Intervention research at ACPMH includes evaluation of existing treatment programs, expert consensus studies, and high quality, real world trials of a range of approaches to the prevention and treatment of posttraumatic mental health problems.
- Universal interventions are those administered in the early aftermath of a traumatic event, and focus on enhancing trauma survivors' natural resilience.
- Indicated interventions are designed to treat established mental health disorders such as PTSD, depression, or substance use, and can only be provided by trained mental health professionals.
Psychological First Aid (PFA)
PFA is an evidence informed approach which is intended to be used in the immediate aftermath of a traumatic event, and involves the provision of basic assistance such as information, emotional support, and instrumental support. ACPMH is developing a series of research trials that aim to test the efficacy of PFA.
Skills for Psychological Recovery training
Skills for Psychological Recovery (SPR) is an evidence-informed program developed by leading experts in the aftermath of Hurricane Katrina in the US. Survivors learn simple and effective coping strategies such as problem solving, managing reactions, building social connections, and promoting helpful thinking. The SPR program was adapted for the Australian context with the assistance of leading national experts, and was first implemented during the Victorian bushfires. Following the rollout of SPR in the wake of the 2011 Queensland floods, the SPR program was formally evaluated for the first time. ACPMH is developing a series of trials that aim to test the efficacy of SPR.
Despite their increasing popularity and implementation across a range of high risk services, there is currently no evidence base for the effectiveness of peer support programs. ACPMH therefore conducted a Delphi study to achieve an international consensus of expert opinion on a range of issues in peer support. Delphi methodology recognises the value of expert opinions, experience and intuition, when full scientific knowledge is lacking. Eight key domains of recommendations emerged from the project findings, centering on the consensus view that all high risk industries should have a well planned, integrated and tailored peer support program for employees. Each context, however, is different, and the project recommendations should be interpreted as appropriate to the specific needs of each organisation. Properly designed and controlled research trials are now crucial to inform our understanding of the effectiveness of peer support models.
Effectiveness of Cognitive Processing Therapy (CPT) for treating PTSD
CPT is a trauma-focussed treatment that is recommended in the Australian and international guidelines for the treatment of PTSD. However, despite evidence of its effectiveness in specialist settings, there is still a need for highly controlled studies demonstrating its effectiveness when delivered in "real world" settings. In collaboration with the Veterans and Veterans Families Counselling Service (VVCS), ACPMH completed a multi-site treatment trial in which veterans seeking treatment for PTSD were randomly assigned to receive either CPT or usual care. Results indicate that CPT is an effective treatment for Australian veterans with PTSD attending community services, and provide evidence that CPT can be implemented in routine clinical settings.
Promoting recovery/ stepped early psychological intervention
While it can be helpful to get early assistance for emotional problems that occur after a trauma can be helpful, the best approach for implementing early intervention for psychopathology after a traumatic event has not been established. The stepped model offers a 'watchful waiting' approach that recognises peoples' capacity to naturally recover from traumatic events, while offering monitoring to those who continue to experience problems and increasingly intensive treatments where the need for such interventions is determined. In this research, we screened injury patients during hospitalisation, and four weeks later followed up those patients identified as having a high risk for developing psychological problems. Those with elevated symptoms were randomly assigned to receive cognitive behavioural therapy or usual care. This ongoing research will identify whether a stepped care model can effectively identify and treat injury patients with high psychiatric symptoms.
Telephone Administered Psychological Intervention Study (TAPIS)
Therapy can be an unsuitable treatment option for many patients who are unable to attend an inner city clinic for reasons such as geographical distance or difficulty travelling due to their injuries. Therefore, this early intervention study offers psychological therapy over the telephone to injury patients identified as having high symptoms of anxiety and/or depression, with the dual aims of improving therapy take-up and identifying the effectiveness of telephone administered psychotherapy. This research offers an opportunity to reduce the barriers to care for injury patients who would not ordinarily access psychological help.
Imagery rescripting trial
Posttraumatic nightmares (PTNMs) are a hallmark of PTSD and are distinct from general nightmares in that they are often repetitive and faithful representations of the traumatic event. PTNMs can recur for decades with little or no change, and cause significant distress for sufferers. This pilot study examined the use of imagery rehearsal in treating combat-related nightmares in Vietnam veterans diagnosed with PTSD. Preliminary data indicate significant reductions in targeted nightmares, as well as improvements in PTSD and comorbid symptomatology. We are in the process of planning a randomised controlled trial with added measures of suggestibility, imagery ability and cognitive set towards nightmares. We hope this work will further our understanding about who would most benefit from this intervention.