Effective trauma treatment available in NZ

Survivors of abuse and violence may soon have an effective new therapy for post-traumatic stress disorder (PTSD) available in Aotearoa New Zealand, thanks to research led by Waipapa Taumata Rau, University of Auckland.

Written exposure therapy has already proven effective in high-quality international research.

“Evidence is positive from randomised trials – whether it’s war trauma, motor vehicle trauma, sexual trauma or violence, all the big ones., the ones that really mess people up,” says lead researcher Professor Bruce Arroll, a part-time GP at the Auckland City Mission.

Written exposure therapy is designed to be delivered by non-psychologists and offers patients an effective treatment outside of specialist services.

Currently, people may have to wait a long time for a specialist appointment and therapy can require a long course of sometimes costly treatment.

Written exposure therapy is a brief intervention that involves five half-hour sessions of writing about a traumatic experience and its impact, with a trained therapist providing feedback and keeping participants on track.

The therapy works by reducing avoidance, which is one of the key mechanisms that keeps PTSD going, says Arroll.

“The way I explain it to people is ‘Think about the thing you least want to write about and that's what you have to write about, if you want to get rid of the PTSD.’

“People with PTSD are trying to avoid the memory, which makes complete sense – but until you stop avoiding it, it will keep haunting you.”

Arroll is now leading a trial at the Auckland City Mission to test whether written exposure therapy is most effective when delivered once or twice a week.

The goal is a two-arm trial with two groups of 14 patients randomised to either schedule.

So far, around 15 people have formally participated in the research project, with more than 20 others accessing the therapy.

Standard questionnaire-based evaluations have shown significant improvements in participants’ PTSD symptoms.

Participant feedback has also been strongly positive. Comments include: “For the first time, I believe in myself and trust myself and like myself. It's amazing… took 60 years.”

Another participant described changes in their relationship with alcohol: “I can't change anything in the past… I've just got to learn to find better techniques to process it, because it hasn't really been processed, it's only been drowned.”

Patients trust the City Mission as a place where they feel safe, says Eunice Tao, a fourth-year medical student who focused on the research during her honours year.

Tao says that, while reading about participants’ traumatic experiences could be confronting, it was protective to know the intervention was helping people heal, and that Arroll’s supervision was available throughout the process.

Arroll says GPs traditionally try to stay clear of treating PTSD.

GPs are able to screen for PTSD using a brief set of questions but often feel they lack the time and resources to treat it, particularly within 15-minute appointments.

However, PTSD can also complicate the treatment of other conditions.

“We deal with the depression and anxiety that comes with it; but it's pretty hard to fix depression if you've got PTSD,” says Arroll.

Arroll has been training and supervising health coaches and some GPs to offer the therapy in general practices across the country.

With strong evidence and a model designed for primary care, written exposure therapy could help close a treatment gap for PTSD at a time when demand for clinical mental health services frequently outstrips capacity to provide them.