Evaluating the efficacy of additional self-compassion or cognitive therapy for treatment of post-traumatic stress disorder (PTSD) and depressive disorders

The intervention is a combined therapy protocol (self-compassion with behavioural therapies). Self-compassion: Comprise techniques that, through regular monitored practice, are designed to improve self-compassion by inter-connecting the three main affect regulation systems (i.e., contentment-soothing, threat, and drive). Behaviour therapies: will comprise either exposure therapy (which can be carried out in real situations (in-vivo), or through imagination, for PTSD) or behavioural activation (based on encouraging the client to engage in routine jobs, pleasurable, and important/necessary activities, for depression). Description of the 12 sessions of the Experimental (Novel) Treatment for PTSD and Depressive Disorders: Step 1: Screening & Planning for Sessions 1 & 2 for both PTSD and Depressive Disorders: *Baseline measures: To be scored by client in waiting room prior to screening. *Information sheet & Consent form: To be explained by therapist, to be read by client & if agreed to be signed by client prior to screening assessment. *Initial screening at session1: Completion of the semi structure assessment tools; Discussing, planning & management risk/safety; *Explaining the rationale for Novel Treatment for PTSD & Depressive Disorders include: To discuss the rationales for PTSD: Exposure-Based Therapies (EBTs) & Self-Compassion (SC) based interventions; To discuss the rationales for depressive disorders: Behavioural Activation (BA) & Self-Compassion (SC) based interventions *Psychosocial history at session 2: Establishing problem and treatment goals; Therapy contract/sessions; Discussion hierarchy of anxiety & homework (from 30 to 60 mins and to practice the task for more than 3 days per week) Step 2: Experimental Treatment from Sessions 3 to 11 for PTSD and Depressive Disorders: *Securing the therapeutic relationship from session 3 to 11: Safety, engagement, & signposting to psychosocial supports. *Psychoeducation from session 3 to 4: PTSD symptoms, processes, it relation to developmental stages & other traumas; Depression symptoms, processes, it relation to developmental stages & other stressors *Collaborating on treatment sequencing from session 3 to 11: Each session is co-operative; the client is expected to be active & to try to generate solutions. *Structure Agenda from session 3 to 11: To review the homework; To assess progress towards client’s goals; To discuss feedback on the previous session; To focus on one or two specific related issues; To plan new homework; To checking their safety; & To organize the next session. *Behavioural therapies (BTs) for PTSD and Depression: EBTs from session 3 to 11for PTSD with graded in-vivo exposure to trauma in relation to interceptive cues and avoidances behaviours; & graded imaginal exposure to trauma memory (i.e., written, verbal and/or recording). BA from session 3 to 11 for Depression: Describe and plan activity scheduling (AS) with client; To structure client’s day according to activities (i.e., routine, necessary & pleasurable) that are avoided; Clients are encouraged to start AS with short-term goals; & Clients learn to treat their AS, as a series of appointments with themselves. *Self-Compassion (SC) based therapies from session 3 to 11 for PTSD: Threat/safety strategies; Formulation in Compassion Focused Therapy (CFT); Fear-based hotspots; Initial re-living identification based on shame & disgust; Building a compassionate image; Compassionate mind training; Critical voice & SC thought record sheet (therapist & client guides); Practice of meditation by Paul Gilbert and/or Kristina Neff from Mindful Self-Compassion (MSC); Developing inner qualities of inner compassion; Compassionate letter writing. SC based interventions from session 3 to 11 for Depression: Formulation in Compassion Focused Therapy (CFT); Building a compassionate image; Compassionate mind training; Critical voice & SC thought record sheets; Practice of meditation by Paul Gilbert and /or Kristina Neff from Mindful Self-Compassion (MSC); Developing inner qualities of inner compassion; Healthy emotion regulation strategies; Compassionate letter writing to self (therapist & client guides); Exercises to increase SC. *Relapse prevention strategies from session 10 to 11 for PTSD and Depression. Step 3: End of active treatment/ Discharge at session 12 for PTSD & Depressive Disorders: *Review progress; Scoring the initial problem and goals; Summary & maintaining changes & gains from therapy; Blueprint & re-capping relapse prevention strategies; Follow-up sessions. *Outcome Measures: To be scored by client at the end of the session 12. As part of the protocol CARD for both Novel and Standard treatments: Clients diagnosed with PTSD work in collaboration with their therapist to establish their graded exposure tasks ( for 30 to 60 mins per day for more than 3 days) for in-vivo and imaginal. As part of the agreement between the therapist and the client, each graded exposure tasks (based on low to high anxiety provoking) will be practiced by client each week and client will report the outcome of their tasks at their next session. A set of standard self-report measures will be completed at both assessment and discharge. Also Problem and Goals statement established by client will be scored from 0 to 8 at these time points. Hand out materials used are obtained from the clinical unit (CARD) and/or other clinical websites such as: www.cci.health.wa.gov.au/resources/consumers.cfm https://cedar.exeter.ac.uk/ https://crufad.org/for clinicians/trauma/https://crufad.org/ Two senior therapists at CARD/SALHN and they have the extensive expertise in both BTs (15 to 20 years) and the SC (10 years) Treatment is face to face and individual Treatment comprises 12 sessions for a duration of 3 months that includes: 2 hours for initial assessment, 1 hour for treatment sessions and 2 hours for discharged session. Treatment is conducted through an outpatient specialist service (CARD) which is part of SA local health network (SALHN) Each therapist has completed the Master in CBT programs as part of Flinders University The two therapists are also from AHP3 and RN3 disciplines The two therapists have finished their training in Compassion focused therapy, Mindful self-compassion and other relevant training in areas of Mindfulness (MBCT)