The intervention content
trauma-related distress, traumatic, post-traumatic stress, dissociative reactions, trauma
EVENT, HOT SPOTS
As in the original PE protocol (Foa et al., The first module is an introduction to the intervention and includes psychoeducation about common reactions after exposure to psychological trauma. The module also introduces controlled breathing as a way for the participant to manage general stress. Participants are encouraged to practice controlled breathing three times a day. The purpose of this module is to normalise and validate the participants' reactions and instil hope of recovery from the symptoms of post-traumatic stress.The second module focuses on imaginal exposure: that is, to revisit and recount the memory of the traumatic event. First, a rationale is provided for the presumed role of imaginal exposure in reducing symptoms of post-traumatic stress and instructions on how to conduct imaginal exposure. Case examples are used to illustrate how to revisit the traumatic memory and were constructed to include common difficulties that may arise during imaginal exposure, such as over-engagement, under-engagement and experiencing dissociative reactions (Foa et al., Module three expands the imaginal exposure exercise and participants are encouraged to approach the most distressing sequences of their traumatic memory (i.e. hot spots). Module three also targets behavioural avoidance and includes a rationale for and instructions on how to approach situations that are perceived as dangerous or triggering trauma-related distress but are objectively safe. Participants are asked to compose a list of avoided situations and rank them in order from least to most distressing. The participants are then encouraged to gradually confront these situations, starting with those that evoke moderate distress. The online therapist assisted in planning the Module four includes a summary of the intervention and a rationale for how to continue to use the strategies learned from the intervention. The participant is asked to summarise their own progress and to make an individual plan for relapse prevention. The participants were asked to use a digital worksheet to review their progress and what they had learned from the intervention, to reflect upon how these changes were accomplished, and how to deal with any temporary increases in symptoms of post-traumatic stress in the future. In the last part of the module, the participants were reminded of the upcoming follow-up assessments and were asked to summarise their experience of the intervention. The participants continued to have access to the intervention for one year after completing the intervention but without therapist support.