Complex Trauma Treatment Guidelines

Understanding complex trauma

Complex trauma goes beyond the instance of experiencing a single traumatic event and is not an acute stress disorder. According to the International Society for the Study of Trauma and Dissociation (2020), complex post-traumatic stress is a type of trauma that goes beyond a one-time event.

The World Health Organization (2024) also estimates that 3.9% of the world's population has experienced post-traumatic stress disorder (PTSD) at some stage in their life. However,

In most cases, complex trauma histories begin in childhood or adolescence. Repeated trauma can cause changes in brain structure and functioning as the brain is developing, which, in turn, affects future development. Traumatic memories of childhood trauma may impact an individual. Consistent exposure to multiple interpersonal traumas over the lifespan can have significant psychological impacts, including the likelihood of developing PTSD as well as other mental disorders (Briere & Scott, 2015). Moroever, mental health disorders such as borderline personality disorder (BPD) may co-occur with PTSD. However, these mental health disorders are not entirely overlapping (Pagura et al., 2010).

Instances where complex trauma occurs may be when:

• individuals are exposed to significant traumatic events repeatedly (first aid responders, military personnel, healthcare workers)
• Exposure to domestic abuse (physical abuse, sexual abuse)
• An individual is exposed to damaging abuse during their childhood within a 'safe' relationship (making it difficult to escape or speak out about the abuse)

Addressing complex trauma requires tailored treatment plans that focus on healing and rebuilding trust, safety, and emotional regulation. Interventions must be carefully considered for each patient as their needs are complex, and there is no one-size-fits-all approach.

Treatment approaches for complex trauma

There are four clinically recommended treatment approaches for complex trauma as well as posttraumatic stress disorder. The American Psychological Association (2020) strongly recommends variations of cognitive behavioral therapy (CBT).

Cognitive behavioral therapy

Cognitive behavioral therapy mainly focuses on relationships among thoughts, feelings and behaviors. It aims to target current problems and symptoms; and focuses on changing patterns of behaviors, thoughts and feelings that lead to difficulties in functioning. CBT is commonly delivered over 12 to 16 sessions in either an individual or group format and can support practitioners to treat PTSD.

Cognitive processing therapy

Cognitive processing therapy (CPT) is a specific type of CBT that supports patients in learning how to modify and challenge unhelpful beliefs that may be related to the trauma. This intervention helps patients create a new understanding and conceptualization of the event, in turn reducing the ongoing negative effects on their present lives. CPT is typically delivered over 12 sessions.

Cognitive therapy

This intervention encompasses modifying the pessimistic evaluations and memories from the trauma. The overall goal of cognitive therapy is to interrupt the disturbing behavioral and thought patterns currently disrupting the patient's day-to-day life. This intervention is typically delivered over 3 months and at weekly sessions.

Prolonged exposure therapy

Prolonged exposure therapy is a specific type of therapy that leads patients to gradually approach trauma-related memories, associated feelings, and related situations. During this intervention, patients will be faced with what they have been avoiding and will presumably learn that the memories and cues are not dangerous and do not need to be avoided. This intervention is provided over 3 months at weekly individual sessions. To fully engage with the therapy, sessions are typically 60 to 120 minutes in length.

How to use our Complex Trauma Treatment Guidelines template

Our treatment guidelines handout template for complex trauma is designed to provide key information about interventions that are clinically and conditionally recommended for this mental health issue. Here's a brief guide on how to use it effectively:

Step 1: Download the template

Download a copy of the Complex Trauma Treatment Guidelines by clicking "Use template", allowing you to edit and customize it via the Careparon app. For a PDF copy, simply choose "Download."

Step 2: Use in your practice

Use the handout as a reference guide for interventions that could be utilized for managing complex trauma in clients. This handout includes evidence-based clinical and conditional recommendations from the American Psychological Association.

Step 3: Share with other clinicians

If you are collaboratively working with other clinicians in the treatment of complex PTSD, you may wish to share this handout with them. This can allow a comprehensive understanding of clinically recommended interventions, as well as keep other practitioners on the same page., especially if patients are experiencing other mental health conditions.

Step 4: Keep it in your patient's file

You can also keep a copy of this handout on the patient's file. This can support future treatment options and provide quick reference for any intervention protocols.

Benefits of using this handout

Here are some of the benefits of using our free guidelines template:

Improved decision making

Treatment guidelines provide evidence-based recommendations that provide mental health practitioners with the information they require to make informed and effective decisions. This handout provides not only clinical recommendations for trauma interventions but also conditional recommendations that may be used in support of first-stage interventions.

Efficiency

Utilizing this guideline handout provides a quick reference that can support clinical decision-making. This can be especially supportive in complex and fast-paced environments. Our handout allows practitioners to source key, up-to-date information about interventions without consulting multiple sources.

Patient safety

Adhering to established and clinically recommended interventions for specific mental health conditions can reduce the risk of errors, complications, and adverse outcomes. These guidelines support the utilization of interventions that the American Psychological Association recommends.

Enhances communication

Employing a common reference point for healthcare teams can support best practices and the same treatment protocols throughout the healthcare facility. This fosters better communication and collaboration amongst clinicians and allows a coordinated approach to trauma issues within the workspace.

References

American Psychological Association. (2020, June). Treatments for PTSD. https://www.apa.org/ptsd-guideline/treatments

Briere, J., & Scott, C. (2015). Complex trauma in adolescents and adults. Psychiatric Clinics of North America, 38(3), 515–527. https://doi.org/10.1016/j.psc.2015.05.004

International Society for the Study of Trauma and Dissociation. (2020). Trauma and complex trauma: An overview. https://www.isst-d.org/wp-content/uploads/2020/03/Fact-Sheet-I-Trauma-and-Complex-Trauma_-An-Overview-1.pdf

Pagura, J., Stein, M. B., Bolton, J. M., Cox, B. J., Grant, B., & Sareen, J. (2010). Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population. Journal of Psychiatric Research, 44(16), 1190–1198. https://doi.org/10.1016/j.jpsychires.2010.04.016

World Health Organization. (2024, May 27). Post-traumatic stress disorder. https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder