The INTEGRATE program: A group-based therapeutic intervention for relational functioning in individuals with complex traumatic stress disorder (CTSD).
The INTEGRATE program: A feasibility implementation trial of a manualised group-based psychotherapeutic intervention for relational functioning in individuals with complex traumatic stress disorder (CTSD).
Dr Carol Keane
20 participants
Apr 10, 2023
Interventional
Conditions
Summary
There is increasing awareness that adaption of existing PSTD treatment approaches for CTSD has had mixed results for individuals who have experienced interpersonal traumas and childhood adversity; often there is a demonstrated attenuation of PTSD symptoms, yet the challenges related to difficulties with DSO remain. There is an internationally recognised need to develop evidence-based clinical interventions that focus on the emotional-, interpersonal-, and self-, dysregulations involved in DSO, and are purpose-built to improve functioning. To date, treatments for the symptoms of DSO have leveraged those more commonly used for personality disorder, such as Dialectical Behaviour Therapy (DBT). DBT is resource intensive, often delivered through extensive one to one therapy over an extended period (up to 2 years) and is not ‘purpose built’ for DSO arising from trauma experiences. It is thus less efficient and less effective than the proposed INTEGRATE program. INTEGRATE is a novel 12-week group-based therapeutic intervention that has been developed in response to this identified need. Importantly, INTEGRATE has been carefully designed to situate as complementary to existing best-practice approaches for treatment of PTSD. The purpose of this study is to evaluate implementation feasibility of INTEGRATE with a community-based sample in collaboration with a Northern Territory (NT) government supported local community service for people who have experienced sexual assault, the Sexual Assault Recovery Centre (SARC). The project has the following aims: 1) to evaluate recruitment capability and gather information about the characteristics of the sample, 2) to evaluate the data collection procedures and outcomes, 3) to evaluate how well the INTEGRATE program is received by participants and suitability of the intervention and data collection procedure for future trials, 4) to gather preliminary evaluation data regarding participants response to the INTEGRATE program, and 5) to gather insights from facilitators and service providers about their perceptions of participants response to INTEGRATE, their evaluations of the benefits, challenges, and impacts of the INTEGRATE program at a client and service level, and identified areas for improvement. Longer-term, the success of INTEGRATE will have both social and economic value to the Australian, and international, community. As a complementary program to those dealing with the symptomology of conventional PTSD reactions, INTEGRTATE will enhance client recovery and act to reduce waitlists of traditional services. INTEGRATE will also reduce treatment costs associated with more lengthy and less efficacious approaches to DSO symptomology. Importantly, INTEGRATE will support holistic client recovery and therefore client function, attenuating the social and economic costs of long-term disability.
Eligibility
Plain Language Summary
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Interventions
The intervention is the INTEGRATE program, which is a 12-week manualised group-based psychotherapeutic intervention. The manualised approach has opportunity for some flexibility to suit the group dynamic, while still maintaining the integrity of the core components of the protocol. The INTEGRATE program is novel and has been designed for the specific purpose of this project. It is not publicly available and the content will remain confidential until such time IP is appropriately protected; however, the following information is provided as a summary overview of the program. The core components are tailored towards therapeutic intervention of the Disturbances of Self Organisation (DSO) triad of affect regulation, self-concept, and interpersonal relating. Accordingly, the program is underpinned by evidence-based cognitive, behavioural, and interpersonal therapeutic techniques. The program combines psychoeducation, facilitator-led activities, interactive group activities and discussions, self-reflective activities, and a between-session self-reflective journaling activity. This between-session activity is anticipated to take between 20 - 30 minutes/week to complete and is intended to both consolidate learning/experience from the past session as well providing continuity of self-reflection practice that is a foundation component of the entire program. Each session duration is 2-hours in total with a half-time 10-minute comfort break. Sessions will run 1x/week for 12 consecutive weeks. INTEGRATE functions as a closed group, meaning all participants commence at week 1 and no additional participants can join the group once it has commenced. The target sample size for a group is 8 – 12 participants. It is planned to run 4 x groups throughout the duration of the feasibility trial. Actual sample size for the first of group is 9 participants. Participants for the current study will be recruited from a Northern Territory (NT) government supported local community service for people who have experienced sexual assault, the Sexual Assault Recovery Centre (SARC). In addition to sexual assault, most clients who present to this service have complex trauma histories and experience of domestic and/or family violence. As such this client group is most representative of the people that might benefit from engagement in the INTEGRATE program. In addition, the information gathered from the SARC service and staff, will provide feasibility and implementation insights from a service that is highly representative of future services who might employ the INTEGRATE program. Delivery of INTEGRATE will be in face-to-face format by two facilitators. Co-facilitation is considered integral for INTEGRATE program to ensure client and facilitator safety. For the current study the two group-facilitators will be provisionally registered psychologists in the final stages of their Master of Psychology (Clinical) program. The facilitators will be supervised by the primary investigator, who is a registered Clinical Psychologist and who is also a PsyBA board approved supervisor. The INTEGRATE program will be conducted at the Charles Darwin University Wellness Centre Psychology Service (CDU-WCPS), which is a university-based psychology training facility that provides psychological services to members of the public. The CDU-WCPS is appropriately resourced to house the feasibility implementation trial of INTEGRATE and provides a neutral environment to assess feasibility elements, as it is separate to SARC, the local support service collaborating in this research. There are two versions of the INTEGRATE program manual, a client version and a facilitator version. The facilitator version mirrors the client manual but also contains scripts, prompts, activity guidelines, that supports a standardised administration. At sections where it is anticipated some flexibility in delivery might be required, facilitators are provided with parameters within which they can flex as required while ensuring the core component of that section holds integrity. Facilitators will be asked to complete a brief fidelity checklist at the end of each session to monitor adherence to core components of the manualised protocol. Each client receives a hard copy spiral bound INTEGRATE manual at commencement of the group, and they use the manual as an interactive therapeutic tool for the duration of the group. As weekly homework is part of the program, with an aim to consolidate therapeutic gains across the weeks, participants are encouraged to take the manual home each week at the end of the session; however, provision is also made to store a client's manual on-site if there are concerns about bringing the manual home. In this case, alternative options for homework will be negotiated as suits the client's needs.
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ACTRN12623000507684