Guided self-help: a new treatment in PTSD?

I’m a research assistant and PhD student based at the National Centre for Mental Health at Cardiff University. I’m part of a team that is studying the efficacy of a new self-help treatment for people living with post-traumatic stress disorder (PTSD).

Who can be affected by PTSD? 

It is very common to develop symptoms of PTSD, following a traumatic event.

Typical symptoms include repeated reliving of the trauma in intrusive memories or flashbacks, dreams or nightmares, a sense of emotional numbness, lack of interest in usual activities, avoidance of reminders and hyperarousal, for example jumpiness.

Studies estimate that around 7% of people will suffer from PTSD at some point in their lives.

Despite this mental health need, waiting lists for evidence-based PTSD treatment can be very long, sometimes up to 18 months, and there are a limited number of therapists who are trained in the delivery of evidence-based psychological treatments of PTSD.

Another potential barrier to treatment is the fact it requires a big commitment from individuals to attend regular appointments in person over several months.

People may find this difficult for a number of reasons, such as difficulty taking time off work, travelling to appointments, and perhaps a perceived stigma about attending mental health services.

We believe guided self-help as a treatment for PTSD may be a solution.

An innovative treatment

Guided self-help combines regular guidance from a therapist with self-help materials. Compared to current standard treatments this method requires less time with a therapist.

It is known that Internet-based Guided Self-Help is an effective and accessible form of psychological treatment for individuals experiencing anxiety and depression, and the evidence-base for its use in treating PTSD is building.

Developed by Cardiff University and Healthcare Learning Company, Spring is a new Guided Self-Help programme, intended for individuals with mild to moderate PTSD.

It is an eight-step online programme which takes users through information about PTSD and typical symptoms, unlocking helpful tools and techniques for symptom management.  Therapists guide and support RAPID participants, encouraging access to the programme and completion of homework.

Spring is being assessed in the RAPID (Pragmatic RAndomised controlled trial of a trauma-focused guided self-help Programme versus InDividual TFCBT for PTSD) clinical trial led by Professor Jonathan Bisson. RAPID aims to determine whether Spring is a suitable alternative to face-to-face therapy for people with mild to moderate PTSD, who have experienced a single traumatic event.

Funded by the National Institute for Health Research (NIHR), RAPID is working from several centres that support people with PTSD across the UK, including NCMH at Cardiff University.

Importantly, the RAPID Trial and its intervention, Spring, has been developed with and for people with lived-experience of PTSD. In fact, the RAPID Trial goes further than that by involving people with lived-experience of PTSD in its design, management and advisory groups.

Reflections

Pauline Taylor, a member of the RAPID Patient and Public Involvement Group, has shared her reflections of the ‘Spring’ programme in relation to her own traumatic experience:

Over twenty years ago I experienced a traumatic event, during which I feared I would die.

 If this programme had been made available to me then, I am certain that the PTSD I suffered after that event would not have continued to so negatively affect my life for many years, because I had not dealt with it in the early stages.

 My PTSD drained me physically and emotionally, I suffered with emotional and physical exhaustion, which impacted on all aspects of my life. This programme would have guided me to an awareness of how PTSD could affect my physical and emotional health so enabling me to be more mindful of my wellbeing, and take control.

 It would have provided an instant emotional safety net when I felt vulnerable and confused, and my feelings and thoughts were very ‘raw’. It would have guided me calmly, and simply to understand my feelings and fears, and empower me to take control and ground the whole shocking experience.

 Throughout, I felt the programme would have become a friend, verbally affirming regularly that my feelings are ‘normal’ and that I will be okay.

 It also addresses general physical and emotional health issues which can arise with PTSD. There are helpful tips regarding physical fitness and the tools to enable the development of Mindfulness.

 I believe it would be most beneficial if the programme was applied across services for personnel in traumatic lines of work, and also made accessible across areas of Mental Health support, general Health Practice and Human Resources in the workplace. 

Empowering

Another member of the RAPID Patient and Public Involvement Group has shared her experiences, following her use of ‘Spring’ as a participant in research that preceded the RAPID Trial and formed the foundations for the current work:

It was empowering. Embarking on a guided self-help programme gave me the control I needed. I’d had enough of being a victim. 

 The programme is narrated and you’re guided through it step by step. A key part of the programme was writing a lengthy first-person account of my traumatic incident and reading it over and over again.

 The programme allowed me to become desensitised to what I’d experienced. You don’t suppress it but you’re able to step away from the memories and then deal with them.

 It was brilliant because you can do it on any computer in any location. It’s adaptable and it suited me as a full-time working single mum.

 I’ve realised that in the time it would have taken me to be on a therapist’s waiting list I was already back to being me. I would recommend this programme to anyone in a similar situation.

 Technology is entering a new era, with apps that can actually make a difference to your mental health. The RAPID programme sits perfectly and legitimately within that.

 RAPID is underway, currently recruiting participants across South Wales, Greater Manchester and shortly will be recruiting in London and Edinburgh.

We believe our trial may be the first comparative trial of online guided self-help and face-to-face therapy for PTSD.

We can’t wait to find out if guided self-help represents a suitable, viable, cost-effective and acceptable treatment for PTSD in the NHS and across other service settings, and we’ll be sure to disseminate our findings as widely as possible.

Read more about the trial or contact Natalie Simon on 02920 688331 or email SimonN2@cardiff.ac.uk