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After the Crash: Psychological Assessment and Treatment of Survivors of Motor Vehicle Accidents Hardcover – January 1, 2004
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Top customer reviews
interested in any resources I may offer to my patients after an evaluation. This book was a great disappointment! I think the title is very misleading. Before you actually arrive at the very tiny section on the assessment and treatment (supportive therapy -- you don't need to spend $40 on a book to learn how to do this!) of MVA survivors, you must wade through almost 350 (yes, 350!) pages of research, statistics, and and endless tables of research findings. Nowhere in the description of this book does it mention that the piece reads like a very long, very dry dissertation. Unless research, tables, and statistics are your thing, don't bother! I have been an Amazon customer for many years and I have never returned a book. However, I am returning this one immediately. I am very disappointed!
It is possible to overlook the chapters that are most relevant to actually doing therapy, if the dense research chapters at the start are too off-putting. Reading the last half FIRST helped me maintain a mind-set that kept the first half from being too intimidating.
The authors have data covering very significant longitudinal follow up of accident survivors - both those identified as "at risk" based on needing medical treatment for accidents and people seeking treatment for psychological symptoms.
The book DOES have a huge amount of research findings to begin with. There is little in the first 350 pages that is a lot different from the 1997 edition. However, there are some very important findings relevant to clinical practice - one is a fairly rigorous analysis of what the risk factors are for developing PTSD and SUBSYNDROMAL PTSD symptoms following accidents. The authors always discuss their findings in the context of what other researchers have found and suggest possible explanations for different findings.
Another is a very thorough discussion of MVAs and PTSD MALINGERING. Blanchard and Hickling experimentally challenged their assessment procedures with trained MVA PTSD simulators to find out which of their assessments distinguished real patients from people likely to be the best malingerers possible.
What IS a significant change from the 1997 edition is the fairly comprehensive research on clinical treatment. The authors did NOT do the typical, develop a treatment protocol and compare to wait list research. What they DID was run two parallel treatment protocols with supportive treatment as one modality (the supportive treatment condition seems to match fairly well what many or sadly MOST patients are likely to get with little emphasis on targeting specific trauma symptoms and a lot of dependence on the power of strengthening coping skills in general and on the therapeutic relationship). The other treatment condition was a targeted Cognitive Behavioral protocol which they compared both to no treatment and to what is likely to be usual care.
Blanchard and Hickling DO provide a brief description of their treatment protocols and manual - this is less detailed than might be wished but sufficient to assist a therapist who regularly uses CBT in modifying her/his approach.
This volume is written with the scientist-PRACTITIONER in mind. The treatment protocol was NOT a lockstep curriculum that ignored the differing needs of different patients and they DO include "clinical hints" to make it as useful as possible to non-research clinicians.
They give a very balanced discussion of the areas in which non-specific supportive treatment was as effective as CBT and where it was weak. As I recall, the treatment effects of BOTH protocols are significant but some symptoms, especially intrusive PTSD symptoms and driving avoidance seem to me to be more amenable to specific CBT interventions. Also, not surprisingly, CBT is likely to continue to have effects after treatment ends, since it is so skills based.
There is more comming in the area of clinical application - how to DO specific CBT tx with MVA PTSD patients in more detail. Two new books, "Overcoming the Trauma of Your Motor Vehicle Accident : A Cognitive Behavioral Treatment Program Workbook (Treatments That Work)" which is a patient workbook and "Overcoming the Trauma of Your Motor Vehicle Accident : A Cognitive-Behavioral Treatment Program Therapist Guide (Treatments That Work)" are scheduled for release in early May. It appears that there will be paperbound volumes of BOTH books right away.
So my recommendation is if you are treating this population you are likely to find the second edition of "After the Crash" a very useful expansion of the first. It is likely that the upcomming practice focussed books will help clinicians more - but knowing how well and why the treatments described in them work is not trivial. If all you need are the "How to do it" aspects you may want to wait til May, but you may also have trouble answering some questions your patient might have about their illness and prognosis.