Incidence of posttraumatic stress disorder (PTSD) varies across population, countries and trauma types, with rough estimates suggesting about 3.5% of the population experience PTSD at some point in their lifetime.
PTSD involves four clusters of symptoms being 1) re-experiencing symptoms (intrusive thoughts); 2) hyperarousal (irritable/startled response); 3) avoidance of reminders of the event; and 4) numbing/negative moods cognition.
The most common events leading to PTSD are sexual violence, childhood abuse, military combat and deployment, motor vehicle accidents, exposure to violence, mass shooting/knifing and natural disaster. I have seen PTSD in teachers, aged care and DCP workers, prison and police officers, lifesavers, park rangers and defense personnel.
Group-based intervention can offer effective ways to reduce PTSD symptoms. It can be more cost and time effective than individual treatment as multiple people can be treated at once by one or more facilitators who lead the sessions.
Group-based psychological treatment for PTSD can offer benefit for wellbeing through sense of belonging and social support. The provision of social support is particularly important for people who have experienced trauma as often the experience of trauma leads to social withdrawal and identity loss.
Social isolation in turn can affect severity of PTSD symptoms as a lack of social support can impair a person’s ability to regulate distress leading to poor clinical outcome.
Group-based treatment can put people in contact with others “like them”. Identification with others can help mitigate the effects of trauma and reduce PTSD symptoms. It is preferable to begin treatment for PTSD as soon as possible after the diagnosis is made by a psychiatrist.
The goals of treatment include maintaining safety of the patient and others, reduce distressing symptoms, reduce avoidant behaviours, diminish anxiety, improve adaptive and psychosocial functioning, and lessen the risk of relapse. SSRIs are an appropriate alternative to psychotherapy and are preferred in patients with comorbid depression or other anxiety disorder, particularly if their symptoms interfere with psychotherapy.
Specific populations which require careful consideration of treatment include substance use disorders, personality disorders and moderate-to-severe traumatic brain injury.
For individuals with PTSD who experience significant sleep disturbance, typically nightmares, an option will be Prazosin. This can be used as an augmenting agent with serotonin reuptake inhibitors or in some cases as monotherapy or combined with trauma-focused therapy.
For individuals with PTSD who have prominent psychotic symptoms, treatment with a combination SSRI and second-generation antipsychotic (SGA) medication.
Medications that are effective for PTSD are continued for at least six months to one year in order prevent relapse or recurrence.
Group therapy in Perth
In 2021, the community-based WA Centre for Trauma Treatment and Research was established launching a series of programs.
An intensive four-week Trauma Recovery and Growth Program tailored for first responders and uniformed personnel showed significant improvements across all measures compared to existing programs. This was extended to WA Police (WAPOL), Department of Fire and Emergency Services (DFES), DVA Veterans, and Insurance Commission of WA Approved Claims (ICWA).
Building on this, gaps were identified in treatment options for workers’ compensation, third-party insurance, the mining industry, and government workers. These individuals often found conventional treatments ineffective and sought alternative solutions.
The four-week group therapy course offered 100 hours of therapy, focusing not only on trauma recovery but also on personal growth. Participants gained insights into the psychological and physiological effects of trauma, often overlooked or misunderstood.
A holistic approach was adopted, encompassing psychiatric and psychological assessments, as well as advice from an exercise physiologist and a nutritionist. Participants were prescribed appropriate medications before beginning therapy to optimise their outcomes.
The program structure included:
- 20 days of group work from 9am to 3pm, Monday to Friday, supervised by a consulting psychiatrist, along with four individual trauma-focused therapy sessions
- A five-hour relapse prevention session held four weeks after program completion
- Follow-up assessments at one month and three months post-completion, along with two three-hour support sessions for partners and significant others
- Comprehensive intake assessments and discharge reports by clinical lead
- All necessary materials, including catering, stationary, workbooks and manuals.
Since inception, 25 program cycles, each with four or five participants have been concluded with positive feedback from both participants and referring organisations. The camaraderie developed during sessions and the trust in therapists have led to sustained benefits for participants.
The centre also emphasises its research component, focusing on report writing and statistical analysis. Positive effects were observed three months post-program, and participants often maintained connections due to the shared journey they experienced.
Key messages
- PTSD can affect a wide variety of people
- Group therapy can produce positive outcomes
- Local research is ongoing.
– References available on request
Author competing interests – the author is clinical lead and company director for WA Centre for Trauma Treatment and Research