A key area of research and improvement activity for Traumatic Stress Wales is the development, evaluation and implementation of effective guided self-help interventions.
Currently, the first-choice treatments for PTSD are individual talking treatments of 12-16 hours duration. The limited number of therapists available and length of treatment means that there can be long waiting lists. People with PTSD may also have difficulty committing to weekly appointments, especially if they are working, have childcare commitments or are scared to go out alone or to new places. If equally effective treatments could be developed that take less time and can be largely undertaken in a flexible manner at home, this would improve accessibility, reduce waiting times and hence the burden of disease. Guided self-help has the potential to address this gap.
Spring is an internet-based, trauma-focused cognitive behavioural therapy guided self-help programme to treat PTSD of mild to moderate severity and was developed by the Traumatic Stress Research Group at Cardiff University. Treatment with Spring involves an initial videoconference meeting with a therapist for about an hour to develop a rapport and describe the eight-step/module programme (see Box below).
Step 1: Learning About My PTSD – Psychoeducation about PTSD illustrated by four actors describing their experience of PTSD to four different types of traumatic event.
Step 2: Grounding Myself - Explanation of grounding and its uses along with descriptions and demonstrations of grounding exercises.
Step 3: Managing My Anxiety – Education around relaxation with learning through videos of a controlled breathing technique, deep muscular relaxation and relaxation through imagery.
Step 4: Reclaiming My Life – Behavioural re-activation to help individuals return to previously undertaken/new activities.
Step 5: Coming to Terms with My Trauma – Provides rationale for imaginal exposure, narratives of the four video characters are provided. The therapist helps the client to begin writing a narrative, which they complete remotely and read every day for at least 30 minutes.
Step 6: Changing My Thoughts – Cognitive techniques to address PTSD symptoms.
Step 7: Overcoming My Avoidance – Graded real life exposure work.
Step 8: Keeping Myself Well – This session reinforces what has been learnt during the programme, provides relapse prevention measures and guidance on what to do if symptoms return.
The initial meeting is then followed by four further, fortnightly sessions of 30 minutes each. These are undertaken via the internet or telephone according to client preference. Each session is accompanied by homework to guide the client through the steps at the appropriate pace. At each session, the therapist reviews progress and guides the client through the programme. The aim of the guidance is to offer continued support, monitoring, motivation and problem solving.
Spring has been shown to help people with PTSD in clinical trials and is now being rolled out in Wales as part of a Traumatic Stress Wales quality improvement project. Traumatic Stress Wales is also currently collaborating with Cardiff University’s Traumatic Stress Research Group to develop and evaluate guided self-help interventions for CPTSD and prolonged grief disorder.