How important are Phase 1 interventions for complex interpersonal trauma? A pilot randomized control trial of a group psychoeducational intervention

Abstract

Although psychoeducational interventions are recommended as Phase 1 interventions for complex trauma, there is limited evidence on their efficacy. This pilot randomized control trial (RCT) investigated the efficacy of a pure psychoeducational intervention for complex trauma. A brief 10‐session intervention was delivered to n = 44 female prisoners in a compressed format to accommodate short sentence lengths and was compared with usual care (n = 42). Results from an intent‐to‐treat (ITT) analysis indicated that there were no statistically significant differences between the two arms across the three assessment time points (including 1‐month postintervention) for the main outcomes (Behavioural Assessment Checklist‐Revised, β = 4.60, 95% CI [−1.60, 10.88], p = .148; posttraumatic stress disorder [PTSD] Checklist, β = −1.47, 95% CI [−4.30, 1.36], p = .303). Post hoc reliable change analyses suggested twice the number of adequate dose participants made progress in addressing PTSD symptoms compared with usual care (30.3% vs. 17.6%, OR 2.03, 95% CI [.64, 6.43]). Although further work in this area is required, initial results, overall, suggest that psychoeducational group‐based treatment modalities achieve only small effect sizes in comparison with usual care.

The Effectiveness of Trauma-Focused Interventions in Prison Settings: A Systematic Review and Meta-Analysis

“…We identified a total of sixteen studies (Ahrens & Rexford, 2002; Barrett et al, 2015; Bradley & Follingstad, 2003; Cole et al, 2007; Ford et al, 2013; Greenbaum & Javdani, 2017; Lynch et al, 2012; Mahoney et al, 2020; Messina et al, 2010; Richards et al, 2000; Swopes et al, 2017; Tripodi et al, 2019; Valentine & Smith, 2001; Wolff et al, 2015; Zlotnick et al, 2009), which reported on a combined sample of 1,184 participants (intervention group = 601, control group = 583; 690 female, 494 male). Fourteen studies examined adult prisoner populations, and two (Ahrens & Rexford, 2002; Greenbaum & Javdani, 2017) used juvenile samples, with a mean age ranging from 15 to 43 years (see Table 1 for key features and methodology of studies).…”

“…No studies utilized Eye Movement Desensitization and Reprocessing (EMDR) or other NICE-recommended interventions (e.g., narrative exposure therapy, cognitive therapy). Facilitators of the interventions were either at graduate ( n = 4), master’s ( n = 5), or doctorate level ( n = 3); this information was omitted in three studies (Lynch et al, 2012; Mahoney et al, 2020; Messina et al, 2010).…”

“…A further limitation is that we were unable to investigate the effectiveness of current trauma-focused interventions on reducing additional symptoms consistent with a Complex PTSD (CPTSD) diagnosis. Given that CPTSD was only recently recognized as a distinct disorder in the ICD-11 (World Health Organization, 2018), investigations of this disorder within prison settings have been limited (Facer-Irwin et al, 2019), and only two studies included in our analysis measured symptoms associated with CPTSD (Cole et al, 2007; Mahoney et al, 2020). The first known study of ICD-11 PTSD and CPTSD in a prison population found that, compared to PTSD, CPTSD was more prevalent, and associated with cumulative, developmental traumas and increased psychiatric comorbidity (Facer-Irwin et al, 2021).…”