Participants
substance-use disorder, psychosis, mania, PTSD, suicidality, DSM-5, trauma
Inclusion criteria were: aged 18–80 years, current or former Australian Defence Force member, PTSD diagnosis as determined by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and a Criterion A trauma that occurred while serving. Exclusion criteria included current: clinician-rated psychosis, mania, high risk of harm to self or others, and severe alcohol or substance-use disorder as determined by the Mini International Neuropsychiatric Interview (MINI), and receiving other trauma-focused psychological therapy and unwilling/unable to pause. Given the prominence of risk within this population, risk to self and others was assessed at several points through the trial, including the initial intake call, T1 baseline assessment, and where needed during therapy. High risk was defined as active thoughts to harm self or others and the potential for immediate harm, or recent risk with the potential to be exacerbated by trauma-focused therapy. Risk to self or others was rated as no foreseeable, low, medium, or high, and previous suicidality did not preclude individuals from participation in therapy. Individuals taking psychotropic medication were required to be on a stable dose (no titration) for at least 4 weeks prior to commencing and without intention to change for the duration of treatment. All participants provided informed written consent to participate in the trial.