Trauma-Focused Cognitive Behavioural Therapy (CBT) and Exercise for Chronic Whiplash

Participants randomised to the intervention arm of this study will participate in 10 weeks of trauma-focused cognitive behaviour therapy (CBT) followed by a 6 week physiotherapy exercise program. CBT: A psychological intervention that targets PTSD symptoms will be delivered first. Treatment will consist of 10 weekly 60-90 minute sessions of individually delivered trauma-focused CBT based on the Australian Guidelines for the treatment of Adults with Acute Stress Disorder and PTSD. Session one will focus on providing psychoeducation regarding the common symptoms of PTSD, maintaining factors and providing a rationale for various treatment components. Sessions two and three will continue to develop patient’s knowledge of PTSD symptoms and teach anxiety management strategies including deep breathing and progressive muscle relaxation. Cognitive restructuring which involves challenging unhelpful and irrational thoughts and beliefs will commence in session three and continue throughout treatment. Sessions four to ten will focus on exposure therapy including imaginal exposure and graded in-vivo exposure. Relapse prevention will also be included in the final session. Specific treatment protocol have been adapted from a detailed manual of individual trauma-focused CBT (see Bryant & Harvey, 2000 for further details) and a checklist for each session will be used to ensure the consistency and integrity of the intervention. Treatment will only be delivered by registered psychologists with postgraduate clinical training and experience delivering trauma-focused CBT interventions Exercise: The 6-week exercise program will be carried out under supervision from the physiotherapist (2 sessions in the first and second weeks; 2 sessions in the third and fourth weeks; and 1 session in the fifth and sixth weeks) and will comprise specific exercises to improve the movement and control of the neck and shoulder girdles as well as proprioceptive and co-ordination exercises. The exercises will be tailored by the physiotherapist for each individual participant. Participants will also perform the exercises at home, once /day. The sessions with the physiotherapist will be up to 45 minutes in duration and the home exercises up to 20 minutes. A log book will be completed by participants to record compliance with the exercises. At the same time, the physiotherapist will guide the subject’s return to normal activities. Prof Michele Sterling (the chief investigator) will audit the physiotherapy sessions twice during the intervention to check for adherence. Principles of cognitive-behavioural therapy will be used by the physiotherapists in their training and supervisory roles for all exercises. The cognitive behavioural therapy principles include the encouragement of skill acquisition by modelling, setting progressive goals, self-monitoring of progress, and positive reinforcement of progress. Self-reliance will be fostered by encouraging subjects to engage in problem-solving to deal with difficulties rather than seeking reassurance and advice, by encouraging relevant and realistic activity goals, and by encouraging self-reinforcement. Daily physical activity at home will be encouraged and monitored using a diary. Written and illustrated exercise instructions will be provided.