The Richards Trauma Process: a before-after single-arm feasibility trial of a novel psychotherapy

The Richards Trauma Process (TRTP) is a novel, very brief transdiagnostic psychotherapy that uses innovative methods to work with parts of the self to reprocess traumatic memories without using exposure techniques. Our objectives were to explore the feasibility of studying this therapy in a community setting, to document the safety and acceptability of TRTP, and to gather preliminary indications of outcomes in adults presenting with elevated levels of psychological distress. This was a before-after single-arm trial of TRTP in consecutive new adult clients presenting to a psychotherapist in Australia. Inclusion criteria were at least mildly elevated levels of depression, anxiety, stress or trauma symptoms; no previous diagnosis of psychosis, Bipolar Disorder or Personality Disorder; and ability to maintain sobriety during the therapy. Feasibility was assessed against 15 criteria relating to 5 broad objectives, evaluating: (1) recruitment and retention capability, (2) data collection procedures, (3) resourcing, (4) acceptability and safety of TRTP, and (5) change in scores. Regarding objective 5, we estimated the mean change in scores on the Depression, Anxiety and Stress Scales (DASS21) and PTSD Checklist for DSM-5 (PCL-5) between follow-up and baseline; and to check for harms (objective 4) we used descriptive statistics to look for clinically meaningful deterioration in individual scores or participants. Of 40 new clients, 23 (58%; 95% Confidence Interval (CI) 41% to 73%) were eligible, consented to the study and commenced TRTP. Of these, 20 (87%; 95% CI 65% to 97%) completed TRTP (averaging six hours of therapy) and follow-up 1-month post-therapy. Eleven of 15 feasibility criteria were met. Unmet criteria could be addressed in a future efficacy trial by modifications to study procedures. All mean scores changed in the desired direction, with no individual scores or participants demonstrating clinically meaningful deterioration. This is the first study that supports the feasibility of a larger trial of TRTP in a community setting. We demonstrated that recruitment and retention of participants, and data collection, were feasible, and that the intervention was acceptable, safe, and worthy of further study. Learnings for a future trial were identified. Retrospectively registered with The Australian and New Zealand Clinical Trials Registry (ACTRN12625001423404).