Past projects/Trials

Trauma-Focused Stepped Care for Posttraumatic Stress Disorder

This project investigated the effectiveness of a trauma-focused stepped care model for treating posttraumatic stress disorder (PTSD). The model combined an existing, low-intensity internet-delivered cognitive-behavioural treatment program (This Way Up; TWU), with an established, higher-intensity PTSD treatment (Cognitive Processing Therapy; CPT). The study was conducted by Professor Reg Nixon and Dr Larissa Roberts from Flinders University and funded by the Breakthrough Mental Health Research Foundation and Flinders Foundation.

Significance of the Trial

The aim of this project was to evaluate whether a trauma-focused stepped care model may be a suitable and effective approach for treating PTSD, by improving access to evidence-based support, within an increasingly stretched health system.

Study Design

This study used an open trial design, meaning that all participants received trauma-focused support (i.e., no control group was used). The stepped-care approach involved two stages: (1) access to the 8-week TWU program with weekly clinician-guidance via videoconference, and (2) the option, following re-assessment, to ‘step up’ to receive CPT delivered via videoconference by a trainee clinical psychologist. Individuals could receive up to 18 weekly individual sessions of CPT, although most required fewer. Outcomes were assessed at pretreatment, post-treatment, and at 3- and 6-month follow-up.

Results

Findings supported that a trauma-focused stepped care approach that used low- and high- intensity evidence-based interventions for PTSD can be effective. Significant reductions in not only PTSD and depression symptoms were observed, but participants also reported improved quality of life. Approximately two thirds of participants only needed to engage in the low-intensity TWU program, with the remainder being stepped up to standard CPT. These results potentially provide insight into who is best suited to, and likely to benefit from, low intensity interventions, versus those who may require escalation to standard, high-intensity support.

The published findings can be read at Prof. Nixon’s ResearchNow page or accessed directly below:

Nixon, R. D., & Roberts, L. N. (2025). Stepped care for posttraumatic stress disorder: An open trial feasibility study. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0001828

Cognitive Processing Therapy (CPT) for Military Members, Veterans and First Responders trial

This project investigated how to enhance the effectiveness of an already established therapy, CPT. CPT was designed to help people recover after experiencing a traumatic event and has been widely used with veterans and military personnel, and now with first responders, for example, police, fire service, and ambulance officers.  The study was conducted by Professor Reg Nixon from Flinders University and was funded by the Road Home Research Foundation (now Military and Emergency Services Australia [MESHA], part of the Hospital Research Foundation Group).

Significance of the Trial

The aim of this project was to see whether we can make CPT more effective in treating PTSD by allowing greater tailoring of therapy for the needs of the client, that is, personalising the treatment better.

Study Design

This study used an open trial design, meaning that all participants received therapy (i.e., no control group was used). Individuals could receive up to 25 individual therapy sessions of flexible CPT with a trained therapist although in most cases clients needed fewer sessions than this. Participants completed questionnaires at post-, and 3-month follow-up to evaluate outcomes. Although analyses are still being undertaken (data is being prepared for publication), preliminary results indicate positive impacts of CPT in terms of reducing posttraumatic stress and depression.

The published findings can be read at Prof. Nixon’s ResearchNow page or accessed directly below:

Nixon, R.D.V., Forbes, D., & Galovski, T.E. (2025, accepted 18.6.25). Cognitive Processing Therapy for posttraumatic stress disorder in first responders and veterans: Flexing the approach with explicit case formulation. Journal of Traumatic Stress. https://doi.org/10.1002/jts.70005

Guided Self-Help Cognitive Processing Therapy (CPT-GSH)

This project investigates an online guided self-help intervention using Cognitive Processing Therapy (CPT-GSH) in a stepped care model to help people recover from PTSD. The stepped-care approach can involve two stages of help, in which a person receiving therapy is matched to the level of therapy that most suits their current needs. This will be compared to a comparison group who will receive a standard Cognitive Processing Therapy.

The findings are being prepared for publication and will be available at Prof. Nixon’s ResearchNow page.

The Effect of Awareness on Negative Thoughts

This study aims to investigate whether increasing awareness of unwanted trauma related thoughts (intrusions) can benefit PTSD treatment outcomes. This research is being conducted because the current assessment of intrusions relies solely on self-reporting and an increased awareness could contribute to these thoughts being assessed more frequently.

The published findings can be read at Prof. Nixon’s ResearchNow page and include the following studies:

Sun, Y.J., Takarangi, M.K.T., & Nixon, R.D.V. (2025). Do alexithymia and maladaptive cognitive processes influence awareness of trauma memories? Psychology of Consciousness: Theory, Research, and Practice. https://doi.org/10.1037/cns0000426

Sun, Y.J., Takarangi, M.K.T., & Nixon, R.D.V. (2023). Exploring intrusions without awareness: Characteristics and influences of meta-awareness failures. Journal of Behavior Therapy and Experimental Psychiatry, 81: 101889. https://doi.org/10.1016/j.jbtep.2023.101889

Daily Diary Trauma Study

This project aims to investigate how different people think, feel, and behave following potentially traumatic experiences. The online diary briefly captures peoples’ days to improve our understanding of small changes in posttraumatic thought processes.

The published findings can be read at Prof. Nixon’s ResearchNow page or accessed directly below:

Canty, A.R., Windsor, T.D., & Nixon, R.D.V. (2024). Using Experience Sampling Methodology (ESM) to improve our understanding of day-to-day intrusion frequency and related distress in survivors of trauma. Journal of Behavior Therapy and Experimental Psychiatry, 82: 101921. http://doi.org/10.1016/j.jbtep.2023.101921