Implementing Trauma Processing Therapy in a Community Substance Use Treatment Program: A Qualitative Study
Authors: Steven Curto, MS; Tasha Bulgin, MA; Jordan Gette, PhD; Angela Gonnella, PsyD; Shannon Kehle-Forbes, PhD; Margaret Swarbrick, PhD; Denise Hien, PhD; Sonya Norman, PhD
Funding Source: National Institute of Mental Health (R01MH128836), Hybrid Effectiveness–Implementation Trial of Massed Prolonged Exposure for PTSD in Community Addiction Treatment (Project COMET).
Principal Investigators (MPIs): Denise Hien, PhD, and Sonya Norman, PhD.
Two researchers, Steven Curto and Tasha Bulgin, collaborated with study leads Hien, Kehle-Forbes and Norman on a qualitative baseline study examining how intensive trauma-focused therapy can be effectively implemented in a community substance use treatment setting. As part of Project COMET, they helped to explore how Massed Prolonged Exposure (M-PE) therapy—a treatment designed to help people recover from posttraumatic stress disorder (PTSD)—can be integrated into community substance use treatment programs serving individuals with both PTSD and substance use disorders (SUDs).
Data for this study were collected at a community substance use treatment setting in Jacksonville, Florida. The project focused on garnering the perspectives of staff regarding the implementation of M-PE in an intensive outpatient program (IOP) setting. Study staff randomly selected interested clinicians, administrators, and peer support specialists employed at the SUD program. A total of 15 participants took part in virtual, audio-recorded interviews lasting approximately 45 minutes. Interviews followed a structured guide exploring participants’ baseline knowledge of trauma-focused treatment, beliefs about trauma-recovery for those living with SUD, cultural and individual influences on perceptions of individuals living with co-occurring PTSD and SUD, and barriers to treatment. Through this process, the team sought to uncover several key insights into how M-PE might extend to IOP and residential settings. The interviews yielded common themes: clinicians and administrators emphasized the need for flexible scheduling, ongoing training, and strong organizational support, and peer specialists, who draw from their own lived experience, spoke to the empowering and restorative potential of M-PE for clients in recovery.
“Working on this project deepened my understanding of how trauma-focused therapies like M-PE can be both powerful and challenging to implement in community addiction settings,” Curto noted. “Successful integration depends not only on evidence-based methods, but also on trust, relationships, and the realities of program capacity.” Curto shared that the experience strengthened his commitment to implementation science. He plans to pursue a PhD in clinical psychology focused on trauma, PTSD, and the lasting effects of early adversity, using tools like ecological momentary assessment to understand how stress and recovery unfold in daily life and to develop equitable, culturally responsive strategies that make trauma-informed care more accessible.
Bulgin, who co-led the project, played a key role in developing the research questions, preparing the study for ethical review, and analyzing the data, alongside Curto. She and Curto recently presented their poster findings at the 41st annual meeting of the International Society for Traumatic Stress Studies and are currently developing a manuscript for publication with other co-authors from CAS, including Dr. Peggy Swarbrick and team leads. This poster represents one component of a forthcoming manuscript addressing a key implementation aim of Project COMET, focused on identifying providers’ initial perspectives prior to the integration of M-PE within a community substance use treatment program. Reflecting on the overall experience, she shared, “Before this project, I had never conducted research involving peer support specialists or individuals with lived experience. This project taught me the profound value of their perspectives and how collaborating closely with stakeholders may lead to stronger, more meaningful research and better outcomes.” Tasha plans to pursue a career in public health, where she hopes to leverage health policy to guide the development of wearable technologies and support the implementation of evidence-based treatments.
Together, these researchers represent a new generation committed to making trauma-informed care more accessible, compassionate, and sustainable. Their work underscores how thoughtful collaboration with community partners at multiple levels of care can strengthen both the design and delivery of care, ensuring that treatments are not only effective in research settings but also responsive to the real-world needs of underserved populations who stand to benefit most. By elevating the perspectives of frontline staff, this study aimed to identify potential gaps between clinical research and practical implementation, advancing efforts to make trauma processing therapies both attainable and effective in community-based substance use treatment programs.