Psychotherapeutic Intervention for Complex Trauma

Background: There is debate about the selection, sequencing and delivery of trauma interventions to meet complex clinical need in trauma populations. One suggestion is the implementation of a phase-orientated treatment, whereby a stabilisation phase precedes a trauma-focused intervention in the form of exposure therapy. Phase-orientated models however remain equivocal, with a lack of consensus as to effectiveness of these models or indeed the therapeutic modalities to be included in such interventions. Method: Two studies were conducted as part of this thesis. Firstly, a systematic review and meta-analysis of existing qualitative and quantitative data on standalone stabilisation interventions and stabilisation followed by trauma-focused therapy (i.e. phase-orientated approach) was undertaken. Secondly, an empirical qualitative study aimed to explore the impact of trauma on participant’s lives before and after completing a phase-orientated ‘Trauma Programme’. The study also endeavoured to understand the role of a compassion-based approach in relating to trauma at pre and post intervention stages. Qualitative content analysis was used to examine the qualitative data. Results: Systematic Review: 31 studies met predefined criteria. A narrative synthesis of qualitative studies yielded three themes which indicated that group stabilisation interventions are helpful for reducing trauma symptoms and in preparing for trauma-focused therapy. Two further themes captured the challenges associated with implementing a stabilisation intervention. A meta-analysis revealed a medium effect size for PTSD symptom reduction using stabilisation interventions. This effect size was reduced when utilising only randomised controlled trial (RCT) stabilisation data. A large effect size was found for phase-orientated quantitative studies and this large effect size was maintained using RCT data. There was tentative evidence that phase-orientated treatment is more effective than standalone stabilisation, with a small effect size. Empirical Study: 20 semi-structured interviews were conducted at pre and post intervention stages with 10 participants with complex trauma presentations. The pre-intervention data gave rise to 4 themes which indicated that trauma exposure in childhood had a widespread negative and distressing impact on participant’s psychological functioning. 5 themes emerged from the post-intervention data which endorsed the trauma intervention in terms of assuaging the emotional distress associated with trauma. A Compassion Focused Therapy (CFT) model is reported as helpful in intervening with core symptoms associated with complex trauma such as guilt, shame and self-criticism. Conclusion: Overall, the results from the systematic review and the empirical study support the value of a phase-orientated model in reducing and alleviating posttraumatic stress disorder symptoms. The combination of stabilisation and exposure therapy was salient in the findings on the Trauma Programme. CFT is discussed in consideration of its use within phase-orientated interventions for trauma. Limitations and areas requiring further research are outlined