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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
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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

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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

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