Book Review: Trauma and Posttraumatic Stress Disorder: A Mental Healthcare Model for Mass Trauma Survivors: Control-Focused Behavioral Treatment of Earthquake, War and Torture Trauma

Trauma and Posttraumatic Stress Disorder A Mental Healthcare Model for Mass Trauma Survivors: Control-Focused Behavioral Treatment of Earthquake, War and Torture Trauma Metin Basoglu, Ebru Salcioglu. New York (NY): Cambridge University Press; 2011. 294 p. US$105.00Reviewer rating: GoodIn this 294-page, well-referenced, well-written, and thoughtful volume, Metin Basoglu and Ebru Salcioglu have made a strong case for a new, accessible, costeffective, and evidence-informed treatment model for survivors of mass trauma. The book is nicely put together and divided into 3 parts that flow naturally from 1 to the next: 1) Theory; 2) Assessment and Treatment; and 3) Implications for Care. The control-focused behavioural treatment (CFBT) model they present recognizes real-world limitations to meeting the needs of the millions of mass trauma survivors worldwide, both in terms of resources and cost, something relevant not only in the developing world but also in developed countries, such as Canada. The authors, based out of the United Kingdom and Turkey, have extensive experience working with earthquake, war, and torture survivors on a large scale and this serves to ground their model in the practical. As such, this volume will likely be of interest not only to clinicians but also to aid agencies and mental health care policy makers.The theoretical underpinnings of CFBT are derived from learning theory. Evidence is presented that suggests it is the unpredictability and uncontrollability of stressors that lead to the development of the fear, helplessness, and avoidance seen in posttraumatic stress disorer (PTSD) and posttraumatic depression. The authors note that these mechanisms are shared in traumas, both of human design and natural causes. Based on this, a strong case is made that overcoming avoidance and enhancing sense of control should be the central targets of therapy.The authors present several scales they have developed to screen for PTSD and depression symptoms and for disability. They describe the use of these scales, both to identify survivor treatment needs and to assess outcomes. The Appendix includes many of these scales, but for the psychometrics, readers are referred to other publications by the authors. Given the large number of established scales measuring the same things, it is not clear why so many additional scales are needed, although the authors contend that their scales have the advantage of being designed in accordance with learning theory. The Sense of Control Scale and the Fear and Loss of Control Subscale of the Emotions and Beliefs After War Scale do, however, seem particularly well-suited to measure change, regarding CFBT's central therapeutic targets. The authors also contend that completing the scales in CFBT has an important therapeutic benefit.A 3-step process for the CFBT session is described, including:1. identifying trauma cues and avoidance behaviour;2. explaining treatment and its rationale; and3. defining treatment tasks and giving self-exposure instructions.Verbatim transcripts of key points to be made by the therapist are suggested, and a full treatment manual for therapists is provided in the Appendix. Case vignettes further illustrate the how-to delivery of CFBT, so a clinician will find everything necessary in this book to be able to provide this treatment. The authors also describe modifications to the process for complicated patients (for example, comorbid depression, suicidal ideas, psychosis, flashbacks, prolonged grief, and comorbid medical conditions) and children. …

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