Beyond Labels: Towards Non-Pathologising Care for Trauma Victim-Survivors

Traumatic experiences are prevalent and often lead to a range of trauma-related psychological difficulties. Victim-survivors frequently experience stigma, which can be intensified by psychiatric labelling.

Systematic Literature Review

A systematic search and meta-analysis was conducted to examine the efficacy of Acceptance and Commitment Therapy (ACT) for trauma-related difficulties and ACT processes. Sixteen studies were identified, most being ‘high risk’ of bias. For overall model, a moderate effect size was found post-intervention (d=-0.48), followed by a moderate pooled effect at short-term (d=-0.51) and large effect at medium-term follow-up (d=-0.76). While subgroup analyses did not identify statistically significant differences in the effects of ACT on individual outcome types, further investigation suggested potential variations. Subgroup analysis also revealed non-significant impact of trauma subpopulation. Study design and study-level bias significantly influenced effect size estimates, as did intervention duration and format. Although promising, the current evidence base is small, underpowered and of poor quality.

Empirical Research Project

Q-methodology was employed to examine the viewpoints of 41 stakeholders regarding their perspectives on the usefulness of the ‘complex post-traumatic stress disorder’ (C-PTSD) diagnosis. Participants sorted 50 statements related to the usefulness of C-PTSD based on their viewpoints. Five viewpoints were identified. ‘Supports trauma-informed care’ highlighted the role of C-PTSD in promoting a trauma-focused care. ‘Pathologising understandable reactions to adversity’ questioned C-PTSD validity, suggesting it overlooks victim-survivors subjective experiences. ‘A valid diagnosis’ depicted C-PTSD accurately reflecting a valid mental health condition. 'An unnecessary addition to diagnostic manuals' challenged the need for C-PTSD, suggesting existing labels suffice. ‘An imperfect alternative to borderline personality disorder' (BPD) preferred C-PTSD over BPD for abuse survivors but raised concerns about its conceptualisations and potential for inadvertent abuse disclosure. Implications of privileging different viewpoints and study limitations are discussed.