Many Lismore residents have suffered from post-traumatic stress disorder (PTSD) from the 2022 floods. Some have sought help from mental health experts, while others have put it aside and soldiered on.

This story may be of use to those still suffering from PTSD or those who feel it is time to seek help.

Southern Cross University is embarking on a clinical trial evaluating new ways to address climate-related PTSD and is now recruiting participants for its HEART (healing climate-related trauma) trial, a community-centric research model.

Central to the success of the HEART trial is its relationship with the local community. The project has set up community advisory groups across the Northern Rivers. This will ensure that the research prioritises the voices and needs of those most affected.

The Federal Government has funded Southern Cross University to undertake the world-first trial of a stepped-care model for treating mental health in response to natural disasters. Lismore and the Northern Rivers are central to the new model.

Dr Janet Schloss, the University’s Principal Investigator of HEART, says the clinical trial is founded on contemporary evidence and understanding of PTSD in a post-disaster context.

"It's actually really exciting. It's what is called a stepped-care process. So, we have our first step, which is starting now, which is a compassion program. The compassion program takes people through either a nature-based or an arts-based compassion therapy. It goes for five weeks, and it's three hours each week."

"The whole aim is actually building community resilience, because what we're after is people who have been traumatised, they will have PTSD from natural disasters. What we find is that community engagement and that connectiveness is really important, and which is why this has already been really community-based.

"If we can do the program to help these people through and build community resilience, we know that this is going to happen again, but now they have the resilience and ability to actually deal with it each time it occurs."

Dr Schloss and her team are looking for people who have gone through he 2022 floods, but you could have gone through the 2017 floods, landslides or the 2019 bushfires. You do need to be 18 years and over, and can be diagnosed or undiagnosed. The trial is looking for 374 people across the Northern Rivers, starting with people in the Lismore and Byron LGAs.

Dr Schloss explained what compassion-based therapy is.

"The beginning part is not only the actual therapy itself, so what they're doing through art to help with what triggers inside of them as a person or in nature that they actually have, and they get given skills throughout the whole session. We have very highly skilled arts-based and nature-based people who are involved in this, and being able to embed this into each of the different participants and the groups as they actually go through."

NATURE-BASED PROGRAM

Eric Bremer is an Associate Professor (Assoc. Prof.) at Southern Cross University, who will be overseeing the nature-based research.

Mr Bremer described the specific type of nature-based intervention that will be used during this trial in order to enhance health and well-being for participants.

"The idea behind that is, the way you've designed it is with a particular purpose of paying attention to and being part of the natural world, as well as the compassion element that goes with it.

"So, in terms of the broad notion of the work, there's a whole variety of possible benefits that people can get, and ways that they can get that, from the more extreme type of activities to the more mundane. And so some of the research suggests that by paying attention to actively using your body to pay attention to the natural world, to utilise your sense of smell, to utilise your vision, to pay attention to the colours and the shades, the nuances of whatever it is in the natural world. We call it attuning to information in the natural world, in the environment.

"Some of it is to do with using your auditory capacities to actively pick up and pay attention to sounds, etc. And that notion of paying attention seems to have a lot of benefits physically and mentally. Work done in the UK, for example, has utilised a program they called Three Good Things in Nature, which was getting people in an urban context to do that.

"They found, over a six-week period, enormous benefits from a mental health perspective, where people sort of changed significantly over a short period of time just by that attention."

Mr Bremer explained that the theoretical framework is around the fact that we are embedded in nature.

"The evolution of human beings is the fact that we have evolved in relation to the natural world. And therefore, everything about us is connected to the natural world. Our eyes, our senses, etc, are much more at home in the natural world than they are in our current urban environment, where there's a more cognitive approach, which is about urban environments being stressful, overly exciting and overly active.

"The natural world allows us to settle down to become more relaxed and calmer, and it allows us to be a little bit more mindful as well.

"Then there's a sort of more emotional type of response, which is more about, again, being in the urban context, very heightened emotions, things going on, being in the natural world, as you can probably feel it now, just sort of settles down a little bit emotionally.

"And then there's the approach that we've been looking at for about 10 or so years, which is much more of an embodied approach, which is about the capacity to tune to information in the natural world. It's sort of partially evolutionary, but also much more, from an ecological psychology perspective, rather than cognitive or evolutionary."

David Roland is a psychologist and the lead facilitator for the nature-based compassion group. David said the approach in this research is based on Shinrin-yoku, a practice developed in the 1980s in Japan.

"The government decided that they needed to help their workers to de-stress. So, they discovered that paying attention to the environment, and in the case of Japan, that was forests, bathing in the forest atmosphere actually had physiological as well as emotional benefits, and so it became a well-being practice. We've developed a protocol based on Shinrin-yoku or forest focus strategies.

"There's probably a few important differences about the nature-based approach that's different from, say, just taking a walk in nature. So, we're not going on a hike, we're not on a naturalist walk. We're not trying to identify the plants or animals. We're using our senses, and it seems that when we use our senses, and I'll be guiding people with activities to connect their senses to the environment, it seems to help us calm down.

"You can see that physiologically and at the end of the walk, people are usually beaming. Really, you can just see the difference in their faces. They're often feeling more energetic and soothing. We're looking for self-soothing practices."

This means field trips into various parts of the Lismore LGA.

"We've identified several environments, and we're going to start with the Lismore local government area. We've got some sites which are safe and easy to get to and don't involve a long walk. So the safety aspect is paramount. People have got to feel safe in the environment. But we've also selected sites that have as much biodiversity as we can have in a safe environment. So it means bird song, different types of plants, trees, you know, earth, things to smell, things to hear. And the other aspect is that these sites are close to facilities like toilets and shelter."

"The Lismore Botanic Gardens is one of the sites that we've chosen, and that has lovely biodiversity. It's got some shelter and toilets, and we can run a range of activities there, even if the weather is a bit wet."

David also spoke about how trauma can change someone's life.

"What happens in trauma is it just completely breaks your worldview. You may have thought you're invincible, that you were able to see your life through, you had a plan for life, and then it totally upends that narrative life story that you've had. So trauma is not just the physiological trauma, it's not just the psychological trauma, it's also the social trauma.

"The community that you had is no longer there, or it's fractured. One of the things we're doing with this program is creating little families, little groups of people, that will create new communities. And it's been shown that after natural disasters, when people come together in self-help groups, that's really restorative and really empowering for them."

David is looking for groups of about 12 people who will go through the group program together.

"They'll become like this little family, and that will be over five weeks. They have three-hour weekly sessions over five weeks. So it works out to be about 15 hours of time."

ARTS-BASED PROGRAM

Sunita Bala is the arts-based program trainer. Sunita explained how the arts will play a role in the research.

"People get to spend time focusing on themselves, time for reflection, time for connection and community, and to be able to create art and use that as a tool to explore the concepts of compassion.

"We're going to try and keep a very open format. It's about engaging in your creativity, and the creativity is just a tool. So there will be some drawing and painting, some collaging, and we're open to exploring those different things that people want to do. Most people don't get the time to play and to explore creative tools, and that's what this time is about. It's about using that time for themselves,

"Creativity is just the tool, but it's really about exploring the concepts of compassion, and how, through the concepts of compassion, people can start to create a blueprint about how to actually reconnect, have the confidence to actually then start making decisions that are kind and good for themselves and for their communities."

RESILIENT LISMORE

Well-known charity organisation Resilient Lismore is also playing a part in the HEART trial.

Executive Director, Ellie Bird, said that Tropical Cyclone Alfred had stirred memories for flood-affected people in 2022.

"We saw what that experience was like for our community. People were feeling very fragile. It really brought up a lot of memories for them, and so this project is really about supporting people to be able to navigate those experiences.

"Some people still have trouble navigating their day-to-day because of their experiences. When it rains heavily, people have reactions, and the experience of trauma is wide-ranging and different for lots of folks, but we do know that it is prevalent in our community, and that's why we're really pleased to be a part of this project.

"I am one of the chief investigators on the project, so my role alongside some other community reps, is to make sure that the work that is done is grounded in community experience, and we provide advice and input into the shape of the project to ensure that it's being designed in a way that will meet the needs of our community."

As the HEART trial is funded by the Federal Government, if successful, it can be rolled out nationally, so it can help any community suffering PTSD from any natural disaster.

Heart is a two-step care program that will run over 2-3 years.

Step 1 is the compassion-based projects outlined above, and Step 2 is for people who have gone through the compassion program and still feel a bit traumatised.

Step 2 is MDMA assisted therapy, which basically means that they will be given MDMA, but they also have the therapy and the compassion component as part of the program.

This much smaller trial will test whether MDMA-assisted therapy is effective for people who still have PTSD after completing Step 1. Step 2 is being planned for 2026 to 2027.

Dr Schloss said the end goal for the HEART trial is to achieve community resilience.

"What we're really trying to do is build that whole community resilience and ability to go through and then have this program to be able to take it to different areas around Australia or the world that have related disasters and are traumatised."

The trial will use a dedicated website, videos, and public talks to communicate with the community and stakeholders. This will ensure clarity, transparency, and engagement.

How to take part in the study

You may be able to take part in the HEART clinical trial if you:

• Are an adult, 18 years or older.

• Were directly impacted by a climate-related disaster (e.g. flood, bushfire or landslide) between 2017 and 2022.

• Live in the Northern Rivers of NSW.

• Have or think you may have PTSD.

• Can understand and communicate in English.

• Agree to take part in the study, including group sessions and follow-up activities.

The trial runs for 5 weeks. Participants meet once a week for a 3-hour session. Before and after the program, participants will complete questionnaires on their mental health and well-being.

To see if you’re eligible, visit the dedicated project website: heart.scu.edu.au.

For more information about the project, email heart@scu.edu.au.