Article

Stabilizing Group Treatment for Complex Posttraumatic Stress Disorder Related to Child Abuse Based on Psychoeducation and Cognitive Behavioural Therapy: A Multisite Randomized Controlled Trial

GGZ inGeest, Amsterdam, The Netherlands.
Psychotherapy and Psychosomatics (Impact Factor: 9.37). 05/2012; 81(4):217-25. DOI: 10.1159/000335044
Source: PubMed

ABSTRACT Evidence-based treatments for complex posttraumatic stress disorder (PTSD) related to childhood abuse are scarce. This is the first randomized controlled trial to test the efficacy of psycho-educational and cognitive behavioural stabilizing group treatment in terms of both PTSD and complex PTSD symptom severity.
Seventy-one patients with complex PTSD and severe comorbidity (e.g., 74% axis II comorbidity) were randomly assigned to either a 20-week group treatment in addition to treatment as usual or to treatment as usual only. Primary outcome measures were the Davidson trauma scale (DTS) for PTSD and the structured interview for disorders of extreme stress (SIDES) for complex PTSD symptoms. Statistical analysis was conducted in the intention-to-treat (ITT) and in the completer sample. Subjects were considered responders when scoring at 20 weeks at least 1 standard deviation below pretest findings.
The 16% attrition was relatively low. After 20 weeks, the experimental condition (large effect sizes) and control condition (medium effect sizes) both showed significant decreases on the DTS and SIDES, but differences between the conditions were not significant. The secondary responder analysis (ITT) revealed significantly more responders on the DTS (45 vs. 21%), but not on the SIDES (61 vs. 42%).
Adding psycho-educational and cognitive behavioural stabilizing group treatment for complex PTSD related to child abuse to treatment as usual showed an equivocal outcome. Patients in both conditions improved substantially during stabilizing treatment, and while significant superiority on change scores was absent, responder analysis suggested clinical meaningfulness of adding group treatment.

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    • ") der vorhandenen Therapiestudien zeigte bei Erwachsenen, die in ihrer Kindheit sexualisierter Gewalt ausgesetzt waren, nur mittlere Therapieeffekte hinsichtlich der PTBS-Symptomatik. Dorrepaal et al. 2012 haben bisher die einzige randomisiert-kontrollierte Studie vorgelegt , bei denen Patientinnen eine komplexe PTBS , die nach SIDES (structured interview for disorders of extreme stress; vgl. Pelcovitz et al., 1997) diagnostiziert war, aufwiesen. "
    Handbuch der Psychotraumatologie, 2 edited by Günter H. Seidler, Harald J. Freyberger, Andreas Maercker, 01/2015: chapter Stabilisierung: pages 641-655; Klett-Cotta., ISBN: 978-3-608-948527
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    • "As suggested by treatment guidelines (ISSTD, 2011), severely dissociative patients in first-phase treatment should identify and modify disordered attachment patterns learned in childhood , and work on competence in social interactions in parallel with development of affect regulation and grounding skills. Manualized stabilizing group treatment, including building interpersonal and affect regulation skills and specific address of dissociative problems, might be added to the program (e.g., Boon, Steele, & Van der Hart, 2011; Cloitre, Cohen, & Koenen, 2006; Dorrepaal et al., 2012). Strengthening of contextual approaches might be considered in severely dissociated patients who deteriorated in their home setting prior to treatment (e.g., Gold & Seibel, 2009). "
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    • "Complex PTSD is associated with repeated interpersonal trauma, such as child abuse and has high comorbidity rates of depressive and dissociative disorders, as well as personality disorders (Kessler et al., 1997; Molnar et al., 2001; Zanarini et al., 1998; Zlotnick et al., 1999). Complex PTSD has an adverse effect on treatment outcome (Ford and Kidd, 1998), although there is evidence for effectiveness of a stabilizing group treatment (Dorrepaal et al., 2010, 2012; Zlotnick et al., 1997). The presence of comorbid disorders e apart from PTSD symptom severity -is associated with high drop-out rates (McDonagh et al., 2005), worse outcomes (Baars et al., 2011) and decreased efficacy of exposure (Foa et al., 2000). "
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