Compassionate Letter Writing for People who Have Experienced Interpersonal Trauma: A Multiple-Baseline Single Case Experimental Design

Abstract

Background: Complex Post-Traumatic Stress Disorder (CPTSD) was introduced in the most recent International Classification of Diseases, 11th Revision, as a more severe form of post- traumatic stress that is accompanied by emotional dysregulation, negative self-views and relationship difficulties (World Health Organisation, 2019). Interpersonal traumas are thought more likely to lead to CPTSD (Hyland et al., 2023). Compassion-Focused Interventions were developed to address high shame and self-criticism and improve the balance between emotion- regulation systems (Gilbert, 2009). Negative self-views and emotional dysregulation are two of the core symptoms of CPTSD. This research sought to investigate whether a compassionate letter writing intervention could be completed individually by participants who have experienced interpersonal trauma and whether there is evidence for improvements in symptoms.

Method: A multiple-baseline single case experimental design plus pre-post measures was used. Nine participants took part in the intervention. Feasibility and acceptability of the intervention were assessed and measures of ‘disturbances of self-organisation’ (DSOs), self- compassion and fears of compassion were used to assess clinical changes.

Results: The intervention demonstrated feasibility and acceptability. Reliable improvements in DSOs were observed for 44.4% of participants, with deterioration in 11.1%. Increases in self- compassion and reductions in fears of compassion were also seen.

Conclusions: This research indicates the potential feasibility, acceptability and clinical benefit of an online, self-directed, compassionate letter writing intervention for people with interpersonal trauma and DSOs. A randomised controlled trial of the piloted intervention, with a larger number of participants, is warranted.