Reintegration interventions for CPTSD: a systematic review

Abstract

Background: Clinical guidelines recommend a phase-based approach to treatment for complex post-traumatic stress disorder (CPTSD), yet little is known about what interventions are being offered and which may be effective in the final 'reintegration' phase. Objective: To systematically review literature on reintegration interventions for CPTSD, describing the nature and effectiveness of interventions. Method: We searched four electronic databases (Medline, PsycINFO, Embase, and PTSDpubs) for interventions aiming to facilitate reintegration for participants with probable CPTSD. We had two aims: firstly, to describe the interventions and secondly, to describe their effectiveness as measured through measures of reintegration, PTSD and/or disturbances in self-organization (DSO), or qualitative data describing changes experienced. Results are presented using narrative synthesis. Results: Fifteen studies met our inclusion criteria. Interventions included yoga, exercise, use of service dogs, residential treatment, education, self-defence and patient research involvement. Overall study quality was low, as assessed by critical appraisal tools. Of the six studies including a control group, two reported a statistically significant improvement in the measure of reintegration between the intervention and control group, four studies reported a statistically significant difference in the measure of PTSD symptoms, but none reported any significant differences between intervention and control groups in DSO. Of all eight quantitative studies, three reported a statistically significant difference in the reintegration measure pre-to post-intervention for the intervention group, five a statistically significant improvement in the measure of PTSD symptoms, and three a significant difference in the DSO measure. From eight studies reporting qualitative date we synthesized themes into eight categories, within which facilitation of connection with others was the most commonly reported benefit. Conclusions: The interventions outlined may facilitate reintegration, however, research in this area is still in its infancy and quality research is lacking. Further research is needed to establish whether reintegration interventions enhance treatment for CPTSD. Intervenciones de reintegración para TEPTC: una revisión sistemáticaAntecedentes: Las guías clínicas recomiendan un enfoque basado en fases para el tratamiento del trastorno de estrés postraumático complejo (TEPTC), aunque se sabe poco acerca de las intervenciones que se ofrecen y cuáles pueden ser efectivas en la fase final de 'reintegración'. Objetivo: Revisar la literatura en forma sistemática acerca de intervenciones de reintegración para el TEPTC, describiendo la naturaleza y efectividad de las intervenciones. Método: Para las intervenciones cuyo objetivo era facilitar la reintegración de los participantes con probable TEPTC, buscamos en cuatro bases de datos electrónicas (Medline, PsycINFO, Embase, y PTSDpubs). Teníamos dos objetivos: en primer lugar, describir las intervenciones y, en s...

The memory and identity theory of ICD-11 complex posttraumatic stress disorder.

“…Herman (1992) recommended that individuals be helped to care for themselves by relinquishing the parts of the self that were developed in the context of trauma and to care for their relationships to increase their sense of power and control. The importance of strengthening a positive identity and increasing self-esteem has been noted (Purnell et al, 2021). Within the M&I theory, this phase can readily be seen in terms of increasing the retrieval strength of positive identities relative to negative identities and by the provision of additional strategies to regulate negative emotions and improve relational difficulties.…”

Expert international trauma clinicians’ views on the definition, composition and delivery of reintegration interventions for complex PTSD

“…Contradicting most current suggestions for reintegration interventions found in the literature, consistent suggestions among experts related to occupation, functioning and social integration interventions. According to the recent systematic review by Purnell et al ( 2021 ) which examined existing published research on reintegration interventions, the only previously researched interventions consisted of physical activity, including yoga, use of service dogs, residential treatment, education, self-defence, and patient involvement in research. The gap between what has been evaluated in research so far and what expert clinicians have suggested to use may go some way to explaining the inconsistent effectiveness of reintegration interventions.…”

“…There is currently no existing literature regarding the evaluation of reintegration interventions, demonstrating the need to examine this question more thoroughly. As Purnell et al ( 2021 ) have previously suggested, a measure for reintegration interventions could prove useful in comparing their effectiveness, it could also be beneficial in the evaluation of reintegration. All the expert clinicians expressed the value of reintegration in their practice along with need for more research on this topic.…”

“…Alongside inconsistency with the definition for the reintegration phase, there is also a lack of evidence about the composition of reintegration interventions. A recent systematic review of the effectiveness of reintegration interventions for CPTSD emphasised a striking absence of research, with most studies either completely overlooking the third phase or suggesting only weak evidence for its effectiveness (Purnell et al, 2021 ). As pointed out by Purnell et al there is so far no existing evidence that systematically evaluates reintegration interventions, which is likely due to the previously mentioned issues with the reintegration phase being ill-defined and inconsistently conceptualised.…”

“…Therefore, to address the inconsistency in definition and the lack of consensus for the composition and key principles of reintegration, this study draws on the findings from the systematic review by Purnell et al ( 2021 ), aiming to define and determine the key principles of ‘reintegration’ and specify the components and method of delivery of treatment. Whilst the official diagnosis of CPTSD is relatively new and research on it still in its infancy, experienced clinicians have nevertheless long been treating people presenting with this constellation of difficulties and have long been providing ‘reintegration’ focused interventions based on Herman’s ( 1992 ) model, even in the absence of established consensus and evidence.…”