On a crisp January day, delegates were welcomed to the stunning surrounds of Wolfson College, University of Oxford by UKPTS President Professor Dominic Murphy for the Society’s annual conference, returning after a year’s hiatus as the result of our hosting duties for ESTSS2023.

Before proceedings began, Prof Murphy paid tribute to our much-missed colleagues, Prof William (Bill) Yule and Dr Hannah Murray.

This year’s theme was broad, ambitious and vital – Trauma Care: Towards an Integrated Approach – not just in respect to treatment, but also in terms of promoting a whole-person, whole-system approach to understanding and conceptualising trauma.

Conference Chair Dr Tony Downes eloquently outlined the challenge, rooting the need for an integrated approach in the historical context as well as his own professional clinical experiences. Dr Downes highlighted one of his own specific areas of interest – medically unexplained physical symptoms (MUPS) and the interplay with trauma. He drew on Gupta’s (2013) review that PTSD in particular is associated with poorly defined somatic symptoms. Understanding and appreciating this relationship he said, was crucial for those delivering primary and secondary healthcare. He reflected back on his professional experience that so much go patients’ physical health was significantly in part the result of psychological trauma, as well as epistemic injustices in health care delivery and systems.

I am having ‘pseudo seizures’- it’s all in my head. I am discharged but nobody explains what ‘pseudo’ means – I assume ‘not real’.
– Delyth Owen

Deyth Owen picked up this theme and powerfully shared her experiences of functional neurological disorder (FND) and dissociative seizures. The stunning short film, RISE introduced her profoundly impactful testimony of the damaging impact a system as a while which ‘was not set up to deal with’ people presenting with FND. “I read about hysteria and realised the stigma was very much within the health care system”, she said. “I fit into the category of the ‘hysterical woman’ perfectly, and they were able to discharge me confidently knowing this – it was a mental health problem. But the mental health team also did not know what to do with me”.

Dr Joanne Mouthaan (Leiden University, and ESTSS President) highlighted that whilst national and international evidence-based treatment guidelines for PTSD and trauma-resultant mental health problems exist, it is still an emerging field with work required to ensure trauma-informed practices are being advocated and disseminated for in occupational contexts, public health organisations, community work, schools and the wider non-trauma specialist community. Here, organisations like the ESTSS have a role to play, but more work is also required to fully understand barriers and facilitators to treatment engagement rooting the responsibility not with the individual, but with the clinician and the wider system. Integrated care needs to be collaborative, trans-disciplinary, and multi-level said Dr Mouthann whilst also paying more attention to context such as trauma histories, ongoing threat and adversity, and poverty.

In a last-minute change to the programme, Prof Murphy (Combat Stress, and King’s College London) echoed the responsibility that health care systems hold to understanding specific barriers and facilitators in order to help under-represented groups engage in research and clinical services. He focused on work by Combat Stress and its partners in using co-production methodologies to develop interventions as well as learn from user groups about how to improve accessibility to care and support. He also demonstrated how co-production with expert stakeholders and those with lived-experience has been used to identify gaps in current provision and making targeted system-level recommendations. According to Prof Murphy, ensuring you can speak the language(s) of the target audience(s) and also meet their specific needs and goals (for example policy makers, or service providers) is central to ensuring that evidence-based findings can be operationalised and lead to effective change.

We need to think about how we build services that do not just focus on the reduction of impairment, but also on the promotion of wellbeing.
– Dr Tanya Edmonds & Dr Kelly Price

Delegates enjoyed a choice of breakout sessions, held throughout the art-infused College surrounds. Drs Tanya Edmonds and Kelly Price further explored improving the health and well being of patients with FND. They highlighted that whilst disease-focused approaches provide a framework for treating the pathology illness, they cannot manage the social, psychological and emotional needs of patients with conditions such as FND. They highlighted the GENIAL model which places individuals within the context of their social and natural colonies as a starting point for promoting pathways to wellbeing from a biopsychosocial perspective.

Meanwhile, Rachel Naunton and Dr Sacha Evans highlighted that in the case of children and young people with FND, a lot of the challenges and barriers faced by adults are heightened, with added sensitivities around mental health discussions and the importance of establishing trust between practitioners and the young person. In essence, the need for centralising the child or young person in the conversation is even more important.

The dynamics of the provider-service user relationship was a particular focus for Jan Bostock who explored the Power Threat Meaning Framework (PTMF) to understand and help with trauma and adversity. At the heart of the PTMF is moving from asking ‘what is wrong with you?’ to ‘what happened to you?’, and a recognition of the social determinants and impact of power processes. Core threats on an individual ripple out to every aspect of the self, including economic and material domains, identity, social context, and emotional environment. Importantly, the PTMF recognises both positive and negative uses of power and it’s impact, and understands trauma with reference to injustices, inequalities, and environmental pressures.

[Psychedelics] allow patients to access the trauma without the fear… they can look at it from different perspectives.
– Prof Eric Vermetten

Dr Susanna Petche presented findings from the ConnectionWorks Programme – an innovative approach to treating Complex PTSD (CPTSD). The Programme involved a year of psychoeducation, lifestyle interventions and body work including yoga, Trauma and Tension Releasing Exercises (TRE), acupuncture, nature walks and equine therapy. Strikingly, outcomes included a reduction on completion in antidepressant, gastritis and insomnia medication use as well as an improvement in self-compassion measures and medical symptoms.

Innovative approaches to treatment or a different type were the subject of sessions from Liam (Nadav) Modlin, and Dr Daniel Leightley and Grace Williamson. Dr Leightley and Ms Williamson’s presented preliminary results from an innovative international study on the use of cutting-edge wearable remote measurement technologies to observe cannabis use among UK and US veterans. Whilst cannabis remains proscribed in the UK and at a federal level in the US, recreational use has been legalised in over twenty American states. Their work research not only tracks cannabis usage patterns but also explores potential therapeutic benefits (or otherwise) for PTSD symptom management.

Liam (Nadav) Modlin guided delegates through the research history and neurobiology of psychedelics and highlight common patient narratives in psychedelic therapy. Whilst similarities existed between treatments-as-usual and psychedelic therapy, Mr Modlin’s highlighted the divergences in his experiences as a psychotherapist, and in particular the therapist’s role as a supportive rather than guiding figures during sessions.

People aren’t always broken, they’re hurting.
– Dan Phillips

This point was echoed and emphasised by Professor Eric Vermetten (Leiden University) in the last of the keynote sessions. Prof Vermetten’s work with psilocybin and MDMA highlighted how the recent rejuvenation of interest psychedelic and psychedelic-assisted psychotherapy is influencing the research therapy agenda. With powerful recorded sessions excerpts, he described how psychedelic-assisted psychotherapy seemed to allow patients to participate in an ‘inner focused’ therapy, rather than being directed. Interestingly, even with exposure elements in therapy, there seemed to be an absence of fear or anxiety in comparison to more traditional exposure-based, non-assisted interventions. Psychedelics seemed to “allow patients to access the trauma without the fear… they can look at it from different perspectives” that can facilitate processing of those experiences, he said.

Dan Phillips (NHS Wales) outlined the East Flintshire Psychological Trauma Service – a trauma-informed professional community which aims to acknowledge the whole person experience of wellness. In a region where primary care is the main (or only) health care point of contact, the Service caters for a cluster of seven GP surgeries to provide multi-disciplinary expertise to treat trauma as a chronic illness, not purely a psychological disorder. Crucially, whilst serving those with PTSD, CPTSD and who have high trauma exposure, patients can also be referred who present with functional pain or MUPS. Such an integrated approach and the positive health outcomes demonstrated how important it was for practitioners to see beyond the initial presentation, and also implement trauma-informed and focused approaches at existing points of health care engagement and entry.

Rounding off Conference, Drs Victoria Williamson (King’s College London) and Brock Chisholm (Trauma Treatment International) expanded on this last point and asked delegates to consider that for those who need help the most, the practical barriers standing between them and treatment or support are often the considerable. Dr Williamson also highlighted that such barriers can cause significant moral distress for clinicians as well. Dr Chisholm expanded on the optimal conditions for trauma recovery and traumatic stress management at all levels. “The conditions and systems that so many people who are traumatised find themselves in, are completely contradictory to recovery”, he said,. In particular, he emphasised that whilst social support has been acknowledged as critical, there remain very few studies or training in how this might be promoted and amplified. They were joined by Abdulkadir Mohamed (NHS CNWL) who foregrounded the experiences of refugees and asylum seekers in particular – including his own. As with Delyth Owen’s opening presentation, he beautifully articulated the need for safety, to be listened to, and to be believed. Not only was this central to ensuring trauma care can be more integrated and better aid those who need support, but in drawing on his own story “after we help [those in need] with their social environment and structure, they can in turn contribute to society for the better”.

Finally, Dr Victoria Williamson was announced to Conference as UKPTS President-Elect. The 2025 UKPTS Annual Conference will be held in Leeds.

Selected highlights from the Conference are available on the @UKPTS Twitter feed or by searching #UKPTS2024.
UKPTS Members can download materials presented at Conference in our Member Area.