Psychotraumatology in the Netherlands

MDMA for treatment of PTSD and neurorehabilitation in military populations

BACKGROUND

Neurorehabilitation in military populations is complicated by higher rates of PTSD and unique characteristics of military institutions. These factors can adversely impact the patient-therapist therapeutic alliance and engagement with the rehabilitation process leading to poorer outcomes. MDMA is a non-classical psychedelic with pro-social and fear regulating properties. MDMA-assisted therapy is being explored as a novel treatment for PTSD that potentially offers rapid symptom improvement and enhances therapeutic alliance.

OBJECTIVE

A review of MDMA-assisted therapy for PTSD is provided in the context of neurorehabilitation in military populations. The molecular mechanism of MDMA is outlined and a novel application of MDMA for neurorehabilitation is proposed.

METHODS

This is an expert review and synthesis of the literature.

RESULTS

Results from late-stage clinical trials suggest MDMA-assisted therapy for PTSD would be of particular benefit for military populations with PTSD. The unique pro-social properties of MDMA could be leveraged to enhance the therapeutic alliance and patient engagement during neurorehabilitation.

CONCLUSION

The unique qualities and benefits of MDMA and MDMA-assisted therapy for PTSD suggest relevant application in military personnel undergoing neurorehabilitation. There are many similarities in patient-therapist dynamics in PTSD treatment and neurorehabilitation. The properties of MDMA which enhance therapeutic alliance, downregulate fear, and increase cognitive flexibility would potentially benefit both military personnel with and without PTSD undergoing neurorehabilitation.

Knowledge about traumatic World War II experiences among ancestors and subjective well-being of young adults: A person-centred perspective

Objectives

The aim of our study is to examine the association between knowledge about the World War II (WWII)-related traumatic experiences of their ancestors and subjective well-being (SWB) of young adults, i.e., descendants of Polish survivors of WWII. Specifically, we focus on the life satisfaction and the mental, physical, and psychosocial well-being of our participants in relation to their knowledge about WWII trauma in their family histories.

Method

The sample comprised 500 Polish young adults recruited from a nonclinical general population. Participants first filled out a questionnaire assessing their knowledge about traumatic events that their ancestors could have experienced during WWII (see grandparents/mothers, great-grandparents/mothers). After that, subjects were given inventories to assess their SWB, i.e., the Satisfaction with Life Scale (SWLS) and the General Health Questionnaire (GHQ-28).

Results

Latent profile analysis was applied to extract profiles of participants differing with regard to the scope of knowledge about WWII-related traumatic experiences among ancestors. Specifically, six profiles were observed, and a general lack of knowledge about this kind of trauma in the family was characteristic of the sample. We also found differences in SWB across profiles of participants, with worse SWB in the profiles with the highest lack of knowledge about WWII-related traumatic experiences in the family.

Conclusion

Our study adds to the literature on intergenerational trauma by applying a person-centred perspective, a methodological approach almost invisible in research on that topic. In addition, our findings can serve as a stimulus for more comprehensive debate on WWII trauma in Polish society.

Trauma and trauma care in Europe

The European countries have a long history of exposure to large-scale trauma. In the early 1990s the increasing awareness of the consequences of trauma within the mental health community led to the foundation of local societies for psychotraumatology across Europe and the European Society of Traumatic Stress Studies (ESTSS), which celebrated its 25th anniversary in 2018. The focus of this article is to describe the current state of care for survivors of trauma in the 15 European countries where ESTSS member societies have been established. Brief descriptions on the historical burden of trauma in each country are followed by an overview of the care system for trauma survivors in the countries, the state-of-the-art of interventions, current challenges in caring for survivors and the topics that need to be most urgently addressed in the future. The reports from the different countries demonstrate how important steps towards a better provision of care for survivors of trauma have been made in Europe. Given the cultural and economic diversity of the continent, there are also differences between the European countries, for instance with regard to the use of evidence-based treatments. Strategies to overcome these differences, like the new ESTSS training curricula for care-providers across Europe, are briefly discussed.

Trauma treatment across Europe: where do we stand now from a perspective of seven countries

There is a lack of knowledge about the state of affairs of the trauma treatments in Europe. To start to fill in this gap, key persons from seven European countries-Georgia, Germany, Lithuania, the Netherlands, Poland, Switzerland, and Turkey-accepted the invitation to give their expert opinion on the state of affairs in their country at an invited panel discussion at the XIV 2015 ESTSS Conference in Vilnius, Lithuania. Brief reports from the seven countries reveal significant diversities among different European countries in terms of awareness of health problems related to trauma, the availability of trauma treatments, and treatment approaches. Political and economic differences across the European countries contribute to the diversities in the developments of trauma treatments. European national psychotrauma societies are active in establishing training curricula and dissemination of trauma-focused treatments. Despite the growing acknowledgment of trauma and dissemination of trauma-focused treatments, there is a lack of Europe-wide policies to ensure availability of trauma treatment in Europe for trauma survivors. The need for more detailed analysis of trauma treatment in all European countries and development of European-level trauma-informed health care policies is outlined.

Trauma research in the Baltic countries: from political oppression to recovery

The aim of this paper is to provide an overview of traumatic stress studies from the three Baltic countries-Lithuania, Latvia, and Estonia-and reveal how specific social context contributes to the topics relevant in traumatic stress field in the region. Traumatic stress studies in the Baltic countries are closely related to the complicated history of the region. It was only since the restoration of independence of the Baltic States in the 1990s when traumatic stress studies could emerge. The start of the psychotraumatology in the Baltic States was inspired by the interest of the psychological effects of political violence. Four major topics in traumatic stress literature from the Baltic countries were identified in this article: political violence studies, epidemiology of trauma and posttraumatic stress disorder (PTSD), disaster studies, and developmental aspects of trauma. Traumatic events prevalence was reported between 70 and 75%, and PTSD prevalence range 2-7% in the Baltic countries. The interest in psychotraumatology in the Baltic countries is rising.

ESTSS and ISTSS: "heterozygous twins"

The development of traumatic stress studies during the past decades has much profited from professionals from the United States and from Europe. However, these professional societies, the International Society for Traumatic Stress Studies and the European Society for Traumatic Stress Studies (ESTSS) still struggle to find an equal common pathway. This is a personal retrospective view of Berthold Gersons, past president of ESTSS on behalf of the 20th anniversary of ESTSS.