute Hospital, Lochgilphead, UK.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Corrigan
authors.affiliation: Perth Royal Infirmary, Perth, UK.
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Hull