Building 'a compassionate armour': The journey to develop strength and self-compassion in a group treatment for complex post-traumatic stress disorder.

OBJECTIVES: Complex post-traumatic stress disorder (PTSD) is associated with severe difficulties in emotional regulation, interpersonal relationships, and shame. For individuals with these difficulties, exposure-based treatment for PTSD symptoms is less effective and can even be harmful. This study aimed to investigate the mechanisms of change at an individual and group level for individuals completing treatment for complex PTSD. DESIGN: Constructivist grounded theory was used to develop an explanatory theoretical model of the change process. METHODS: Semi-structured interviews were conducted with 11 women with a diagnosis of complex PTSD who had completed the group treatment. RESULTS: The theoretical model captured change as an ongoing journey, which continued after treatment finished. Participants identified three essential aspects of the group that brought about change. The first was the group itself, in which valued relationships were formed. Additionally, participants described two key mechanisms - developing a comprehensive understanding of themselves and their difficulties, and experiencing their emotions and compassion from others. CONCLUSIONS: The key mechanisms of change were the relationships formed within the group and the need for a deeper understanding of the self in order to reduce shame and prepare for exposure-based treatment. Further support is provided for a phase-based approach to complex PTSD treatment. Psychoeducation alone, however, was not sufficient, and it was also crucial that participants could safely access their emotions and experience compassion from others in order for change to come about. PRACTITIONER POINTS: Important aspects of treatment for complex PTSD are emphasised to inform professional practice. In particular, the role of relationships is altering self-perceptions through group therapy. Other key elements included participants building an understanding of themselves and their difficulties through psychoeducation, developing compassion for others and themselves, and safely accessing their emotions. This study also builds upon the body of evidence for the benefits of phase-based treatment which addresses shame and emotional regulation prior to exposure therapy.