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: 9.2). 05/2012; 81(4):217-25. DOI: 10.1159/000335044
Source: PubMed


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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Available from: Kathleen Thomaes, Aug 20, 2015
    • ") 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. "

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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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    ABSTRACT: Little is known about the possible predictors of treatment outcome in early chronically sexually abused adults. The current study aimed to investigate what impact initial levels of dissociation and pre-treatment negative change in interpersonal functioning have on treatment response after 3 months of first-phase trauma inpatient treatment as well as after a period of 1 year the patients returned to their usual lives. The sample comprised 48 inpatients with childhood sexual abuse histories and mixed trauma-related disorders who were examined at discharge and prospectively followed up for a period of 1 year under naturalistic conditions. Outcome variables were general psychiatric symptoms and interpersonal problems as measured with the Symptom Check List-Revised (SCL-R) and the Inventory of Interpersonal Problems (IIP) Circumplex. The central findings were that pathological dissociation and deterioration in interpersonal functioning prior to admittance predicted general psychiatric symptom levels and interpersonal problems at the end of treatment and at 1-year follow-up. Pathological dissociation, involving memory and identity problems, alone predicted negative outcome at the end of treatment. The findings at 1-year follow-up indicate that it is not pathological dissociation in isolation that affects outcomes, but rather the interaction between dissociation and change in interpersonal functioning prior to treatment. These findings indicate the need of addressing dissociation and interpersonal problems in treatment planning and favor an integrated treatment approach for complex trauma patients. Future research should investigate whether and how this leads to better outcome, including long-term maintenance of gains after the end of treatment.
    Full-text · Article · Dec 2013 · European Journal of Psychotraumatology
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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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    ABSTRACT: While there is evidence of clinical improvement of posttraumatic stress disorder (PTSD) with treatment, its neural underpinnings are insufficiently clear. Moreover, it is unknown whether similar neurophysiological changes occur in PTSD specifically after child abuse, given its enduring nature and the developmental vulnerability of the brain during childhood. We systematically reviewed PTSD treatment effect studies on structural and functional brain changes from PubMed, EMBASE, PsycINFO, PILOTS and the Cochrane Library. We included studies on adults with (partial) PTSD in Randomized Controlled Trials (RCT) or pre-post designs (excluding case studies) on pharmacotherapy and psychotherapy. Risk of bias was evaluated independently by two raters. Brain coordinates and effect sizes were standardized for comparability. We included 15 studies (6 RCTs, 9 pre-post), four of which were on child abuse. Results showed that pharmacotherapy improved structural abnormalities (i.e., increased hippocampus volume) in both adult-trauma and child abuse related PTSD (3 pre-post studies). Functional changes were found to distinguish between groups. Adult-trauma PTSD patients showed decreased amygdala and increased dorsolateral prefrontal activations post-treatment (4 RCTs, 5 pre-post studies). In one RCT, child abuse patients showed no changes in the amygdala, but decreased dorsolateral prefrontal, dorsal anterior cingulate and insula activation post-treatment. In conclusion, pharmacotherapy may reduce structural abnormalities in PTSD, while psychotherapy may decrease amygdala activity and increase prefrontal, dorsal anterior cingulate and hippocampus activations, that may relate to extinction learning and re-appraisal. There is some evidence for a distinct activation pattern in child abuse patients, which clearly awaits further empirical testing.
    Full-text · Article · Nov 2013 · Journal of Psychiatric Research
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