Development and Evaluation of an Integrative Group Therapy Treatment for Survivors of Complex Trauma

Almost 700,000 cases of child abuse and neglect have been substantiated annually, with many more un-reported children being exposed to community and interpersonal violence (U.S. Department of Health and Human Services, 2017). Exposure to chronic or multiple potentially traumatic events places large numbers of children to grow up into emotionally and physically at-risk adults (Felitti et al., 1998). Although some helpful treatments already exist, examination of tailored alternative approaches is needed to address the broader somatic and psychological problems associated with complex trauma exposure. The current study involved developing and evaluating a pilot integrative group therapy treatment for adults who have experienced complex trauma. The treatment components draw from the field of interpersonal neurobiology and polyvagal theory. Interpersonal neurobiology approaches treatment through the lens of the embodied brain, including both the brain and the nervous system (Siegel, 2012). Polyvagal theory brings greater nuance to the interplay between experiencing trauma and the impacts on the autonomic nervous system via the dorsal and ventral vagal nerves (Porges, 2011). The group treatment combined process-oriented therapy with trauma-sensitive yoga delivered once weekly over the course of eight weeks. The treatment offered participants psychoeducation, opportunities for trauma processing, and various meditative grounding exercises. The study examined feasibility, acceptability, and preliminary efficacy across a range of psychological and physiological domains including complex traumatic stress, depression, anxiety, sleep disturbance, and physical pain. Participants were recruited by flyers and an informational website through which interested individuals could message the lead researcher. Thirty eligible individuals completed intake procedures and ten participants were lost or dropped out before the treatment began. Participants (N=20) were randomly assigned to either the treatment or waitlist control group with ten participants falling into each condition. The sample included nineteen women and one man, were 60% White, with a mean age of 25.3 years. Independent samples t-tests indicated that at the time of intake there were no significant differences across the treatment and waitlist control conditions for all reported participant characteristics. Participants in the treatment condition felt that the group members accepted one another, that despite having differences, the group felt secure, and that the members felt that what was happening was important and there was a sense of participation. Paired samples t-tests examined change in depression, anxiety, complex traumatic stress symptoms, sleep disturbance, and physical pain intensity for each condition, but the only significant change was sleep disturbance between pre- and post-treatment for the treatment condition. Treatment effect sizes calculated at the conclusion of the study showed that the treatment condition saw moderate to large reductions in their complex traumatic stress symptoms (d = .64), and large reductions in their sleep disturbances (d = 1.09). Despite paired samples t-tests indicating no significant differences for the waitlist control condition, effect sizes also indicated that the waitlist control condition had moderate increases in their physical pain intensity (d = -.56) and small to moderate reductions in their complex traumatic stress symptoms (d = .38).Compared to similarly integrative trauma treatments (Nguyen-Feng et al., 2019; Niles et al., 2018), the current study found comparable reductions in symptoms of traumatic stress and depression and fewer reductions in anxiety as indicated by treatment effect size calculations. The current study was subject to some unexpected situations that may have affected results. First, the final group session and post-treatment survey coincided with a period of multiple stressors and uncertainty due to ongoing campus strikes, and the onset of the COVID-19 pandemic social distancing efforts. This may have affected participants’ current stress levels when completing the survey. This study supports that it is feasible to take a combined psychological and physiological approach to trauma treatment through combining trauma-sensitive yoga with more traditionally process- and trauma-oriented talk therapy for survivors of complex traumatic stress. Last, given the study findings and participant feedback, further research into the use and ways of combining somatic and psychological trauma treatment approaches is warranted