Treatment as Usual psychological therapy for Complex Post Traumatic Stress Disorder in National Health Services in Scotland

Objectives: Complex Post Traumatic Stress Disorder (CPTSD) is a relatively new diagnostic category, and clinical practice has adapted ahead of the evidence base. It is prudent that we gather information about current ‘treatment as usual’. This study aims to describe the current clinical landscape of psychological therapies offered for CPTSD in NHS services in Scotland. Methods: An online survey was distributed via heads of service managers to clinician’s working with adults in psychological therapies services. The survey posed questions about psychological therapy models, and professional experience, and, for the clinician’s latest 3 discharged cases, the length of therapy and perceived patient outcomes. Results: Forty-nine clinicians, most of whom were clinical psychologists, took part and provided data for 139 clinical cases. Twenty-three different therapeutic models were cited by clinicians, with phased based approaches described by 64% of clinicians. Most clinicians (89%) offer trauma memory reprocessing, and two thirds offer phased based approaches. The modal number of sessions was 21-30. Most cases were described by clinicians as completed, with 28% ending before therapy was completed, and a further 7% dropped out. Of those reported to have completed therapy, 86% were judged to have improved after therapy, with 11% judged to have deteriorated.Conclusions: There is wide variety in psychological therapies offered as treatment as usual for CPTSD, with most offering elements of trauma memory reprocessing and stabilisation skills. Innovative interventions and clinical trial data is required to support future clinical decision making regarding optimal therapeutic models, therapy components and therapy length.