This was an opportunity to create and trial a truly innovative treatment programme.

The majority of participants, and all participants in Year 2 stated they had previously tried talking therapies – from the standard 6-12 weeks of CBT offered by NHS IAPT
services (Improving Access to Psychological Therapies) – many had had several courses of this.

Most stated this was not helpful, and a third actually stated that it was harmful.

Many stated that the course of treatment was too short to start to trust the therapist or that just when they started uncovering something, it finished, and they were left to ‘figure it out myself’, which destabilised them further. Some had privately funded longer term therapy which from feedback was more helpful, but for many the cost became a barrier to continuing.

The intention of the Connection Works programme is to provide a safe container to have a lived experience of connection and support. The focus was to provide participants with knowledge and understanding about how trauma was impacting their bodies, minds and behaviours, and to empower them with tools they could use lifelong for their healing journey.

A truly innovative treatment programme

A programme focused on reducing inflammation in the body; the mediator behind the physical and mental health symptoms of CPTSD was carefully curated. The intervention were psychoeducation, education around nutrition, sleep, and boundaries, experiences of connection with nature, and encouraging a sense of community and exploring body trauma-focused therapies. ^{23. 27} Many participants had already tried many of the interventions prior to joining Connection Works, but it was the experience of doing this in small groups, over many months so it was paced to match their nervous systems and held by trauma-informed clinicians without having to think about where to go or what to do when, that was so powerful.

The year-long duration of the programme was very intentional; CPTSD literally impacts the structure of the brain. In order to create new neural pathways, new habits, the body and brain needs safety, repetition and time. The programme provided participants with the opportunity to trial a variety of treatment modalities and to have consistent messaging around self-care, self-compassion, self-worth, empowerment and agency. There are many studies looking at the individual components which make up the ConnectionWorks programme, as brief intervention. However, to embed these changes to create lasting positive change in a patient population for whom self-neglect is very common, is challenging and takes repetition and time. The regularity of interventions with the consistent messaging, over time helped participants to reconsider their own self narrative story and move from self-neglect to self-care. The length of time of allowed for participants to start to view themselves differently, not as ‘time-wasting’ patients who are chronically ill, unable to work, function properly or have meaningful relationships, but instead, viewing themselves as people with potential.¹⁸

All of the interventions and treatment modalities were chosen both as they have both evidence-based but also accessible and reproducible. ^{8, 9, 16, 19, 22, 29, 34, 41, 42, 43, 44}

They were all delivered by practitioners who were experienced in working with trauma.

The core team of Connection Works were a Psychotherapist who is also an Equine-Assisted Learning Facilitator and Reiki Master, and a Senior Mental Health Social Worker who is also a Medical Herbalist. Between them, they conducted all the intake and exit appointments, the nature and foraging walks, the small group check-ins and supported the education sessions and were the point of contact for participants. They worked very closely with Dr Susanna Petche, a GP who also had training in functional medicine and lifestyle medicine who ran all the education sessions, the two workshops and all of the individual sessions.