Towards an understanding of readiness for trauma-focussed therapy in post-traumatic stress disorder: A conceptual integration of empirical data and theoretical constructs.

For people with post-traumatic stress disorder (PTSD), the concept of being 'ready' for trauma-focused therapy (TFT) has emerged from research as an important factor in initiation and completion of therapy. Lack of readiness of individual service users has been proposed as a reason for poor uptake of TFT in large implementation programs. However, there has been almost no investigation of what constitutes readiness for TFT. In this review we build a conceptual case for readiness for TFT. We use qualitative research exploring PTSD treatment service users' and providers' experiences and perspectives of care together with two motivational theories (self-determination theory and motivation to engage in treatment) to propose a model of readiness for TFT. Readiness appears to encompass a) a motivational factor that includes willingness to undertake TFT and b) a set of determinants of motivation that may include the emotional burden of TFT, perceived suitability of TFT rationale; outcome expectancy; level of suffering; perceived competence; therapeutic relationship; autonomy; social supports; stigma; and problem recognition. This review is designed to encourage further research into this important clinical construct. It offers a new perspective on the need for a preparation phase before exposure in TFT, an issue of debate in the field.