Intensive vs. Traditional Format with Patient Involvement in PTSD

This project is affiliated with The University of Gothenburg Centre for Person-centred Care GPCC.

Background

Post-Traumatic Stress Disorder (PTSD) is very common after trauma and can occur when individuals are unable to psychologically manage difficult life events that have posed a risk to life and health. PTSD is characterized by distressing re-experiencing of the event, avoidance of reminders, thoughts, and feelings, as well as increased physiological and psychological arousal (i.e., readiness and vigilance). Examples of potentially traumatizing events include natural disasters, war and torture experiences, interpersonal violence, or sexual violence and abuse [1]. The lifetime prevalence of PTSD is estimated to be between 5-7% in Sweden and Western Europe [2]. Having untreated PTSD increases the risk of other psychiatric conditions as well as deteriorated physical health [3]. PTSD significantly impacts an individual's functional ability, often resulting in reduced quality of life, increased healthcare consumption both psychiatric and somatic, and worsened economic conditions [4].

At the Psychiatry Department, Södra Älvsborg Hospital, a research project is ongoing where two different treatment formats are compared. We have introduced a new format where treatment is conducted over 8 days, an intensive format. Since intensive treatment for PTSD is untested in Sweden and there are no studies on individuals' experiences, it is important to involve the person in the decision about which treatment format they prefer and suits their current life situation. Studies indicate that when individuals are involved, it has a positive effect on satisfaction with care and increases the effect with symptom relief as a result. The different treatment formats consist of an intensive 8-day format with 16 trauma processing sessions, physiotherapy/physical activity 4 times a day, and psychoeducation in the evening. Therapist rotation is part of the concept. Patients stay at a patient hotel to focus on the treatment.

The other treatment format consists of a traditional format. It starts with six stabilization sessions corresponding to the psychoeducation in the intensive format. The patient undergoes trauma processing with the same therapist for 16 sessions.

The treatment in both formats consists of two evidence-based methods developed to process trauma. Trauma-focused CBT: Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR). The methods have shown good effect in traditional treatment formats [5].

Cornerstones of the Project

Person-centered care with a focus on participation and co-determination. The patient receives information about the available treatment options. The information includes a description of the differences between the treatment formats/methods, where the patient, together with the therapist, discusses what it entails and what works best for the patient. This enables an informed decision about which treatment format is most suitable. The starting point is that the patients know and understand their situation best. A treatment plan is then co-created, including a trauma inventory, which is then used in trauma processing.

Therapist Rotation

The intensive format uses therapist rotation. This means that the focus is on the patient and not on the relationship between the patient and therapist, which is common in psychotherapeutic treatment. We have preliminary results from a thesis where experiences of therapist rotation were examined according to methodological principles from Reflective Lifeworld Research [6, 7].

The Importance of the Team

The team is interdisciplinary, consisting of 3 psychologists, 2 nurses (1 licensed psychotherapist), 1 occupational therapist (licensed psychotherapist), 1 social worker, and 1 orderly, all of whom have at least basic training in psychotherapy, and a physiotherapist who leads the physical activity. The team meets twice a day and reports to the entire team. The information is taken into account and referred to in the next treatment session. An important component is responsiveness to the patient's needs. A secure patient is a prerequisite for being able to carry out a treatment that is difficult and demanding.