Treatment for PTSD Related to Childhood Abuse: A Randomized Controlled Trial

Nathan Kline Institute, Orangeburg, New York, United States
American Journal of Psychiatry (Impact Factor: 12.3). 08/2010; 167(8):915-24. DOI: 10.1176/appi.ajp.2010.09081247
Source: PubMed


Posttraumatic stress disorder (PTSD) related to childhood abuse is associated with features of affect regulation and interpersonal disturbances that substantially contribute to impairment. Existing treatments do not address these problems or the difficulties they may pose in the exploration of trauma memories, an efficacious and frequently recommended approach to resolving PTSD. The authors evaluated the benefits and risks of a treatment combining an initial preparatory phase of skills training in affect and interpersonal regulation (STAIR) followed by exposure by comparing it against two control conditions: Supportive Counseling followed by Exposure (Support/Exposure) and skills training followed by Supportive Counseling (STAIR/Support).
Participants were women with PTSD related to childhood abuse (N=104) who were randomly assigned to the STAIR/Exposure condition, Support/Exposure condition (exposure comparator), or STAIR/Support condition (skills comparator) and assessed at posttreatment, 3 months, and 6 months.
The STAIR/Exposure group was more likely to achieve sustained and full PTSD remission relative to the exposure comparator, while the skills comparator condition fell in the middle (27% versus 13% versus 0%). STAIR/Exposure produced greater improvements in emotion regulation than the exposure comparator and greater improvements in interpersonal problems than both conditions. The STAIR/Exposure dropout rate was lower than the rate for the exposure comparator and similar to the rate for the skills comparator. There were significantly lower session-to-session PTSD symptoms during the exposure phase in the STAIR/Exposure condition than in the Support/Exposure condition. STAIR/Exposure was associated with fewer cases of PTSD worsening relative to both of the other two conditions.
For a PTSD population with chronic and early-life trauma, a phase-based skills-to-exposure treatment was associated with greater benefits and fewer adverse effects than treatments that excluded either skills training or exposure.

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    • "No CBT protocols we are aware of have consistently shown a 100% remission rate. Our survey of the literature has shown us that remission rates vary widely, such as less than 30% for the short-term treatment of complex PTSD in persons who have experienced childhood sexual abuse (Cloitre et al., 2010) and up to 80% recovery rate in a two-year course of schema therapy for personality disorders (Bamelis et al., 2014). One question would be as to whether contemPorary cognItIve behavIor theraPy 451 non-responders need more of the same (i.e., a longer version of the same treatment) or something different (i.e., a modified or even entirely different approach). "
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    • "Studies in this vein focus specifically on treatments directly related to problems controlling physical aggression towards others in controlled trials. However, individuals who have been the victim of childhood physical abuse may seek treatment for a multitude of concerns such as substance abuse/dependence (Easton et al. 2007; Kilpatrick et al. 2000), interpersonal problems and issues related to trust and safety (Styron and Janoff-Bulman 1997), to discuss ways to decrease the likelihood of committing physical abuse towards romantic partners (Connors et al. 2012), and/or developing posttraumatic stress disorder (Cloitre et al. 2010). Therefore, investigating the effectiveness of therapy involvement, in general as opposed to a highly controlled and specialized intervention , may provide a more representative and generalizable finding that can be better applied to the community. "
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    • "We are unaware of any parenting interventions specifically for mothers with histories of CSA who are having difficulties with parenting. Interventions that treat some of the common sequelae of abuse, such as post-traumatic stress disorder and dissociative disorders (Cloitre et al., 2010; Maldonado, Butler, & Spiegel, 2002; Resick, Suvak, Johnides, Mitchell, & Iverson, 2012), may be helpful in improving affect and interpersonal regulation more generally as well as in relation to their children. Furthermore, attachment-based parenting interventions (Suchman et al., 2010) may help survivors who are mothers with some of their parenting difficulties, including strengthening their attachment bonds with children and expressing more affection. "
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