"Like a huge weight lifted off my shoulders": trauma-focused therapy trial

"Like a huge weight lifted off my shoulders": trauma-focused therapy trial

11 January 2022

Trauma-focused cognitive behavioural therapy (TF-CBT) can be difficult but it often leads to transformative change in young people, an Orygen pilot trial has found.

The study found that only one of the 16 participants who were diagnosed with post-traumatic stress disorder (PTSD) at the start of the treatment had a PTSD diagnosis at the end of the treatment.

Orygen Research Fellow Wilma Peters, who worked on the study, said it was great to see how much participants noticed changes in themselves.

“Participants reported improvements in PTSD, anxiety and depression symptoms at the end of treatment,” Peters said of the findings, published in Psychological Trauma: Theory, Research, Practice, and Policy. Peters conducted the therapy for the trial as part of her PhD.

“A minority of participants reported a brief exacerbation in symptoms of PTSD, anxiety and depression during therapy, however all symptoms resolved at the end of treatment. Most participants (85 per cent) rated the intervention as helpful and said they’d recommend TF-CBT to a peer.”

TF-CBT uses psychoeducation, gradual exposure, behaviour modelling, coping strategies, and body safety skills training to help prevent and treat post-traumatic stress, depression, and behavioural changes.

The research project involved 20 young people aged 15–25 who were experiencing post-traumatic stress following an inter-personal trauma. They typically completed 12–20 TF-CBT sessions with a single therapist. Analysis found that TF-CBT was safe, tolerable, and acceptable.

There are currently very few interventions for PTSD that have been specifically adapted for young people. It’s hoped the pilot project can be expanded to a randomised controlled trial to help fill the gap in the evidence base for 15–25 year olds.

A second paper, published in Psychotherapy Research, examined 13 participants’ experiences of TF-CBT through qualitative analysis of structured interviews.

Transformative change was one of four themes identified, with one young person telling researchers their life had completely changed after completing the therapy.

“I was doing drugs. People would ask, what’s your future? I would say nothing. I’ve got no plans and now I’m going to university. Now I’m getting a job. I’ve got better friends, I’m not doing drugs … My life’s completely changed for the better,” the study participant said.

Another theme was that talking about trauma was difficult but important. One participant said: “to be completely honest, [doing therapy] sucked! I hated the whole process of going over it again because I hadn’t talked about it in over a decade”.

In the end though, none of the participants regretted talking about their traumatic experiences.

“We took it slow, but in the end we ended up talking about what happened and that was like a huge weight lifted off my shoulders,” one participant said.

The third theme was the importance of feeling authentically cared for during TF-CBT, with one respondent describing it as making their “heart warm and fuzzy … like I was an actual person and that I was cared for”.

Orygen’s Associate Professor Sarah Bendall, who led the qualitative study, said the final theme was that young people valued being actively involved in the therapeutic process.

“An important element of TF-CBT is that from the outset the therapist provides transparency regarding the content and the direction of the therapy,” Associate Professor Bendall said.

“This enables young people to feel empowered to take charge of their recovery, reclaim a sense of agency and control in their care.”

Associate Professor Bendall said the findings offered useful guidance for therapists working with young people who had experienced traumatic events.

“Research shows that mental health practitioners are often reluctant to address trauma with young people because they don’t want to cause distress or exacerbate symptoms. But our findings show just how important therapy can be for young people when it is trauma-focussed, sensitive and genuine,” Associate Professor Bendall said.       

The TF-CBT pilot trial was funded by a University of Melbourne Margaret Cohen Research Grant.