The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
Usability - Rating: 99 - -99
Present Centred Therapy (PCT) is a manualised, non-trauma focused psychological therapy used in the treatment of PTSD in adults. PCT is “present centred” as it focuses on the individual’s current situation. PCT helps individuals to recognise the influence of their trauma history on current maladaptive behaviours. It also teaches systematic problem-solving strategies to manage current stressors (related to the trauma/ PTSD symptoms), and enhance coping capacity. It is anticipated that application of these approaches will enhance psychosocial functioning and alleviate PTSD symptoms.
PCT consists of three main components; 1) Psychoeducation on the impact of PTSD symptoms on day-to-day functioning; 2) Problem solving strategies for managing daily challenges; and 3) Homework to help patients monitor current stressors, and to practice and enhance their problem-solving skills.
PCT is typically been delivered in outpatient mental health settings, over a varied number of sessions. The first two sessions typically focus on the rationale behind PCT, as well as psychoeducation on PTSD symptoms and other trauma related responses. Subsequent sessions focus on issues identified by the patient(s) and adaptive solutions to address these problems. The final session reviews patient progress and brings an end to the delivery of the intervention.
Greater understanding of what PCT is can be gained by description of what PCT is not. PCT is not a trauma-focused intervention, hence it does not focus on details of the trauma event, nor does it involve exposure to trauma cues or triggers. PCT is not founded on Cognitive Behavioural Therapy (CBT) framework, hence, it has no focus on , cognitive restructuring, or more general relaxation/stress management techniques. Lastly, PCT is not a solely supportive intervention as it requires completion of between session homework assignments.
Fidelity
Present-Centred Therapy (PCT) treatment sessions can be recorded for supervisor review and feedback. No adherence rating tool designed specifically for PCT has been identified.
Modifiable Components
Present-Centred Therapy (PCT) can be delivered in individual and group formats. In research studies, PCT has been delivered over a varied number of sessions (10-12 sessions for individual delivery; 12-32 sessions for group delivery), and varied length of sessions (e.g. 60-90 minutes). The topics discussed /addressed during PCT vary, and are largely focused on those chosen by the patient(s) receiving treatment. PCT has been shown to be effective in treatment of co-morbid depression, and in military populations.
Supports - Rating: 99 - -99
Implementation Support
A present-centred group therapy book for PTSD is available for purchase. The book describes the intervention’s underpinning theory and background. It also provides evidence supporting the intervention, guide for implementation, its applications, and specific advice for group delivery. No training opportunities have been identified. Training is not currently delivered by NES/within NHS in Scotland.
Pre training Requirements
There are no pretraining requirements set out. However, It is recommended practice in Scotland that this psychological intervention is conducted under regular supervision with a practitioner who has expertise in a) the intervention b) the clinical area and c) has completed training in supervision of psychological therapies and interventions (further information: https://www.nes.scot.nhs.uk/our-work/supervision-of-psychological-therapies-and-intervention/)
Start-up Costs
Costs can include costs of purchasing the Present-Centred Group Therapy for PTSD book. The book can be purchased here https://www.routledge.com/Present-Centered-Group-Therapy-for-PTSD-Embracing-Today/Wattenberg-Gross-Niles-Unger-Shea/p/book/9780367338831.
Building Staff Competency
Qualifications Required
Present Centred Therapy (PCT) is delivered by mental health professionals (e.g. psychotherapists, psychiatrists, and social workers). Practitioners should demonstrate core therapeutic skills of empathy, sincerity, positive regard.
Training Requirements
There is currently no training in this intervention provided through NES or University training programmes. Costs apply when training is provided by private organisations. No formal training courses have been identified.
Supervision Requirements
Present Centred Therapy (PCT) treatment sessions can be recorded for supervision purposes. It is recommended practice in Scotland that this psychological intervention is conducted under regular supervision with a practitioner who has expertise in a) the intervention b) the clinical area and c) has completed training in supervision of psychological therapies and interventions (further information: https://www.nes.scot.nhs.uk/our-work/supervision-of-psychological-therapies-and-intervention/)
Evidence - Rating: 99 - -99
Theory of Change
Present Centred Therapy (PCT) was designed as a control intervention to assess the effectiveness of trauma-focused interventions. PCT recognises the contribution of common / non-specific factors (e.g. sense of hope and optimism, positive therapeutic relationship, understanding of treatment rationale, and talking in a safe space) to the outcomes observed on delivery of psychological therapies. It is expected that people seeking services would benefit from these common elements as they gain insights to the influence of PTSD symptoms on current behaviours, and as they learn about, and employ, more effective problem-solving strategies to manage daily stressors. This approach is expected to enhance psychosocial functioning and alleviate PTSD symptoms.
Research Design & Number of Studies
Four RCTs for the treatment of PTSD in adults were included in one meta-analysis produced by NICE. These studies included women with intimate partner violence-related PTSD or subthreshold PTSD; mothers with victimisation-related PTSD; and adult female survivors of childhood sexual abuse who were diagnosed with PTSD. Complete information on studies included in the meta-analysis, and detailed results from the meta-analysis can be found within the NICE guideline evidence reviews 2018. Reported significant improvements have been summarised below.
Outcomes Achieved
Compared to the treatment as usual group or wait-list control group, the following outcomes were reported;
- Significantly reduced PSTD symptoms at endpoint for multiple incident trauma, following early treatment (1-3months) and delayed treatment (> 3 months)
- Significantly reduced depression symptoms at endpoint for multiple incident trauma, following early treatment (1-3 months), sustained at 3-months and 6-months follow-up
- Significantly reduced depression symptoms, dissociative symptoms and anxiety symptoms following delayed treatment (>3 months) for multiple incident trauma
Key References
- Evidence reviews for psychological, psychosocial and other non-pharmacological interventions for the treatment of PTSD in adults. NICE guideline evidence reviews 2018. (https://www.nice.org.uk/guidance/ng116/evidence/evidence-review-d-psychological-psychosocial-and-other-nonpharmacological-interventions-for-the-treatment-of-ptsd-in-adults-pdf-6602621008). Accessed 20th July 2021.
Need
Comparable Population
Present-Centred Therapy (PCT) is delivered to adults for the treatment of PTSD. Evidence of effectiveness comes from four Randomised Controlled Trials (RCTs) that were combined and evaluated in one meta-analysis. These studies included women with intimate partner violence-related PTSD or subthreshold PTSD; mothers with victimisation-related PTSD; and adult female survivors of childhood sexual abuse who were diagnosed with PTSD. Other studies not included in the meta-analysis were conducted in active duty military and Veteran populations.
Desired Outcome
Present-Centred Therapy (PCT) is associated with significant improvements in symptoms of PTSD, and in symptoms of comorbidities associated with PTSD, including depression, dissociation, and anxiety. Improvements were observed following early treatment (1-3months) and delayed treatment (> 3 months).
1 - Does Not Meet Need
The intervention has not demonstrated meeting need for the identified population
2 - Minimally Meets Need
The intervention has demonstrated meeting need for the identified population through practice experience; data has not been analysed for specific subpopulations
3 - Somewhat Meets Need
The intervention has demonstrated meeting need for the identified population through less rigorous research design with a comparable population; data has not been analysed for specific subpopulations
4 - Meets Need
The intervention has demonstrated meeting need for the identified population through rigorous research with a comparable population; data has not been analysed for specific subpopulations
5 - Strongly Meets Need
The intervention has demonstrated meeting the need for the identified population through rigorous research with a comparable population; data demonstrates the intervention meets the need of specific subpopulations
Fit
Values
Present Centred Therapy (PCT) is a “present centred” intervention that focuses on individual’s current situation. It is a manualised, non-trauma focused psychological therapy used in the treatment of PTSD in adults. PCT does not focus on details of the trauma event and does not involve exposure to trauma cues or triggers.
Priorities
Present Centred Therapy (PCT) helps patients recognise the influence of their trauma history on current maladaptive behaviours. It also teaches systematic problem-solving strategies to manage current stressors (related to the trauma/ PTSD symptoms), and enhance coping capacity. It is anticipated that application of these approaches will enhance psychosocial functioning and alleviate PTSD symptoms.
Existing Initiatives
1 - Does Not Fit
The intervention does not fit with the priorities of the implementing site or local community values
2 - Minimal Fit
The intervention fits with some of the priorities of the implementing site, but it is unclear whether it aligns with local community values and other existing initiatives
3 - Somewhat Fit
The intervention fits with the priorities of the implementing site, but it is unclear whether it aligns with local community values and other existing initiatives
4 - Fit
The intervention fits with the priorities of the implementing site and local community values; however, the values of culturally and linguistically specific population have not been assessed for fit
5 - Strong Fit
The intervention fits with the priorities of the implementing site; local community values, including the values of culturally and linguistically specific populations; and other existing initiatives
Capacity
Workforce
Present Centred Therapy (PCT) is delivered by mental health professionals including psychotherapists, psychiatrists, and social workers. It has been delivered over a varied number of sessions (10-12 sessions for individual delivery; 12-32 sessions for group delivery), and varied length of sessions (e.g. 60-90 minutes).
Technology Support
Present Centred Therapy (PCT) is typically delivered without access to technology. Access to technology to record sessions for supervision may be required.
Administrative Support
Present-Centred Therapy (PCT) is typically delivered in outpatient mental health settings, either in individual or group formats. Administrative support is needed to manage therapy appointments, as well as to collate and input outcome measures.
Financial Support
Training in PCT is primarily provided by private organisations and costs will apply. There are no start-up costs associated with training provided within university training programmes (if training through an NHS place) or by NES.
1 - No Capacity
The implementing site adopting this intervention does not have the capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
2 - Minimal Capacity
The implementing site adopting this intervention has minimal capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
3 - Some Capacity
The implementing site adopting this intervention has some of the capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
4 - Adequate Capacity
The implementing site adopting this intervention has most of the capacity necessary, including a qualified workforce, financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
5 - Strong Capacity
Implementing site adopting this intervention has a qualified workforce and all of the financial supports, technology supports, and administrative supports required to implement and sustain the intervention with integrity
