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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

Published online by Cambridge University Press:  03 July 2020

Lilian Skilbeck  and
Christopher Spanton Open the ORCID record for Christopher Spanton [Opens in a new window]
Lilian Skilbeck*
Affiliation:
East London NHS Foundation Trust, Newham Talking Therapies, Vicarage Lane Health Centre, 10 Vicarage Lane, Stratford, LondonE15 4ES, UK
Christopher Spanton
Affiliation:
East London NHS Foundation Trust, Newham Talking Therapies, Vicarage Lane Health Centre, 10 Vicarage Lane, Stratford, LondonE15 4ES, UK
*
*Corresponding author. Email: l.skilbeck@nhs.net
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Abstract

The main current intervention for post-traumatic stress disorder (PTSD) in adult primary care is individual trauma-focused cognitive behavioural therapy (TF-CBT). Group TF-CBT for PTSD has been advocated in order to improve access and cost. Barriers to the development of group TF-CBT include the need for a large number of sessions and therapist input in order to manage high levels of affect, possible dissociation and secondary traumatisation. This case study was prompted via our community engagement project when local women who had been involved in a single road traffic accident requested group therapy. The aim was to develop a NICE guideline-compliant brief 8-session group TF-CBT intervention that circumvented the above-mentioned barriers and is described in detail. In order to improve access, the group was delivered in the community. Standard and PTSD-specific measures were administered pre-therapy and post-therapy. Eight clients were offered treatment: two dropped out and six completed treatment. At the end of treatment, 3/6 clients attained reliable improvement in their PTSD symptoms. Two of these three clients also reached recovery. This change was maintained at 3-month follow-up where 4/6 clients attained reliable improvement, with three maintaining recovery. The remaining two clients showed minimal change in their PTSD symptoms. Overall, clients reported high-level satisfaction with the treatment protocol. This case study demonstrates a potentially clinically effective and cost-effective group TF-CBT intervention for non-complex single-incident PTSD.

Key learning aims

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

  1. (1) Use of a brief group TF-CBT protocol to treat homogeneous single incident trauma in adults.

  2. (2) Adaptations to overcome barriers to group TF-CBT in adults.

  3. (3) Implementation of individualised reliving based on written-narrative rather than spoken-narrative.

  4. (4) Focus on the processes of PTSD, whilst using content as a theme to contextualise the symptoms.

  5. (5) Emphasis on the use of homework in order to enhance group affect-modulation and individual learning.

Keywords

cognitive appraisalscognitive behavioural therapygroup psychotherapyNICEPTSDtrauma
Type
Case Study
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e21
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Further reading

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. https://doi.org/10.1016/s1077-7229(05)80049-5CrossRefGoogle 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. https://doi.org/10.1037/0022-006x.69.3.541CrossRefGoogle Scholar
Thompson, A. R., Wilde, E., & Boon, K. (2008). 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. https://doi.org/10.1017/s1754470x0800007xCrossRefGoogle Scholar

References

APA (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn). Washington, DC.Google 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. https://doi.org/10.1016/s1077-7229(05)80049-5CrossRefGoogle ScholarPubMed
Beck, J. G., Coffey, S. F., Foy, D. W., Keane, T. M., & Blanchard, E. B. (2009). Group cognitive behavior therapy for chronic posttraumatic stress disorder: an initial randomized pilot study. Behavior Therapy, 40, 82–92. https://doi.org/10.1016/j.beth.2008.01.003CrossRefGoogle ScholarPubMed
Beaumont, E., Galpin, A., & Jenkins, P. (2012). Being kinder to myself: a prospective comparative study, exploring post-trauma therapy outcome measures, for two groups of clients, receiving either cognitive behaviour therapy or cognitive behaviour therapy and compassionate mind training. Counselling Psychology Review, 27, 31–43.Google Scholar
Cloitre, M. (2015). The ‘one size fits all’ approach to trauma treatment: should we be satisfied? European Journal of Psychotraumatology, 6, 27344. https://doi.org/10.3402/ejpt.v6.27344CrossRefGoogle Scholar
Deblinger, E., Pollio, E., & Dorsey, S. (2016). Applying trauma-focused cognitive-behavioral therapy in group format. Child Maltreatment, 21, 59–73. https://doi.org/10.1177/1077559515620668CrossRefGoogle ScholarPubMed
Dōmen, I., Ejiri, M., & Mori, S. (2012). Narrative exposure therapy for the treatment of complex PTSD: an examination of the effect and adaptation. Japanese Journal of Psychotherapy, 13, 67–74.Google Scholar
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy, 43, 413–431. https://doi.org/10.1016/j.brat.2004.03.006CrossRefGoogle ScholarPubMed
Foy, D. W., Glynn, S. M., Schnurr, P. P., Janowski, M. K., Wattenberg, M. S., Weiss, D. S., … & Gusman, F. D. (2000). Group therapy. In Effective Treatments for PTSD (ed. Foa, E. B., Keane, T. M. & Friedman, M. J.), pp. 155–175. New York, USA: Guilford Press.Google Scholar
Frost, N. D., Laska, K. M., & Wampold, B. E. (2014). The evidence for present-centered therapy as a treatment for posttraumatic stress disorder. Journal of Traumatic Stress, 27, 1–8. https://doi.org/10.1002/jts.21881CrossRefGoogle ScholarPubMed
Grech, P., & Grech, R. (2018). Narrative exposure therapy for post-traumatic stress disorder. Alternative & Integrative Medicine, 7. https://doi.org/10.4172/2327-5162.1000264.CrossRefGoogle Scholar
Hathaway, L. M., Boals, A., & Banks, J. B. (2010). PTSD symptoms and dominant emotional response to a traumatic event: an examination of DSM-IV Criterion A2. Anxiety, Stress & Coping, 23, 119–126. https://doi.org/10.1080/10615800902818771.CrossRefGoogle ScholarPubMed
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 in Psychology, 6. https://doi.org/10.3389/fpsyg.2015.01273.CrossRefGoogle ScholarPubMed
IAPT (2014). Measuring Improvement and Recovery Adult Services Version 2. Retrieved from: http://www.oxfordahsn.org/wp-content/uploads/2015/11/measuring-recovery-2014.pdfGoogle Scholar
Imel, Z. E., Laska, K., Jakupcak, M., & Simpson, T. L. (2013). Meta-analysis of dropout in treatments for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 81, 394–404. https://doi.org/10.1037/a0031474CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.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
McManus, S., Meltzer, H., Bebbington, P., & Jenkins, R. (2008). Adult Psychiatric Morbidity in England, 2007. Results from a household survey London/Leeds: The NHS information centre for Health and Social Care. Retrieved from: https://files.digital.nhs.uk/publicationimport/pub02xxx/pub02931/adul-psyc-morb-res-hou-sur-eng-2007-apx.pdfGoogle Scholar
Mitchell, J. T., & Hopkins, J. (1998). Critical incident stress management: a new era in crisis intervention. Traumatic Stress Points, 12, 6–10.Google Scholar
Monson, C. M., Price, J. L., & Ranslow, E. (2005). Treating combat PTSD through cognitive processing therapy. Federal Practitioner, 22, 75–83.Google Scholar
Mundt, J. C., Marks, I. M., 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. https://doi.org/10.1192/bjp.180.5.461CrossRefGoogle ScholarPubMed
NICE (2018) Post Traumatic Stress Disorder (NICE Guideline NG116). Retrieved from: https://www.nice.org.uk/guidance/ng116.Google Scholar
NHS Digital. (2019). Psychological Therapies: reports on the use of IAPT services, England September 2019 Final including reports on the IAPT pilots and Quarter 2 2019-20 data: Waiting times. Retrieved from: https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services/september-2019-final-including-reports-on-the-iapt-pilots-and-quarter-2-2019-20-data/waiting-timesGoogle Scholar
Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29, 95–129. https://doi.org/10.1177/0145445504270876CrossRefGoogle Scholar
Resick, P. A., Wachen, J. S., Dondanville, K. A., Pruiksma, K. E., Yarvis, J. S., Peterson, A. L., Mintz, J., and the STRONG STAR Consortium, Borah, E. V., Brundige, A., Hembree, E. A., Litz, B. T., Roache, J. D., & Young-McCaughan, S. (2017). Effect of group vs individual cognitive processing therapy in active-duty military seeking treatment for posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry, 74, 28–36. https://doi.org/10.1001/jamapsychiatry.2016.2729CrossRefGoogle ScholarPubMed
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, 29, 415–431. https://doi.org/10.1080/10503307.2017.1405168CrossRefGoogle ScholarPubMed
Sloan, D. M., Sawyer, A. T., Lowmaster, S. E., Wernick, J., & Marx, B. P. (2015). Efficacy of narrative writing as an intervention for PTSD: does the evidence support its use? Journal of Contemporary Psychotherapy, 45, 215–225. https://doi.org/10.1007/s10879-014-9292-xCrossRefGoogle ScholarPubMed
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine, 166, 1092. https://doi.org/10.1001/archinte.166.10.1092CrossRefGoogle ScholarPubMed
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. https://doi.org/10.1037/0022-006x.69.3.5CrossRefGoogle ScholarPubMed
Thompson, A. R., Wilde, 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. https://doi.org/10.1017/s1754470x0800007xCrossRefGoogle 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. https://doi.org/10.1037/gdn0000077.CrossRefGoogle ScholarPubMed
VA/DOD (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.pdfGoogle Scholar
Weiner, D. A., Schneider, A., & Lyons, J. S. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: treatment retention and outcomes. Children and Youth Services Review, 31, 1199–1205. https://doi.org/10.1016/j.childyouth.2009.08.013.CrossRefGoogle Scholar
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. New York, USA: Guilford Press; pp. 399–411.Google Scholar
Whitfield, G. (2010). Group cognitive-behavioural therapy for anxiety and depression. Advances in Psychiatric Treatment, 16, 219–227. https://doi.org/10.1192/apt.bp.108.005744CrossRefGoogle Scholar
Wild, J., & Ehlers, A. (2010). Self-study assisted cognitive therapy for PTSD: a case study. European Journal of Psychotraumatology, 1, 5599. https://doi.org/10.3402/ejpt.v1i0.5599CrossRefGoogle ScholarPubMed
Yalom, I. D. (1995). The Theory and Practice of Group Psychotherapy (4th edn). New York, USA: Basic Books.Google Scholar
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