{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T21:22:02Z","timestamp":1782336122775,"version":"3.54.5"},"reference-count":47,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2020,4,19]],"date-time":"2020-04-19T00:00:00Z","timestamp":1587254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["bpspsychub.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psychol Psychother"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Complex post\u2010traumatic stress disorder (PTSD) is associated with severe difficulties in emotional regulation, interpersonal relationships, and shame. For individuals with these difficulties, exposure\u2010based 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Constructivist grounded theory was used to develop an explanatory theoretical model of the change process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Semi\u2010structured interviews were conducted with 11 women with a diagnosis of complex PTSD who had completed the group treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u2013 developing a comprehensive understanding of themselves and their difficulties, and experiencing their emotions and compassion from others.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u2010based treatment. Further support is provided for a phase\u2010based 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Practitioner points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Important aspects of treatment for complex PTSD are emphasised to inform professional practice. In particular, the role of relationships is altering self\u2010perceptions through group therapy.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>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.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>This study also builds upon the body of evidence for the benefits of phase\u2010based treatment which addresses shame and emotional regulation prior to exposure therapy.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/papt.12275","type":"journal-article","created":{"date-parts":[[2020,4,19]],"date-time":"2020-04-19T04:53:41Z","timestamp":1587272021000},"page":"286-303","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Building \u2018a compassionate armour\u2019: The journey to develop strength and self\u2010compassion in a group treatment for complex post\u2010traumatic stress disorder"],"prefix":"10.1111","volume":"94","author":[{"given":"Emily","family":"Ashfield","sequence":"first","affiliation":[{"name":"Wokingham Community Mental Health Team Berkshire Healthcare Foundation Trust UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2600-2827","authenticated-orcid":false,"given":"Carmen","family":"Chan","sequence":"additional","affiliation":[{"name":"Horizon (Supporting Young People and Families Affected by Sexual Harm) Oxford Health NHS Foundation Trust UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Lee","sequence":"additional","affiliation":[{"name":"Berkshire Traumatic Stress Service Berkshire Healthcare Foundation Trust UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,4,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.177.2.144"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1352465813000362"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732318788379"},{"key":"e_1_2_9_6_1","volume-title":"Constructing grounded theory","author":"Charmaz C.","year":"2014"},{"key":"e_1_2_9_7_1","volume-title":"Treating survivors of childhood abuse: Psychotherapy for the interrupted life","author":"Cloitre M.","year":"2006"},{"key":"e_1_2_9_8_1","volume-title":"The ISTSS expert consensus treatment guidelines for complex PTSD in adults","author":"Cloitre M.","year":"2012"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.70.5.1067"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2010.09081247"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-3204.41.4.412"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2015.10.003"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2004.03.006"},{"key":"e_1_2_9_14_1","volume-title":"Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies","author":"Foa E. 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