RCT of Gestalt Therapy Effectiveness with Veterans

A pilot RCT is a full-scale randomized trial with all methodological standards, conducted on a smaller sample. Its purpose is to test the feasibility of the design, obtain initial data on the effect, and determine parameters for a future large-scale study. This is the world's first RCT of gestalt therapy with veterans - the results have scientific value regardless of sample size.

The study has been approved by the Academic Council of KISPP (protocol No. 8, dated 13.03.2024) as a dissertation research. Ethical review is conducted by the KISPP Ethics Committee. Informed consent is signed by both participants and therapists.

Currently, the study has no external funding. Therapists work pro bono. HRV measurement equipment and all organizational costs are funded from the personal resources of the principal investigator, Pylyp Dukhlii.

No. A manualized protocol prescribes specific techniques for each session (as in CPT or PE). The adherence framework is a set of principles that define the boundaries of the therapeutic intervention: what should be present in the work, and what falls outside the scope of the study. You retain the freedom to choose specific interventions within these boundaries.

This will be discussed at the training seminar. Preliminarily: the inclusion of elements from other therapies in the format of a gestalt experiment is part of the intervention and will be described in the adherence framework. Specific boundaries are determined at the seminar together with the therapists.

Yes. The training seminar will include time for discussion and feedback. The framework is developed in consultation with practicing therapists, not imposed from above.

All participants have clinically significant symptoms: PCL-5 ≥ 31 (clinical PTSD level), or PHQ-9 ≥ 10 (moderate depression or higher), or GAD-7 ≥ 10 (moderate anxiety or higher). In practice, these are people with real psychological difficulties, but without acute psychosis and without active suicidal risk (verified during screening).

Yes. The inclusion criterion is combat experience OR service ≥ 6 months. Among veterans who were not in a combat zone, there are sufficient numbers of people with mental health problems.

If you feel that you cannot work with a specific client (for example, due to a personal connection or a feeling of incapability) - notify the PI. The client will be reassigned. This will have no negative consequences for you.

The "snake" allocation means the most severe client goes to the first therapist, the second most severe to the second, and so on. Then in reverse order. This guarantees that the severity workload is distributed evenly among all therapists.

The PI is available for consultations regarding any challenging situations. Additionally, you will have mandatory supervision and a list of recommended psychiatrists for referrals.

24 sessions equals 12 weeks at 2 sessions per week. The first 12 sessions (~6 weeks) correspond to the duration of a standard Cognitive Processing Therapy (CPT) course, allowing for comparison of effects at the midpoint. 24 sessions provide sufficient duration to evaluate the effect of gestalt therapy with a clinical population.

Meta-analyses show that a frequency of ≥2 times per week reduces dropout (21% vs 34% with less frequent sessions) and is no less effective than standard protocols. Moreover, this halves the overall study duration and, importantly, shortens the waiting time for the control group (12 weeks instead of 24) - significantly reducing dropout risk in the wait-list group.

Caveat: these data pertain to manualized protocols (PE, CPT), not gestalt therapy - this is an acknowledged limitation.

Session duration is fixed for standardization purposes. If a client is in crisis - you end the session in a safe format, stabilize the state, and contact the PI if necessary. Separate time for crisis intervention is not limited - this is your clinical decision, and such time does not count as part of the standard session.

Participants are distributed across Ukraine; an offline format would make participation impossible for most veterans. The limitations of the online format regarding body interventions are an acknowledged limitation of the study, noted in the dissertation. The seminar will include a discussion on adapting body techniques to the Zoom format.

The study currently has no external funding. Pro bono participation is common practice in pilot studies. Your contribution is recognized in publications and study materials.

Participation in the world's first RCT of gestalt therapy with veterans. Specifically: acknowledgment in the dissertation and publications (with your consent), research participation experience (valuable for your CV), a training seminar on working with trauma, access to a project-specific supervision group (if organized), and participation in building the evidence base for the gestalt approach.

Up to 4 clients x 2 sessions/week = up to 8 sessions/week for ~12 weeks. Plus time for filling out post-session forms (~2-3 min/session) and supervision.

The specific frequency will be determined in the SOP. Approximately - no less than once every 2 weeks for study clients.

Currently, the study budget does not cover these costs. The study will encourage supervisors from the list to open group supervisions for the project, which may be cheaper than individual supervision.

Yes, provided that your supervisor is not simultaneously a therapist or screener-assessor in the study. It is preferable that the supervisor has experience working with trauma.

A detailed protocol for the online format will be developed and presented at the training seminar. Generally: maintain contact, do not abruptly end the session, assess the risk level, notify the PI.

This issue will be addressed within the SOP and the participant's informed consent. The informed consent will include provision for the participant to provide a trusted person's contact for crisis situations.

You bear standard professional responsibility as a therapist. The study provides a referral protocol, a list of psychiatrists, and PI support for crisis situations. Your responsibility is to follow the protocol and notify the PI about significant events.

The coordinator maintains contact with the participant. The participant is provided with crisis support resources. Measurements (questionnaires, HRV) continue. If the participant consults a psychiatrist - therapy resumes.

Shelling, evacuation, and other war-related emergencies are valid reasons that do not count as "unexcused" absences. The criterion applies only to absences without valid reasons and without prior notice. Illness, technical problems, and notice ≥24 hours in advance with rescheduling also do not count.

The specific limit on total course duration will be defined in the SOP. The goal is 24 completed sessions regardless of time.

Preparation for termination begins around session 20. The last session includes a summary of the work done and a discussion of resources for continued support. Do not promise continuation of therapy within the study. After the last session, complete the final documentation form.

Notify the PI as early as possible. There will be no negative consequences for you. If possible, conduct a closing session with each client. If that is not possible - the coordinator will arrange a transition to another therapist.

In anonymized form: therapist sample characteristics (experience, qualifications, number - at the group level, not individually) and adherence ratings (mean scores). Your name does not appear in publications without your consent.

Adherence rating is a brief self-assessment after each session: 7 approach components (C1-C7) on a 0-3 scale (absent / peripheral / present / central), plus several categorical fields (other approaches with function indicated, CB-awareness, session themes, significant events).

Philosophical principles (P1-P3) and process aspects (PA1-PA4) are not rated by you per session - P1-P3 are rated by an independent rater, and PA1-PA4 are discussed in supervision. This is a tool for fidelity analysis (whether therapists work consistently), not an evaluation of your work quality. It is not used to compare therapists against each other.

Yes, all therapy sessions are recorded (audio only, no video). The client gives separate consent for recording in the informed consent and can withdraw it at any time. If the client has not given consent or has withdrawn it - the session proceeds without recording, and therapy continues. Recordings are stored in coded form (without names) on the project's secure storage.

In addition to your self-report, a small portion of recordings (3 sessions per therapist - early, middle, and late phases of the course) will be evaluated by an independent rater - a certified gestalt therapist who is not a participant in the study.

The rater evaluates approach components (C1-C7 on a 0-3 scale; C4 - only if the body focus is explicitly verbalized in the audio), integral philosophical stance (Philosophical stance, 0-3), overall quality of therapeutic work (Global competence, 0-3), and the presence of contraindicated behaviors (CB checklist). The rater does not see your self-reports and does not know the client outcomes. The goal is to provide independent fidelity evidence for the dissertation.

This is a standard procedure for RCTs that allows confirmation that adherence self-reports correspond to what actually happens in sessions. The rater listens to audio recordings and evaluates the presence of approach components on a 0-3 scale (as you do), as well as additional integral items. Results are compared post hoc (after all therapy is completed) and reported in the dissertation at the group level, not individually.

Yes. You may indicate your participation as a therapist in the study. The specific wording should be agreed upon with the PI.

Interoceptive awareness is the ability to perceive and interpret signals from one's own body (heartbeat, breathing, muscle tension, sensations in the abdomen). In veterans with PTSD, this ability is often impaired - the body is perceived as a source of threat or is ignored. Gestalt therapy works directly with awareness of bodily processes, making interoception a logical expected mechanism of change.

Heart rate variability (HRV) is a measure of how flexibly the autonomic nervous system adapts to changes. Low HRV is associated with PTSD, depression, and anxiety. For the client, it is a painless procedure (~17 min, a sensor on the chest) conducted by the research team, not by you. You do not need to know anything about HRV for your work.

During the study - no, to avoid influencing your work. After the study is completed and results are published - overall results will be available to all therapists. Individual results of specific clients are not shared.

It depends on the pace of participant recruitment. Enrollment is rolling, so clients appear gradually. The first client may come a few days after the seminar or a few weeks later.

A short vacation (up to one week) is permissible with advance notice to clients and the PI. The course is extended accordingly. A longer vacation is discussed with the PI individually. It is preferable to plan vacations between client courses rather than during them.

Email: pylyp@pylyp.com.ua. For urgent matters (crisis situations) - an additional communication channel will be provided at the seminar. Expected response time: within the working day for standard questions, immediately for crisis situations.

Approximately 2-3 minutes after each session. If you forget - fill it out as soon as possible (before the next session with the same client). The coordinator will send reminders about unfilled forms.

Possibly. A reference may be requested as part of the selection procedure. If this happens - you will be notified in advance.

No. Working with bodily processes is an important part of the gestalt approach. The adherence framework does not prohibit body interventions, but defines the boundaries of their adaptation to the online format. Details will be covered at the seminar.