Complex Trauma Care Pathway: Results of a 12-Month Pilot.

Introduction: Sustained, developmentally adverse experiences in childhood put survivors at risk for posttraumatic stress disorder and impairments in biological, affective, cognitive, and intra/interpersonal domains. Complex trauma symptoms are often treated in isolation without addressing their common root cause. The trauma-focused phased Complex Trauma Care Pathway (CTCP) was developed to address this care gap.

Methods: We piloted the CTCP in 2 medical centers for 12 months among 46 therapist-referred adults. Outcome measures collected every 3 months included standardized scales assessing anxiety, depression, suicidal thoughts, and disorders of extreme stress not otherwise specified (DESNOS).

Results: Statistically significant improvements occurred in mean scores for anxiety (p = 0.003), total DESNOS scores (p < 0.001), and 5 DESNOS domains: alterations in regulation of affect and impulses, alterations in regulation of attention or consciousness, alterations in self-perception, alterations in relationships with others (p < 0.001 for all), and alterations in systems of meaning (p = 0.006). In contrast, decreases in symptoms of somatization, depression, substance use, and suicidal thoughts were not statistically significant. Participant feedback was very positive.

Discussion: Many trials evaluate phased interventions for posttraumatic stress disorder, but much less evidence exists about effective interventions for complex trauma. Our study fills a knowledge gap.

Conclusion: The CTCP shows promising clinical efficacy and should be evaluated using a more rigorous design. Further research should also explore the relationship between the CTCP or similar interventions and chronic disease management, overall healthcare utilization, and suicide risk.