Culturally modified Cognitive Processing Therapy for trauma survivors from a South-East Asian background

The aim of this research is to examine the effectiveness of a treatment program designed to reduce posttraumatic distress (PTSD) in those who have experienced trauma and are from a South- East Asian cultural background. Following a comprehensive clinical face-to-face assessment (1.5 hour), participants will receive twelve weekly 2 hour face-to-face group sessions of a treatment program called culturally modified Cognitive Processing Therapy (CPT-cm). CPT Session Outline Session 1: Symptoms of PTSD, explanation of symptoms (cognitive theory), description of therapy. Practice assignment: Write Impact Statement. Session 2: Patient reads Impact Statement. Therapist and patient discuss meaning of trauma. Begin to identify stuck points and add to Stuck Point Log. Review symptoms of PTSD and theory. Introduction of A-B-C Worksheets with explanation of relationship among thoughts, feelings, and behaviour. Practice assignment: Complete 1 A-B-C sheet each day including at least one on the worst trauma. Session 3: Review A-B-C practice assignment. Discuss stuck points with a focus on assimilation. Review the event with regard to any acceptance or blame issues. Begin Socratic questioning regarding stuck points. Practice assignment: Reassign A-B-C Worksheets. Session 4: Review A-B-C practice assignment and challenge assimilation with Socratic questions. Introduce Challenging Questions Worksheet to challenge specific assimilated beliefs regarding the trauma. Practice assignment: Challenge one stuck point per day using the Challenging Questions Worksheet (focus on assimilation/blame). Session 5: Review Challenging Questions Worksheets. Introduce Patterns of Problematic Thinking Worksheet. Practice assignment: Complete Patterns of Problematic Thinking Worksheet on a daily basis. Continue using Challenging Questions as needed. Make sure patient understands the importance of balance in beliefs rather than extreme, either/or thinking. Session 6: Review practice assignment. Determine patterns of problematic thinking. Introduce Challenging Beliefs Worksheet. Teach patient to use the new worksheet to challenge cognitions about the trauma(s). Practice assignment: Complete Challenging Beliefs Worksheets daily on the trauma, as well as, everyday events. Session 7: Review Challenging Beliefs Worksheets. Introduce Safety Module. Discuss how previous beliefs about safety might have been disrupted or seemingly confirmed by the index event. Use Challenging Beliefs Worksheet to challenge safety beliefs. Practice assignment: Read Safety Module and complete Challenging Beliefs Worksheets on safety. Session 8: Review Challenging Beliefs Worksheets and help patients to challenge problematic beliefs they were unable to complete successfully on their own. Introduce Trust Module. Pick out any stuck points on self-trust or other-trust. Practice assignment: Read Trust Module and complete Challenging Beliefs Worksheets on trust. Session 9: Review Challenging Beliefs Worksheets. Introduce Power/Control Module. Discuss how prior beliefs were affected by the trauma. Practice assignment: Read Power/Control Module and complete Challenging Beliefs Worksheets on power/control. Continue to challenge other stuck points on a daily basis using the Challenging Beliefs Worksheets. Session 10: Review Challenging Beliefs Worksheets. Introduce module on Esteem (self-esteem and regard for others). Practice assignment: Read module and complete Challenging Beliefs Worksheets on esteem, as well as assignments regarding giving and receiving compliments and doing nice things for self. Continue to challenge other stuck points on a daily basis using the Challenging Beliefs Worksheets. Session 11: Review Challenging Beliefs Worksheets. Discuss reactions to two behavioural assignments. Introduce final module on Intimacy. Practice assignment: Continue giving and receiving compliments, read Intimacy Module, and complete Challenging Beliefs Worksheets on stuck points regarding intimacy. Final assignment: Write final Impact Statement. Continue to challenge other stuck points on a daily basis using the Challenging Beliefs Worksheets. Session 12: Go over all the Challenging Beliefs Worksheets. Have patient read the final Impact Statement. Read the first Impact Statement and compare the differences. Discuss any intimacy stuck points. Review the entire therapy and identify any remaining issues the patient may need to continue to work on. Encourage the patient to continue with behavioural assignments on compliments and doing nice things for self. Remind patient that she is taking over as therapist now and should continue to use skills he has learned. Modified CPT-C Cognitive Therapy that targets cultural differences in self and trauma-related appraisals, with focus on: *Communion and belonging *Connectedness – fear of alienation/isolation *Social obligations- duty towards one’s group *Adjustment to event *Norm-self compatibility *Appraisals that will be modified- appraisals derived from the interdependent aspect of self – challenging appraisals associated with the public aspects of self (I am a failure as a mother) and communal self-appraisals (such as isolation from the group and a sense of social failing) *Re-framing and reducing the level of autonomous orientation and increasing levels of relatedness *The impact of trauma on identity and self-definition- consideration of social roles, the impact of trauma on such social roles and the value of role complexity and diversity *Self-consistency not as important - distress focused on social role changes (not changes to private aspects of self) *Cultural variation in self may impact transformation of meaning –need to consider what the trauma has meant for individual’s family and other significant groups and communities to which they belong and to the relational aspects of self Modifications are based on cross cultural research that highlights differences in self and appraisals evident in individualistic versus collectivistic cultures. Following the 12th treatment session, participants will be asked to complete a brief assessment session. We will also contact participants 3 months following treatment to again complete a brief assessment. This will be conducted by phone. The treatment will be conducted by a provisional psychologist and 3rd year doctoral student, who has been trained in CPT. Supervision will be provided 3 senior clinical psychologists; Dr Laura Jobson trauma and culture specialist, Dr James Courtney CPT specialist and Professor Peter Norton anxiety disorders specialist. Treatment adherence will be monitored. An interpreter will be present for all assessment and treatment sessions.