BACKGROUND: a new diagnosis of complex post-traumatic stress disorder, CPTSD, has been agreed by the World Health Organization, WHO, and evidence is needed for what psychological treatment might be effective, particularly from those with experience of the disorder. We used a novel participatory approach to explore patient views and simultaneously studied the impact on the patient researchers of the research process itself. In this paper, we report on the latter section of the study how the involvement in research of patients with CPTSD affected their mental health. Symptoms of CPTSD may include emotional dysregulation, feelings of self-worthlessness and difficulties in relationships. OBJECTIVE: the aim of this study section was to explore whether patients' mental health could be promoted through empowering them to participate in research on CPTSD. DESIGN: the study had a qualitative, participatory design. The clinician who led the research (first author) held group meetings with patient researchers to explore the impact of the research process. The clinician also kept notes on the process in a reflective log. SETTING AND PARTICIPANTS: Six patient researchers participated in research with other patients with lived experience of CPTSD in an NHS outpatient unit in a London hospital. INTERVENTION STUDIED: the research process itself was analysed in group meetings with researchers which the clinician recorded and transcribed. FINDINGS: Participation in research may promote increased self-confidence and social inclusion for those with CPTSD. CONCLUSION: Involvement in research may be seen as an empowering intervention because patients felt it contributed to recovery.

People who have been subjected to human mistreatment, such as torture or sexual abuse, may develop mental health problems for which they seek psychotherapy from the NHS. In the past, many were diagnosed as having Post-traumatic Stress Disorder, PTSD, and offered psychotherapy for this, although such treatment did not address all their symptoms. A new diagnosis has now been drawn up by the World Health Organisation (2012), which describes complex symptoms more comprehensively: Complex PTSD. It is set to be approved by WHO member countries in 2019.

There is little research on what patients with the new diagnosis might find helpful and this study set out to explore patient views on psychotherapy for Complex PTSD in a community setting in south London. While patients did not formally have the diagnosis, they had the symptoms of Complex PTSD at assessment. The study was innovative in that it took a collaborative, participatory approach where researchers, who had formerly been patients, were trained to carry out interviews (n=24) with each other, as well as contributing to the analysis.

The findings were that the key factor in recovery was enabling patients to rebuild relationships with others, beginning with the psychotherapist. Establishing trust in the relationship with the therapist, followed by other people, was identified as crucial, because trauma had been caused by human mistreatment. Although this may be considered a non-specific element of treatment, the participants considered it to be an active mechanism of change. They also emphasised that sufficient time, at least one year, had to be provided for therapy. These findings are explained by a psychoanalytic theoretical framework based on the concepts of attachment and object relations.

The findings come at an opportune time because the UK government through the National Institute of Health and Care Excellence (NICE), will need to recommend treatment guidelines for the new diagnosis based on the evidence of scientific studies, as well as clinician expertise and patient views.