Gates Cambridge Scholars Alicja Podgorski and Nimrod Hertz have been collaborating on research to address the complexity of PTSD.
How do you improve treatments for patients who are suffering from Post Traumatic Stress Disorder?
Nimrod Hertz [2022] and Alicja Podgorski, Gates Cambridge Scholars from different cohorts, have combined forces to address the problem, brought together by their supervisor over two years before Alicja began her PhD in Medical Science at the MRC Cognition and Brain Sciences Unit in 2025.
When Nimrod started his PhD in the same unit in 2022, Alicja was a therapist in a trauma clinic near Toronto where she was working with PTSD patients. She had no intention of applying to Cambridge, but was in the city for her husband’s work and was encouraged to get in touch with Cambridge professors working in her area. She contacted Professor Tim Dalgleish, Nimrod’s supervisor. He connected Nimrod and Alicja as Nimrod needed access to PTSD patients for his PhD studies and Alicja’s patients were a good fit. All the PTSD patients in her project group were primarily first responders and included police officers – some of whom had been involved in mass shootings – and healthcare workers who had experienced the Covid pandemic.
Addressing trauma complexity
The two met on Zoom and formed a bond. Both were clinicians with an interest in research. Nimrod’s research project aims to understand the different ways trauma affects patients and its different drivers in order to offer a more personalised form of treatment, which continues to draw on clinical PTSD theory.
Alicja says: “We are attempting to use an idiographic response to trauma — based on the specific symptoms each individual shows, rather than the generalised categories you’d find in the DSM-5-TR (a standard reference manual for diagnosing mental health conditions).”
Nimrod concurs that different types of trauma may require different forms of treatment and says that trauma can often be multi-layered, with a recent trauma triggering a past one. Alicja says that some people may indeed be drawn into professions such as nursing or the police force because of past trauma and a desire to do something meaningful to help others, but are at the same time vulnerable to perpetuating their own symptoms.
What’s more, trauma symptoms can range widely, from intrusive thoughts and nightmares to withdrawal, feelings of self blame and guilt as well as substance abuse. Nimrod’s approach is to see trauma symptoms as a network, with different symptoms potentially affecting each other and which type of treatment might work best. For instance, Alicja says that to undergo EMDR requires a certain degree of emotional regulation which may not initially work for some people going through trauma.
Gathering data
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Alicja had a good rapport with her patients who showed a range of symptoms and were undergoing different forms of treatment, from EMDR to Cognitive Behavioural Therapy. They agreed to take part in Nimrod’s longitudinal study. It involved them filling in questionnaires on a daily basis, with the information being cross validated by Alicja’s experience of treating the patients on a day-to-day basis.
She emphasises the time commitment involved from patients, but says they were very invested in making things better for PTSD patients in the future. One patient, a police officer who was in the US air force, did 700 assessments, providing a huge amount of invaluable data. Nimrod says this kind of positive motivation to help others is distinctive of PTSD, where people often feel a sense of community with others who have been through similar experiences.
When he started collecting data in 2023, patients had to fill in the questionnaire five times a day for several weeks through alerts on their phones, but eventually this was reduced as he developed new methodologies that would reduce patient burden and be more feasible in a clinical setting.
The questionnaires sought to measure people’s intrusive memories, physical reactions and negative appraisals about themselves and the world at particular points of the day and whether they thought something in particular had triggered those experiences. The data captured potential triggers such as anniversaries, locations, situations or other trauma reminders and enabled insights into the drivers of post-traumatic stress in everyday life. Alicja says doing these repeated questionnaires helped patients with their recovery as these mini-exposures served as an opportunity to reflect and process the trauma and integrated with their therapeutic work. “They were more aware of their symptoms and the ways to mitigate them,” she says.
Different types of trauma
Through studying the data he received from the intensive longitudinal measurement, Nimrod was able to come up with four sub-types for PTSD which help to determine which treatment might be better at which point in time. They are:
- The triggered type where there is a strong connection between trauma triggers and physiological/emotional activation.
- The re-experiencing type where people relive trauma-related memories vividly and think about them often.
- The cognitive type based on negative beliefs, such as that the world is very dangerous or that the trauma they suffered is all their fault.
- The threat reactive type where a person who experiences a trigger or senses immediate danger will take short-term action such as withdrawing, working too hard or drinking heavily in order to avoid thinking about the trauma and processing the event, which prevents trauma processing and perpetuates the post-traumatic cycle.
What’s next
Nimrod is just finishing his PhD and has written three papers based on his research so far. He will take his research findings forward in his next role working as a clinician and research director in a child and adolescent trauma clinic in Israel.
Alicja, who Nimrod encouraged and coached to apply to Gates Cambridge, will use some of his data for her PhD which is looking at trauma interventions for children aged three to eight. She says that, historically, it was thought that children ‘bounce back’ from trauma. She has seen from working with her patients that there are often layers of trauma involved that date back to a traumatic childhood event. “My research looks at what happens if we intervene early – using a trauma-focused therapy adapted specifically for young children, so we can disrupt the trauma response before it takes hold and help them go on to live fuller lives,” she says.
She will recruit 80 children across the UK for a randomised controlled trial comparing usual care with a trauma-focused therapy specifically adapted for young children. “If we can demonstrate that this intervention is valuable, we can inform national treatment guidelines,” says Alicja, adding that she is also likely to be working with healthcare services and schools to identify children who need support.
*Top photo by Priscilla Du Preez 🇨🇦 on Unsplash
