Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-18T18:47:47.921Z Has data issue: false hasContentIssue false
  • English
  • Français

Delivery of a trauma-focused CBT group for heterogeneous single-incident traumas in adult primary care: a follow-on case study

Published online by Cambridge University Press:  06 April 2022

Lilian Skilbeck Open the ORCID record for Lilian Skilbeck [Opens in a new window]  and
Christopher Spanton
Lilian Skilbeck*
Affiliation:
East London NHS Foundation Trust, Newham Talking Therapies, Vicarage Lane Health Centre, 10 Vicarage Lane, Stratford, London E15 4ES, UK
Christopher Spanton
Affiliation:
East London NHS Foundation Trust, Newham Talking Therapies, Vicarage Lane Health Centre, 10 Vicarage Lane, Stratford, London E15 4ES, UK
*
*Corresponding author. Email: l.skilbeck@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Group therapy for adult post-traumatic stress disorder (PTSD) has been a subject of debate over the past few years. A recent update on five international clinical practice guidelines on the use of group-therapy for PTSD in adults ranged from moderate support (e.g. the International Society for Traumatic Stress Studies) to no recommendation (e.g. the National Institute for Health and Care Excellence, NICE). However, a unanimous recommendation was that practitioners collaborated with their clients and weighed up the guidelines and client preferences to make the appropriate decisions. The current case study was guided by these recommendations. A minority of clients presenting to the service expressed a preference for group therapy for their PTSD symptoms. The current study follows on from a previous shared-trauma therapy group. It illustrates how the service took the NICE guidelines fully into account alongside the clients’ needs and preferences to deliver a NICE-compliant heterogenous trauma-focused CBT group. Twenty-four clients presenting with PTSD from different single-incident traumas opted for group therapy. Clients attended one of three 8-session trauma-focused CBT groups depending on preference (e.g. date/time, location). The groups were conducted face-to-face on a weekly basis. Seventeen clients completed treatment. Eleven clients no longer showed clinically important symptoms of PTSD as assessed on the PCL-5 and interview. This was sustained at 3-month follow-up. Four other clients showed reliable change. Two clients showed minimal improvement. This study is discussed with reference to opportunities, challenges and recommendations for clinical practice and research.

Key learning aims

It is hoped that the reader of this case study will increase their understanding of the following:

  1. (1) Delivery of a trauma-focused CBT group for heterogeneous single-incident traumas.

  2. (2) Taking full consideration of the NICE guidelines alongside the clients’ needs and preferences.

  3. (3) Guiding the focus of therapy on processing the trauma memory and its aftermath.

  4. (4) Effective use of group processes to facilitate outcomes.

Type
Case Study
Information
the Cognitive Behaviour Therapist , Volume 15 , 2022 , e17
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.CrossRefGoogle ScholarPubMed
Hamblen, J. L., Norman, S. B., Sonis, J. H., Phelps, A. J., Bisson, J. I., Nunes, V. D., Megnin-Viggars, O., Forbes, D., Riggs, D. S., & Schnurr, P. P. (2019). A guide to guidelines for the treatment of posttraumatic stress disorder in adults: an update. Psychotherapy, 56, 359–373.CrossRefGoogle ScholarPubMed
Skilbeck, L. & Spanton, C. (2020). Primary care community engagement – delivery of an enhanced and brief homogeneous group TF-CBT intervention for trauma from a single-incident road traffic accident: a case study. The Cognitive Behaviour Therapist, 13.CrossRefGoogle Scholar

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn). Arlington, VA, USA: American Psychiatric Publishing.Google Scholar
American Psychiatric Association (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. Washington, DC, USA: American Psychiatric Publishing.Google Scholar
Braehler, C., & Neff, K. (2020). Self-compassion in PTSD. In Tull, M. , & Kimbrel, N. (eds), Emotion in Posttraumatic Stress Disorder (pp. 567–596). Elsevier.CrossRefGoogle Scholar
Beck, J. G., & Coffey, S. F. (2005). Group cognitive behavioral treatment for PTSD: treatment of motor vehicle accident survivors. Cognitive and Behavioral Practice, 12, 267–277.CrossRefGoogle ScholarPubMed
Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–735.CrossRefGoogle ScholarPubMed
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489–498.CrossRefGoogle ScholarPubMed
Deblinger, E., Pollio, E. & Dorsey, S. (2016). Applying trauma-focused cognitive-behavioral therapy in group format. Child Maltreatment, 21, 59–73.CrossRefGoogle ScholarPubMed
Department of Veterans Affairs and Department of Defense (2017). Clinical Practice Guideline for the Management of Post-Traumatic Stress Disorder and Acute Stress Disorder. Retrieved from: https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGFinal012418.pdf Google Scholar
Department of Veterans Affairs and Department of Defense (2021). PTSD-DSM-5 Measures. Retrieved from: https://www.ptsd.va.gov/professional/assessment/dsm-5_validated_measures.asp Google Scholar
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.CrossRefGoogle ScholarPubMed
Hamblen, J. L., Norman, S. B., Sonis, J. H., Phelps, A. J., Bisson, J. I., Nunes, V. D., Megnin-Viggars, O., Forbes, D., Riggs, D. S., & Schnurr, P. P. (2019). A guide to guidelines for the treatment of posttraumatic stress disorder in adults: an update. Psychotherapy, 56, 359–373.CrossRefGoogle ScholarPubMed
Harris, S. (2014). How effective is group cognitive behavioral therapy to treat PTSD? Federal Practitioner. Retrieved from: https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/Document/September-2017/031110020.pdf Google Scholar
Hoffart, A., Øktedalen, T., & Langkaas, T. F. (2015). Self-compassion influences PTSD symptoms in the process of change in trauma-focused cognitive- behavioral therapies: a study of within-person processes. Frontiers of Psychology, 6, 1273.CrossRefGoogle ScholarPubMed
IAPT (2014). Measuring Improvement and Recovery Adult Services, version 2. Retrieved from: http://www.oxfordahsn.org/wp-content/uploads/2015/11/measuring-recovery2014.pdf Google Scholar
International Society for Traumatic Stress Studies. (2018). ISTSS PTSD prevention and treatment guidelines: Methodology and recommendations. Retrieved from http://www.istss.org/getattachment/TreatingTrauma/New-ISTSS-Prevention-and-Treatment-Guidelines/ISTSS_PreventionTreatmentGuidelines_FNL-March-19-2019.pdf.aspx Google Scholar
Kazantzis, N., Brownfield, N. R., Mosely, L., Usatoff, A. S., & Flighty, A. J. (2017). Homework in cognitive behavioral therapy: a systematic review of adherence assessment in anxiety and depression (2011–2016). Psychiatric Clinics of North America, 40, 625–639.CrossRefGoogle Scholar
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Levi, O., Wald, I., Svetlitsky, V., Zusmanovitz, S., Parasha, E., Shoval-Zuckerman, Y., Afik, G., Haikin, G., & Fruchter, E. (2017). Combat-related multifaceted trauma-focused group therapy. The Journal of Nervous and Mental Disease, 205, 133–139.CrossRefGoogle ScholarPubMed
Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. European Journal of Psychotraumatology, 11, 1729633.CrossRefGoogle ScholarPubMed
Manfield, P., Lovett, J., Engel, L. & Manfield, D. (2017). Use of the flash technique in EMDR therapy: four case examples. Journal of EMDR Practice and Research, 11, 195–205.CrossRefGoogle Scholar
Meyer, E. (2019). Mindfulness, values-based goal setting can improve lives of Veterans with PTSD and alcohol use disorder. Retrieved from: https://www.blogs.va.gov/VAntage/60637/mindfulness-values-based-goal-setting-can-improve-lives-veterans-ptsd-alcohol-use-disorder/ Google Scholar
Mundt, J., Marks, I., Shear, M. K., & Greist, J. M. (2002). The work and social adjustment scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2018). Post Traumatic Stress Disorder (NICE Guideline NG116). Retrieved from: https://www.nice.org.uk/guidance/ng116 Google Scholar
NHS England (2017). Patient and Public Participation Policy (2017). Retrieved from: https://www.england.nhs.uk/wp-content/uploads/2017/04/ppp-policy.pdf Google Scholar
Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29, 95–129.CrossRefGoogle ScholarPubMed
Penk, W. E., Little, D., & Ainspan, N. D. (2019). Group therapy for PTSD. In Moore, B. A. , & Penk, W. E. (eds), Treating PTSD in Military Personnel: A Clinical Handbook (pp. 169–190). New York, USA: Guilford Press.Google Scholar
Phoenix Australia Centre for Posttraumatic Mental Health (2013). Australian guidelines for the treatment of acute stress disorder and posttraumatic stress disorder. Melbourne, Australia. Retrieved from: https://www.phoenixaustralia.org/australian-guidelines-for-ptsd/ Google Scholar
Schwartze, D., Barkowski, S., Strauss, B., Knaevelsrud, C. & Rosendahl, J. (2017). Efficacy of group psychotherapy for posttraumatic stress disorder: systematic review and meta-analysis of randomized controlled trials. Psychotherapy Research, 27, 1–17.Google Scholar
Sloan, D. M., Bovin, M. J., & Schnurr, P. P. (2012). Review of group treatment for PTSD. Journal of Rehabilitation Research & Development, 49, 698–702.CrossRefGoogle ScholarPubMed
Skilbeck, L. & Spanton, C. (2020). Primary care community engagement – delivery of an enhanced and brief homogeneous group TF-CBT intervention for trauma from a single-incident road traffic accident: a case study. the Cognitive Behaviour Therapist, 13.Google Scholar
Sloan, D. M., Feinstein, B. A., Gallagher, M. W., Beck, J. G., & Keane, T. M. (2013). Efficacy of group treatment for posttraumatic stress disorder symptoms: a meta-analysis. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 176–183.CrossRefGoogle Scholar
Sloan, D. M., & Beck, J. G. (2016). Group treatment for PTSD. PTSD Research Quarterly: Advancing Science and Promoting Understanding of Traumatic Stress, 27, 1050–1835.Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Lowe, B. (2006). A brief measure for assessing generalised anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefGoogle Scholar
Taylor, S., Fedoroff, I. C., Koch, W. J., Thordarson, D. S., Fecteau, G. & Nicki, R. M. (2001). Posttraumatic stress disorder arising after road traffic collisions: patterns of response to cognitive-behavior therapy. Journal of Consulting and Clinical Psychology, 69, 541–551.CrossRefGoogle ScholarPubMed
Thompson, A. R., Wild, E., & Boon, K. (2009). The development of group CBT for the treatment of road-traffic-accident-related post-traumatic stress disorder: a pilot study. the Cognitive Behaviour Therapist, 2, 32–42.CrossRefGoogle Scholar
Thompson-Hollands, J., Litwack, S. D., Ryabchenko, K. A., Niles, B. L., Beck, J. G., Unger, W., & Sloan, D. M. (2018). Alliance across group treatment for veterans with posttraumatic stress disorder: the role of interpersonal trauma and treatment type. Group Dynamics: Theory, Research, and Practice, 22, 1–15.CrossRefGoogle ScholarPubMed
Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event Scale-Revised. In Wilson, J. P. , & Keane, T. M. (eds), Assessing Psychological Trauma and PTSD, pp. 399–411. New York, USA: Guilford Press.Google Scholar
Whitfield, G. (2010). Group cognitive-behavioural therapy for anxiety and depression. Advances in Psychiatric Treatment, 16, 219–227.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.