“Like a huge weight lifted off my shoulders”: Exploring young peoples’ experiences of treatment in a pilot trial of trauma-focused cognitive behavioral therapy

Eastwood, Oliver; Peters, W.H.M.; Cohen, Judith A.; Murray, Leigh; Rice, Simon; Álvarez‐Jiménez, Mario; Bendall, Sarah

doi:10.1080/10503307.2020.1851794

Cited by 13 publications

(14 citation statements)

References 58 publications

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“…This finding adds nuance to quantitative findings that trauma screening is not found to be upsetting by most participants (Skar et al, 2019). The finding further supports qualitative studies of trauma affected young people accessing mental health services for PTSD and depression, and for PTSD and FEP, which found a clinical paradox in that the process of talking about trauma can be distressing but ultimately experienced as beneficial (Eastwood et al, 2021;Tong et al, 2017). Whilst this study was only concerned about the experiences in initial trauma screening, and in theory was not a therapeutic intervention, the participants described it as important and described benefitting from the process.…”

Section: Discussionsupporting

confidence: 75%

“…These findings suggest that the clinician being alongside the young person as they completed the questionnaires provided containment, connection and an unspoken sense of non-judgemental understanding as to what the young person may have experienced in their lifetime. This experience of authentic care has been highlighted in other recent studies (Eastwood et al, 2021;Tong et al, 2018) as being integral to aiding the development of the therapeutic relationship, allowing the young person to feel ready to talk about trauma and to realise their own autonomy in recovery. This information further highlights the need for therapists to be attuned to the interpersonal needs of trauma-exposed young people (Eastwood et al, 2021) and supports consensus that the clinician to build a trusting relationship with the service user is central to trauma informed care in early psychosis services (Mitchell et al, 2021).…”

Section: Discussionmentioning

confidence: 95%

“…Trauma-informed care is an approach to service delivery that realises the widespread impact of trauma, recognises the signs and symptoms of trauma among clients and staff, responds by integrating knowledge about trauma into practice and proactively resists retraumatisation (SAMHSA, 2014). Bendall et al (2021) highlight the broad consensus that universal screening is one of the essential components of trauma informed care in youth mental health settings.…”

Section: Practitioner Pointsmentioning

confidence: 99%

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“They may be confronting but they are good questions to be asking” young people's experiences of completing a trauma and PTSD screening tool in an early psychosis program

2022

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Background There is a history of inadequate enquiry about, and assessment of, trauma in young people within Early Psychosis services and even when screening does occur there is little known about how young people experience this process. Aims This study aimed to explore young people's experiences of completing a trauma and PTSD screening tool when receiving a service in an Early Psychosis Program. Method Semi‐structured interviews were conducted with 10 young people, aged 18–24 years, to explore their subjective experience of this process. Transcripts were analysed via interpretative phenomenological analysis. Results Four super‐ordinate themes were identified: (i) an emotional experience, (ii) the importance of the relationship with the clinician, (iii) an opportunity to reflect on past experiences, and (iv) the ability to be able to provide honest responses. Results from this study indicated that young people expected to be asked about their trauma experiences, acknowledged that this was challenging for them but found that this was made easier due to the relationship they had built with the clinician, the timing of the screening and also, possibly, by the written style format of the questionnaires. Conclusions Young people in this study accepted the need for screening for traumatic histories, and expected to be asked about their traumatic experiences, despite the possibility of a short‐term increase in distress. The support offered by a trusted clinician, whom the young person had built a relationship with, appeared to be an important component to the willingness and the ability of the young person to complete the questionnaires. This reinforces the fact that screening for trauma in an early psychosis service can be conducted in a way that is safe and acceptable to young people.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 95%

Section: Practitioner Pointsmentioning

confidence: 99%

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“They may be confronting but they are good questions to be asking” young people's experiences of completing a trauma and PTSD screening tool in an early psychosis program

2022

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“…If distress, self-harm and suicidality occur, the TF-CBT model offers a structured approach to safety-related concerns. Although some young people have reported that trauma narration was difficult and confronting, they believed they could navigate through this challenging phase (Eastwood et al, 2021). Early engagement including a level of agency and choice via informed consent can reduce the likelihood of negative outcomes (Lorenz et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Subjective distress, self-harm, and suicidal ideation or behavior throughout trauma-focused cognitive-behavioral therapy in transitional age youth.

Peters¹,

Rice²,

Cohen³

et al. 2024

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: Elevations in distress, self-harm, and suicidal ideation or behavior are of significant concern in clinical practice. We examined these in a pilot trial of Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) for transitional age youth (aged 15-25 years) with histories of interpersonal trauma and symptoms of posttraumatic stress disorder. Method: Participants were 20 young people (13 females, M = 19.5 years) from a pilot study of TF-CBT. Frequencies of elevated distress, self-harm, and suicidal ideation or behavior were measured throughout treatment sessions and across the treatment phases of TF-CBT. Results: Across the 279 sessions of TF-CBT (m = 15.5 sessions), there were 16 incidents of elevated distress in seven participants (i.e., six in Phase I and five each in Phases II and III); 15 incidents of self-harming behavior in seven participants (five incidents in each of the three phases) and one incident of both elevated distress and suicide ideation (Phase I). Conclusion: Findings indicate that there may be a relationship between the experience of in session distress and self-harming behaviors. The importance of safety planning and coping skills (acquired in Phase 1) is stressed to ensure the effective implementation of TF-CBT. Clinical Impact StatementElevations in distress, self-harm, and suicidal ideation or behavior are of significant concern to clinicians treating young people exposed to interpersonal trauma (i.e., physical or sexual abuse, maltreatment or neglect) and symptoms of posttraumatic stress. Specifically, clinicians have raised concerns about the tolerability of exposure techniques. Nevertheless, results indicated they while a minority of participants experienced elevation in distress, self-harm, and suicidal ideation, these symptoms were resolved by the end of treatment.

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“…Another benefit of COPE-A is that young people do not have to tell their story and form a therapeutic relationship with a different therapist for the PTSD and SUD symptoms, an important consideration when qualitative reports from trauma-exposed young people show the importance of a trusted relationship with their therapist (Ellinghaus et al, 2021: Eastwood et al, 2020).…”

Section: Treatment Implications Of the Casementioning

confidence: 99%

Integrated Trauma-Focused Psychotherapy for Traumatic Stress and Substance Use: Two Adolescent Case Studies

Schollar‐Root

Cassar

Peach

et al. 2021

Clinical Case Studies

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Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) occur frequently as comorbid diagnoses among adolescents. Historically, these conditions have been treated using a sequential model; however, emerging evidence suggests that an integrated treatment model may be most effective. This article presents two de-identified clinical case studies from an ongoing randomised controlled trial examining the efficacy of an integrated, exposure-based, cognitive-behavioral psychotherapy (CBT) for PTSD and SUD among adolescents (COPE-A), relative to a supportive counselling control condition (person-centred therapy). In both case studies, participants were randomised to receive the COPE-A integrated treatment, which incorporates prolonged exposure (PE) including imaginal and in vivo exposure as a core treatment component alongside CBT for PTSD and SUD. The clinical profile and treatment response of each participant is discussed. Promising results were found in both cases, with substantially reduced traumatic stress symptoms and decreased or stable levels of substance use by the end of treatment. Clinical implications of these early findings are discussed.

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“Like a huge weight lifted off my shoulders”: Exploring young peoples’ experiences of treatment in a pilot trial of trauma-focused cognitive behavioral therapy

Cited by 13 publications

References 58 publications

“They may be confronting but they are good questions to be asking” young people's experiences of completing a trauma and PTSD screening tool in an early psychosis program

“They may be confronting but they are good questions to be asking” young people's experiences of completing a trauma and PTSD screening tool in an early psychosis program

Subjective distress, self-harm, and suicidal ideation or behavior throughout trauma-focused cognitive-behavioral therapy in transitional age youth.

Integrated Trauma-Focused Psychotherapy for Traumatic Stress and Substance Use: Two Adolescent Case Studies

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