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

Abstract

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) Use of a brief group TF-CBT protocol to treat homogeneous single incident trauma in adults. (2) Adaptations to overcome barriers to group TF-CBT in adults. (3) Implementation of individualised reliving based on written-narrative rather than spoken-narrative. (4) Focus on the processes of PTSD, whilst using content as a theme to contextualise the symptoms. (5) Emphasis on the use of homework in order to enhance group affect-modulation and individual learning.