Group-based Stabilization and Skill Training for Patients With Lasting Posttraumatic Reactions in Mental Health Care

Study Overview
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Brief Summary
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This study evaluates the addition of a group based stabilization and skill-training intervention to individual out-patient treatment for long lasting post-traumatic reactions. Half of the participants will receive the combined treatment while the other half will receive individual treatment as usual.

Detailed Description
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Many patients in mental health care have previously experienced life-stressors and traumatic events that are related to the problems they seek treatment for. Although the diagnostic labels vary, the clinical picture often demonstrates long lasting complex psychological and somatic post-traumatic symptoms such as avoidance, bodily activation, difficulties in regulating emotions and in relationships with others, impaired quality of life and reduced level of function. Patients often receive long-term individual therapy in general mental health care, occasionally without clinically significant improvement. Still, they continue treatment due to high symptom pressure and low level of functioning. The study targets a novel intervention which tests the effect of adding a group based stabilization and skill training intervention to conventional individual treatment among 160 patients already receiving treatment in a community mental health hospital. Change in variables covering mental health issues, functional impairment, well-being, use of hospital services and drug prescriptions will be examined, as well as markers of inflammation found in sera before and after intervention. The purpose is to develop better and more effective treatment options for a large number of patients who receive mental health care in community mental health hospitals.

Official Title
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Adding a Group Based Stabilization and Skill Training Intervention for Patients With Long Lasting Posttraumatic Reactions Receiving Outpatient Treatment in Specialized Mental Health Care - A Randomized Controlled Trial

Conditions
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Stress Disorders, Post-Traumatic, Mental Disorders, Trauma and Stressor Related Disorders

Intervention / Treatment
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* Behavioral: Group-based stabilization and skill training in addition to individual treatment
* Other: Treatment as usual


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Receiving treatment in ordinary out-patient clinics Having been exposed to or witnessing to traumatic event(s) defined as one or several extremely threatening or horrific events or series of events or situations being of such a character which is likely to overwhelming distress in almost anyone in a similar situation, measured by Stressful Life Events Screening Questionnaire Presenting with posttraumatic reactions such as hyperarousal, avoidance, intrusions, emotional dysregulation or interpersonal difficulties. Symptom duration for a minimum of six months. Understand and speak Norwegian to an extent that is required to participate in a stabilization- and skill-training group. Exclusion Criteria: Active psychotic symptoms. Substance or drug addiction or abuse. High suicidal risk considered by the individual therapist. Having participated in the course previously.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>Group-based stabilization and skill-training combined with individual treatment. | Behavioral: Group-based stabilization and skill training in addition to individual treatment<br>* Group-based stabilization and skill training, weekly 2-hour sessions during 20 weeks. Based on the manual Tilbake til Nåtid (Back to here and now) (Holbæk, 2014) developed by clinicians in the highly specialized national trauma clinic 'Modum Bad's Trauma Clinic'.<br>|
| Active Comparator: controls<br>Individual treatment as usual only. | Other: Treatment as usual<br>* Treatment as usual: conventional individual treatment (outpatient). Not standardized.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Questionnaire about Process of Recovery' (QPR) Change from baseline | Experienced personal recovery is measured by self-report; 'Questionnaire about Process of Recovery' (QPR) | 4 weeks after intervention group has completed group treatment | 
| Questionnaire about Process of Recovery' (QPR) Change from baseline | Experienced personal recovery is measured by self-report; 'Questionnaire about Process of Recovery' (QPR) | 6 months after intervention group has completed group treatment | 
| Questionnaire about Process of Recovery' (QPR) Change from baseline | Experienced personal recovery is measured by self-report; 'Questionnaire about Process of Recovery' (QPR) | 12 months after intervention group has completed group treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Work and Social Adjustment Scale (WSAS) change from baseline | Functional impairment associated with mental Health measured by self-report | 4 weeks, 6 months and 12 months after intervention group has completed group treatment | 
| The International Trauma Questionnaire (ITQ) change from baseline | Self-report to capture elements of post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) | 4 weeks, 6 months and 12 months after intervention group has completed group treatment | 
| The Clinical Outcome in Routine Evaluation (CORE-10) change from baseline | Sel-report measure of psychological distress, capturing general mental health issues. | 4 weeks, 6 months and 12 months after intervention group has completed group treatment | 
| WHO Five Well-Being Index (WHO-5) change from baseline | Questionnaire assessing subjective psychological well-being and also a measure of depression. | 4 weeks, 6 months and 12 months after intervention group has completed group treatment | 
| Posttraumatic Cognition Inventory (PTCI-9) change from baseline | Self-report measure of negative and dysfunctional posttraumatic cognitions | 4 weeks, 6 months and 12 months after intervention group has completed group treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Psychotherapy