3 - (SYM 21) Does a Phased Approach Enhance Outcomes for Trauma-focused Cognitive Therapy for ICD-11 Complex Posttraumatic Stress Disorder?

Patients with complex posttraumatic stress disorder (CPTSD) are currently treated in a wide range of treatment services with different treatment protocols. The ISTSS Guidelines Position Statement on CPTSD in Adults (Berliner et al., 2019) concluded that further research on the effects of existing and novel psychological treatments on the symptoms of poor emotion regulation, negative self-concept and disturbances in relationships is needed and suggested systematic comparisons of protocols that add interventions that directly address these problems with established treatments, either in sequenced or integrated form.

The presentation will report the results of a randomized effectiveness trial comparing a phased version of Cognitive Therapy for PTSD (CT-PTSD), one of the evidence-based CBTs for PTSD, with standard trauma-focused CT-PTSD. Participants were offered 24 treatment sessions of 60-90 min. The phased treatment started with 8 sessions of compassionate resilience training (Gilbert, 2009), designed to address problems in self-regulation. CT-PTSD uses an individualized formulation (based on Ehlers & Clark, 2000) that allows a flexible tailored order of delivery of treatment components. Treatment focuses on identifying and addressingexcessively negative personal meanings (e.g., ‘I am a bad person’, ‘I can’t trust anyone’) linked to the traumas and/or their aftermath, memory characteristics that lead to re-experiencing symptoms and unhelpful coping strategies. Core procedures include work on rebuilding life, updating trauma memories and discrimination of triggers, and Socratic dialogue and behavioral experiments to test and change personal meanings and coping strategies.

Patients and therapists were recruited from UK National Health Service outpatient clinics in 5 sites in Northern Ireland, and 5 sites in England. Patient participants (N=117) met diagnostic criteria for CPTSD and were randomly allocated to either phased or nonphased treatment. Their CPTSD had developed in response to a wide range of traumas in childhood and/or adulthood. Therapist received training and supervision in CT-PTSD, and, if delivering the phased intervention, in compassionate resilience training. Outcome measures included measures of CPTSD symptoms, depression, anxiety, disability, quality of life. These were given monthly during treatment and at 39 and 52-week follow-up post-randomization. Questionnaires and qualitative interviews assessed patient and therapist experience with treatment.