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Bohus M, Vonderlin R. [Dialectical behavioral therapy for complex posttraumatic stress disorder (DBT-PTSD): an evidence-based disorder-specific treatment program]. DER NERVENARZT 2024; 95:630-638. [PMID: 38874612 DOI: 10.1007/s00115-024-01680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/15/2024]
Abstract
Dialectical behavioral therapy for complex posttraumatic stress disorders (DBT-PTSD) is a modular treatment program that was developed at the Central Institute for Mental Health at the University of Heidelberg, Germany in 2005-2021. DBT-PTSD is designed to meet the needs of patients with complex PTSD related to sexual or physical trauma in childhood and adolescence. It is specifically designed for patients suffering from severe emotional dysregulation, persistent self-injury, chronic suicidal ideation, severe dissociative symptoms and a markedly negative self-concept with a high level of guilt, shame, self-loathing and interpersonal problems. To address these different core symptoms, DBT-PTSD combines evidence-based therapeutic strategies: principles, rules, and skills of DBT, trauma-specific cognitive and exposure-based techniques, imaginative interventions and procedures for behavioral change. The treatment program is designed to be carried out in an outpatient (45 weeks) or residential (12 weeks) setting. The results from two randomized controlled trials showed large effect sizes across very different symptom domains and a significant superiority of DBT-PTSD over Cognitive Processing Therapy (CPT). Based on these results, DBT-PTSD is currently a promising evidence-based treatment program for all features of a complex PTSD after sexual abuse in childhood and adolescence.
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Affiliation(s)
- Martin Bohus
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland.
- McLean Hospital, Harvard Medical School, Boston, MA, USA.
- Forschungs- und Behandlungszentrum für Psychische Gesundheit, Abteilung für Klinische Psychologie und Psychotherapie, Ruhr Universität Bochum, Bochum, Deutschland.
| | - Ruben Vonderlin
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
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Brenner L, Chrysanthou S, Rothermund E, Köllner V. [Effects of complex trauma disorder on the workplace: a scoping review]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:833-842. [PMID: 38890155 DOI: 10.1007/s00103-024-03908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The "International Classification of Diseases 11th Revision" (ICD-11) introduces complex post-traumatic stress disorder (CPTSD) as a separate diagnosis to account for the effects that persistent or repetitive trauma can have. In CPTSD, disorders of self-organization are added to the core symptoms of PTSD. It can be assumed that those affected are impaired in their professional lives as a result. The aim of this paper is to provide an overview of the effects of CPTSD on work-related functioning and to present possible consequences for therapeutic and rehabilitative treatment. METHOD A scoping review with a literature search in the MEDLINE, APA PsycArticles, and APA PsycInfo databases was conducted in February 2024. RESULTS Of 2378 studies on KPTBS, five studies were included, of which only three dealt more specifically with the impact on the world of work. Those affected appear to have a poorer prognosis for maintaining their ability to work and are therefore to be regarded as a socio-medical risk group with regard to long-term maintenance of participation in working life. DISCUSSION The current state of research on the effects of the CPTSD symptom complex on the world of work is surprisingly limited. In comparison, the results indicate that CPTSD has a greater negative impact on the ability to function in the world of work than PTSD and other mental disorders. It is still unclear which psychopathological mechanisms mediate the connection. Only basic findings on the psychopathology of CPTSD are available. Treatment approaches that address the disorders of self-organization in addition to PTSD symptoms appear necessary.
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Affiliation(s)
- Lorena Brenner
- Forschungsgruppe Psychosomatische Rehabilitation, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Sophia Chrysanthou
- Reha-Zentrum Seehof der Deutschen Rentenversicherung, Lichterfelder Allee 55, 14513, Teltow, Deutschland
| | - Eva Rothermund
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Volker Köllner
- Forschungsgruppe Psychosomatische Rehabilitation, Charité Universitätsmedizin Berlin, Berlin, Deutschland.
- Reha-Zentrum Seehof der Deutschen Rentenversicherung, Lichterfelder Allee 55, 14513, Teltow, Deutschland.
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Sanchez M, Fouques D, Gorgiard C, Soussy A, Romo L. Intimate Partner Sexual Violence: An Exploratory Study on Sexual Victimization Profiles Among Survivors of Intimate Partner Violence in France. Violence Against Women 2024; 30:1731-1759. [PMID: 38477712 DOI: 10.1177/10778012241238241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Intimate partner sexual violence (IPSV) is a common form of intimate partner violence (IPV). This study aimed to (a) identify a typology of intimate partner sexual victimization among French women victims of IPV on the basis of the frequency of various forms of sexual violence and (b) evaluate whether these profiles differ in several clinical characteristics. A total of 93 women consulting a specialized hospital service were recruited. Cluster analyses suggested four profiles: highly frequent rapes (5.4%), predominant sexual coercion (20.4%), medium frequency of all forms (20.4%), and low frequency of all forms (19.4%). Further person-centered research focusing on IPSV is warranted.
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Affiliation(s)
| | - Damien Fouques
- Laboratoire Psychopathologie et Processus de Changement, ED 224, Université Paris 8 Vincennes-Saint-Denis, Saint-Denis, France
| | | | - Annie Soussy
- Unité Médico-Judiciaire, Hôpital Intercommunal de Créteil, Créteil, France
| | - Lucia Romo
- Unité de Recherche CLIPSYD, Université Paris Nanterre, Nanterre, France
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Liu A, Ren Y, Yang S, Li Z, Zhu Z, Zhang LM, Peng Y. Contemporaneous and temporal network analysis of complex Posttraumatic stress disorder among Chinese college students with Childhood adversity: A longitudinal study. Psychiatry Res 2024; 336:115872. [PMID: 38581767 DOI: 10.1016/j.psychres.2024.115872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/17/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To enhance understanding of the longitudinal progression of complex posttraumatic stress disorder (CPTSD) symptoms, this longitudinal study examined how CPTSD symptoms interact over time in Chinese college students with childhood trauma. METHODS From 18,933 college students who took part in two surveys 12 months apart, 4,006 participants who reported adverse childhood experiences were screened. Cross-sectional network comparisons and cross-lagged panel network (CLPN) analysis characterized interactions among CPTSD symptoms. RESULTS In the cross-sectional networks, feeling like a failure and avoid activities reminiscent of the trauma were the central symptoms. Takes long time to calm down and exaggerated startle are important bridge symptoms in the two networks respectively. The comparison of cross-sectional networks indicates that the global network strength was stable. The findings of the CLPN model reveal that feel worthless and feel like a failure had the highest "out" expected influence; exaggerated startle and avoid thoughts and feelings about the trauma had the highest "in" expected influence. CONCLUSIONS By conducting cross-sectional network analyses, the study illuminated the attributes of CPTSD networks across various time points. Additionally, the CLPN analysis uncovered the longitudinal patterns of CPTSD symptoms.
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Affiliation(s)
- Aiyi Liu
- Faculty of Psychology, Beijing Normal University, Beijing 100875, PR China
| | - Yizhen Ren
- Faculty of Psychology, Beijing Normal University, Beijing 100875, PR China
| | - Shuhan Yang
- Faculty of Education, Yunnan Normal University, Kunming 650500, PR China
| | - Zimi Li
- Faculty of Psychology, Northeast Normal University, Changchun 130024, Jilin Province, PR China
| | - Zibin Zhu
- School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK
| | - Lake Mozi Zhang
- Faculty of Psychology, Beijing Normal University, Beijing 100875, PR China
| | - Yu Peng
- Students Mental Health Education & Counseling Center, Kunming University of Science and Technology, Kunming 650500, China; Faculty of Social Sciences & Liberal Arts, UCSI University, Kuala Lumpur 56000, Malaysia.
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5
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Chessa A, Sentissi O. [ICD-11: New revision and impact of this classification in psychiatry]. L'ENCEPHALE 2024; 50:329-338. [PMID: 38092593 DOI: 10.1016/j.encep.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/26/2023] [Accepted: 10/27/2023] [Indexed: 05/31/2024]
Abstract
OBJECTIVES After more than 20 years of work, the World Health Organization's efforts have culminated in the adoption of the 11th revision of the International Classification of Diseases (ICD-11). The process has been guided by the principles of global applicability, scientific validity, and clinical utility. The update of the chapter on mental, behavioral, and neurodevelopmental disorders (MBND) within the ICD-11 has generated widespread interest worldwide. This has raised various questions about the status of mental disorder nosology, changes to diagnostic guidelines, and the potential implications for clinical practice. METHODS We conducted a narrative analysis of the literature in four different languages to track the various stages of the ICD-11 revision and to highlight the major changes. We searched databases such as PubMed, EMBASE, MEDLINE, and Google Scholar, and consulted the official websites of the WHO, APA, and UNICEF. A total of 79 articles from 40 different editorials and websites were analyzed and included in this study. RESULTS The new chapters on mental disorders in the ICD-11 include 21 groups, as opposed to the 11 in the ICD-10. The changes aim to align the diagnoses with those of the DSM-5 and introduce a new chapter structure, new diagnostic categories, modifications to diagnostic criteria, and advancements in dimensionality. For the first time in the history of the ICD, sleep and wakefulness disorders, as well as disorders related to sexual health, have been addressed in separate chapters of the international classification. Four new diagnoses have been added: complex post-traumatic stress disorder (PTSD), gaming disorder, prolonged grief disorder, and compulsive sexual behavior which replaces "excessive sexual activity" in the ICD-10. Moreover, the ICD-11 revision has brought about a fundamental change in the clinical conceptualization of addictive behaviors, introducing a distinction between substance use disorders and addictive behaviors. The criteria for many existing conditions have been revised, particularly those related to bipolar disorders, eating disorders, and gender identity disorders. CONCLUSIONS The revision process for mental, behavioral, and neurodevelopmental disorders in the ICD-11 has witnessed unprecedented participation in the history of mental disorder classification. These changes could have a significant impact on clinical practice in psychiatry. However, it is crucial to examine the advantages and limitations of this new classification compared to previous versions.
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Affiliation(s)
- Ambra Chessa
- Département de psychiatrie, service de psychiatrie adulte, CAPPI jonction, hôpitaux universitaires Genève, 35, rue des Bains, 1205 Genève, Suisse
| | - Othman Sentissi
- Département de psychiatrie, service de psychiatrie adulte, CAPPI jonction, hôpitaux universitaires Genève, 35, rue des Bains, 1205 Genève, Suisse.
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Hamid A, Williams ACDC, Albakri M, Scior K, Morgan S, Kayal H, Wilcockson M, Drouish Alkaja R, Alsayed S, Logie R, Farrand S, Abdul-Hamid W. Mental health and conflict: a pilot of an online eye movement desensitisation and reprocessing (EMDR) intervention for forcibly displaced Syrian women. Front Public Health 2024; 12:1295033. [PMID: 38873297 PMCID: PMC11173598 DOI: 10.3389/fpubh.2024.1295033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Background The Syrian conflict has been ongoing since 2011. Practical and scalable solutions are urgently needed to meet an increase in need for specialised psychological support for post-traumatic stress disorder given limited availability of clinicians. Training forcibly displaced Syrians with a mental health background to remotely deliver specialised interventions increases the availability of evidence based psychological support. Little is known about the effectiveness of online therapy for forcibly displaced Syrian women provided by forcibly displaced Syrian women therapists. Purpose To pilot an evidence-based trauma therapy, Eye Movement Desensitisation and Reprocessing (EMDR), carried out online by trained forcibly displaced Syrian women therapists for forcibly displaced Syrian women who require treatment for post-traumatic stress disorder (PTSD). Methods 83 forcibly displaced Syrian women, living in Türkiye or inside Syria, with diagnosable PTSD, were offered up to 12 sessions of online EMDR over a period of 3 months. This was delivered by forcibly displaced Syrian women therapists who were trained in EMDR. Data were gathered, using Arabic versions, on PTSD symptoms using the Impact of Events Scale Revised, depression symptoms using the Patient Health Questionnaire-9 and anxiety symptoms using the Generalised Anxiety Disorder Assessment-7 at baseline, mid-point, and end of therapy. Results PTSD scores, depression scores and anxiety scores all significantly reduced over the course of treatment, with lower scores at midpoint than baseline and lower scores at end of treatment than at midpoint. Only one participant (1%) exceeded the cutoff point for PTSD, and 13 (16%) exceeded the cutoff points for anxiety and depression at the end of treatment. Conclusion In this pilot study up to 12 sessions of online EMDR were associated with reductions in PTSD, anxiety and depression symptoms in Syrian women affected by the Syrian conflict. The training of forcibly displaced Syrian mental health professionals to deliver online therapy is a relatively low cost, scalable, sustainable solution to ensure that those who are affected by the conflict can access specialised support. Further research is needed using a control group to confirm that the observed effects are due to EMDR treatment, as is research with post-treatment follow-up to ascertain that benefits are maintained.
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Affiliation(s)
- Aseel Hamid
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Amanda C. de C. Williams
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | | | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | | | | | - Matthew Wilcockson
- Coventry University and Coventry and Warwickshire Partnership Trust, Coventry, United Kingdom
| | - Rouba Drouish Alkaja
- Trauma Aid UK, Somerset, United Kingdom
- Independent Psychologist, Gaziantep, Türkiye
| | - Sahbaa Alsayed
- Trauma Aid UK, Somerset, United Kingdom
- Independent Psychologist, Gaziantep, Türkiye
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Riedl D, Kampling H, Nolte T, Kirchhoff C, Kruse J, Sachser C, Fegert JM, Gündel H, Brähler E, Grote V, Fischer MJ, Lampe A. Utilization of Mental Health Provision, Epistemic Stance and Comorbid Psychopathology of Individuals with Complex Post-Traumatic Stress Disorders (CPTSD)-Results from a Representative German Observational Study. J Clin Med 2024; 13:2735. [PMID: 38792277 PMCID: PMC11121826 DOI: 10.3390/jcm13102735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Complex post-traumatic stress disorder (CPTSD) is a severely debilitating recently added symptom cluster in the International Classification of Diseases (ICD-11). So far, only limited information on mental health treatment-uptake and -satisfaction of individuals with CPTSD is available. The aim of this study is to investigate these aspects in a representative sample of the German general population. Methods: Participants completed the International Trauma Questionnaire (ITQ) to identify participants with CPTSD, as well as questionnaires on mental health treatment uptake and satisfaction, adverse childhood experiences, anxiety, depression, working ability, personality functioning, and epistemic trust. Results: Of the included n = 1918 participants, n = 29 (1.5%) fulfilled the criteria for CPTSD. Participants with CPTSD had received mental health treatment significantly more often than participants with PTSD or depression (65.5% vs. 58.8% vs. 31.6%; p = 0.031) but reported significantly less symptom improvement (52.9% vs. 78.0% vs. 80.0%; p = 0.008). Lower levels of epistemic trust were associated with higher CPTSD symptoms (p < 0.001). Conclusions: Our study shows that while the vast majority of individuals with CPTSD had received mental health treatment, subjective symptom improvement rates are not satisfactory. CPTSD was associated with a broad number of comorbidities and impairments in functioning. Lower levels of epistemic trust may partially explain worse treatment outcomes.
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Affiliation(s)
- David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35392 Giessen, Germany
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London N1 9JH, UK
- Research Department for Clinical, Educational and Heath Psychology University College London, London WC1E 6BT, UK
| | - Christina Kirchhoff
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35392 Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, 35037 Marburg, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, 89075 Ulm, Germany
- German Center for Mental Health (DZPG), Partner Site Ulm, 89075 Ulm, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, 89075 Ulm, Germany
- German Center for Mental Health (DZPG), Partner Site Ulm, 89075 Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Ulm Medical Center, 89081 Ulm, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, Germany
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- VAMED Rehabilitation Center Kitzbuehel, 6370 Kitzbuehel, Austria
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria; (V.G.); (M.J.F.)
- VAMED Rehabilitation Montafon, 6780 Schruns, Austria
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Bressington D, Hyland P, Steele H, Byrne M, Mitchell D, Keane C, Shevlin M, Ho G, Murta JCD, Easpaig BNG, Liu X, Zhai J, Murphy D, Karatzias T. ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder in mental health support-seeking former-serving Australian defence force veterans. Aust N Z J Psychiatry 2024; 58:416-424. [PMID: 38332613 DOI: 10.1177/00048674241230197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND ICD-11 complex post-traumatic stress disorder is a more severe condition than post-traumatic stress disorder, and recent studies indicate it is more prevalent among military samples. In this study, we tested the psychometric properties of the International Trauma Questionnaire, assessed the relative prevalence rates of post-traumatic stress disorder and complex post-traumatic stress disorder in the sample population and explored relationships between complex post-traumatic stress disorder and post-traumatic stress disorder and a range of risk factors. METHODS Survey participants (N = 189) were mental health support-seeking former-serving veterans of the Australian Defence Force (ADF) recruited from primary care. Confirmatory factor analysis was used to test the factorial validity of the International Trauma Questionnaire. RESULTS The latent structure of the International Trauma Questionnaire was best represented by a two-factor second-order model consistent with the ICD-11 model of complex post-traumatic stress disorder. The International Trauma Questionnaire scale scores demonstrated excellent internal reliability. Overall, 9.1% (95% confidence interval = [4.8%, 13.5%]) met diagnostic requirements for post-traumatic stress disorder and an additional 51.4% (95% confidence interval = [44.0%, 58.9%]) met requirements for complex post-traumatic stress disorder. Those meeting diagnostic requirements for complex post-traumatic stress disorder were more likely to have served in the military for 15 years or longer, had a history of more traumatic life events and had the highest levels of depression, anxiety and stress symptoms. CONCLUSION The International Trauma Questionnaire can effectively distinguish between post-traumatic stress disorder and complex post-traumatic stress disorder within primary care samples of Australian Defence Force veterans. A significantly greater proportion of Australian Defence Force veterans met criteria for complex post-traumatic stress disorder than post-traumatic stress disorder. Australian military mental health services should adopt the International Trauma Questionnaire to routinely screen for complex post-traumatic stress disorder and develop complex post-traumatic stress disorder specific interventions to promote recovery in Australian Defence Force veterans with complex post-traumatic stress disorder.
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Affiliation(s)
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Mitchell Byrne
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - David Mitchell
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
- Department of Health, Office of the Chief Psychiatrist, Darwin, NT, Australia
| | - Carol Keane
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Grace Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China SAR
| | | | | | - Xianliang Liu
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Jianxia Zhai
- STEM College, RMIT University, Melbourne, VIC, Australia
| | - Dominic Murphy
- Department of Research, Combat Stress, Leatherhead, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
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9
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Karatzias T, Shevlin M, Cloitre M, Busuttil W, Graham K, Hendrikx L, Hyland P, Biscoe N, Murphy D. Enhanced Skills Training in Affective and Interpersonal Regulation versus Treatment as Usual for ICD-11 Complex PTSD: A Pilot Randomised Controlled Trial (The RESTORE Trial). PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:203-215. [PMID: 38688242 DOI: 10.1159/000538428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/16/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Complex PTSD (CPTSD) is a relatively new condition in ICD-11. This pilot randomised controlled trial aimed to compare a four-module intervention developed to target all symptoms of ICD-11 CPTSD, namely Enhanced Skills in Affective and Interpersonal Regulation (ESTAIR) with treatment as usual (TAU). The purpose of the study was to assess feasibility, safety, acceptability, and preliminary outcomes at the end of treatment and 3-month follow-up. METHODS A total of N = 56 eligible veterans with CPTSD were randomised to either ESTAIR (n = 28) or TAU (n = 28). Linear mixed models were conducted to assess CPTSD severity, the primary outcome, as measured by the International Trauma Questionnaire (ITQ). RESULTS Treatment dropout in ESTAIR and TAU was low and equivalent (18% vs. 11%; χ2 (1) = 1.19, p = 0.275), and study retention was high, supporting the feasibility of the study. No serious adverse effects and very few adverse effects occurred, none of which were deemed related to the study. ESTAIR provided significantly greater reduction in CPTSD severity across time for ITQ PTSD (p < 0.001) and DSO (p < 0.001) symptoms. CPTSD pre-to-post effect sizes for ESTAIR were large (PTSD d = 1.78; DSO d = 2.00). Remission of probable CPTSD diagnosis at post-treatment was substantially greater in ESTAIR compared to TAU with only 13.6% versus 84% (p < 0.001) retaining the diagnosis. CONCLUSION A trial of ESTAIR versus TAU for the treatment of ICD-11 CPTSD indicates the potential efficacy of ESTAIR as well as its feasibility, safety, and acceptability.
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Affiliation(s)
- Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- NHS Lothian Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Northern Ireland, UK
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, California, USA
| | | | | | | | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Dominic Murphy
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
- King's Centre for Military Research, Kings College London, London, UK
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10
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Swee MB, Corman AG, Margolis JM, Dick AM. Compassion-Focused Therapy for the Treatment of ICD-11-Defined Complex Posttraumatic Stress Disorder. Am J Psychother 2024:appipsychotherapy20230019. [PMID: 38680060 DOI: 10.1176/appi.psychotherapy.20230019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The most effective treatments for ICD-11-defined complex posttraumatic stress disorder (CPTSD) remain unknown. Further research is needed to determine whether such treatments for CPTSD are the same as or different from-or require integration with-existing gold standard treatments for posttraumatic stress disorder (PTSD). Individuals with CPTSD experience the hallmark symptoms of PTSD (i.e., reexperiencing symptoms, avoidance symptoms, and the pervasive sense of perceived threat) and pervasive disturbances in self-organization, including affective dysregulation, negative self-concept, and difficulties with interpersonal relationships. Compassion-focused therapy (CFT) is a transdiagnostic approach that was originally developed to treat shame and self-criticism. CFT helps individuals learn how to regulate their emotions, shift their emotional response style from shaming and self-critical to wise and understanding, and engage in more compassionate and rewarding patterns of relating to self and others. This article describes CFT's possible application in the treatment of CPTSD and delineates areas for future research.
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Affiliation(s)
- Michaela B Swee
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Swee, Dick)
| | - Allison G Corman
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Swee, Dick)
| | - Jessica M Margolis
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Swee, Dick)
| | - Alexandra M Dick
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Swee, Dick)
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11
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Grinsill R, Kolandaisamy M, Kerr K, Varker T, Khoo A. Prevalence of Complex Post-Traumatic Stress Disorder in Serving Military and Veteran Populations: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241246996. [PMID: 38651819 DOI: 10.1177/15248380241246996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Serving military personnel and veterans are known to be at elevated risk of post-traumatic stress disorder (PTSD), and some veterans have been shown to respond poorly to current standard treatments. Evidence so far suggests that according to the 11th edition of the International Classification of Diseases and Related Health Problems guidelines, complex PTSD (CPTSD) may be of higher prevalence in the general population than PTSD. The aim of the study was to investigate the prevalence of CPTSD compared to PTSD in serving and ex-serving military populations. A systematic review was conducted with the search criteria set to peer-reviewed English language journal articles, focusing on serving military or veteran populations, reporting on the prevalence of CPTSD, not restricted by year. Four comprehensive databases (Psycinfo, Pubmed, CINAHL, and Embase) were searched. Of the 297 identified articles, 16 primary studies were eligible for inclusion. The review was registered in the PROSPERO database (CRD42023416458), and results were reported based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of the 16 studies, 13 demonstrated higher prevalence of CPTSD than PTSD. Studies were predominantly veteran focused. Prevalence of CPTSD ranged from 5% to 80.63%, while prevalence of PTSD ranged from 3.8% to 42.37%. There was high heterogeneity in study populations, preventing meta-analysis. This is the first systematic review to assess the prevalence of CPTSD in serving military and veteran populations, with the findings demonstrating a higher rate of CPTSD compared to PTSD. It is hoped that the review will assist clinicians and military and veteran health services with appropriate assessment, diagnosis, and intervention for those affected by CPTSD, as well as PTSD.
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Affiliation(s)
| | | | - Katelyn Kerr
- Toowong Private Hospital, QLD, Australia
- Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt, QLD, Australia
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, QLD, Australia
- Savoir Rooms Specialist Medial Practice, Milton, QLD, Australia
| | - Tracey Varker
- Phoenix Australia-Centre for Posttraumatic Mental Health, University of Melbourne, Carlton, VIC, Australia
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Day S, Hay P, Basten C, Byrne S, Dearden A, Goldstein M, Hannigan A, Heruc G, Houlihan C, Roberts M, Tannous WK, Thornton C, Valentine N, Mitchison D. Posttraumatic stress disorder (PTSD) and complex PTSD in eating disorder treatment-seekers: Prevalence and associations with symptom severity. J Trauma Stress 2024. [PMID: 38637955 DOI: 10.1002/jts.23047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
Although childhood trauma and posttraumatic stress disorder (PTSD) have been well-researched in eating disorder epidemiology, prevalence rates are unavailable for complex PTSD (CPTSD). Under recently introduced ICD-11 criteria, individuals with CPTSD have both PTSD symptoms and additional disturbances in self-organization (DSO). Using ICD-11 criteria, this study aimed to determine the prevalence of PTSD and DSO symptoms, diagnostic rates of PTSD and CPTSD, and childhood trauma exposure in eating disorder treatment-seekers. Participants (N = 217) were individuals attending residential, partial hospitalization, and outpatient services who completed measures of eating disorder- and trauma-related symptoms and childhood adverse experiences. One third of participants reported PTSD symptoms, and over half reported DSO symptoms, with probable ICD-11 diagnostic rates of 3.8% for PTSD and 28.4% for CPTSD. CPTSD was significantly more prevalent than PTSD and more common in higher levels of care. Both PTSD and DSO symptom severity were positively correlated with eating disorder symptoms and impairment, rs = .285-.642. DSO symptom severity was a significant and unique explanatory factor of eating disorder severity and impairment. The findings highlight the prevalence of CPTSD in eating disorder populations and the association between DSO symptoms and eating psychopathology independent of PTSD symptoms. Implications are discussed for adjunct treatment approaches for individuals with comorbid eating disorders and PTSD or CPTSD.
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Affiliation(s)
- Sinead Day
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Penrith, Australia
- Mental Health Services Camden and Campbelltown Hospitals, South West Sydney Local Health District, Sydney, Australia
| | | | - Susan Byrne
- School of Psychology, University of Western Australia, Perth, Australia
- The Swan Centre, Perth, Australia
| | - Amanda Dearden
- Queensland Eating Disorder Service, Indooroopilly, Australia
| | - Mandy Goldstein
- School of Medicine, Western Sydney University, Penrith, Australia
- everyBody Psychology & Wellbeing, Bondi Junction, Australia
| | - Amy Hannigan
- Queensland Eating Disorder Service, Indooroopilly, Australia
| | | | - Catherine Houlihan
- School of Health, University of the Sunshine Coast, Queensland, Australia
| | - Marion Roberts
- Department of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
- Nurture Psychology, Auckland, New Zealand
| | - W Kathy Tannous
- School of Business, Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | | | | | - Deborah Mitchison
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
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Wigard I, Meyerbröker K, Ehring T, Topper M, Arntz A, Emmelkamp P. Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial. Eur J Psychotraumatol 2024; 15:2332104. [PMID: 38629403 PMCID: PMC11025408 DOI: 10.1080/20008066.2024.2332104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..
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Affiliation(s)
- I. Wigard
- Parnassiagroep, Amsterdam, the Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - K. Meyerbröker
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
- Altrecht Academic Anxiety Centre, Utrecht, the Netherlands
| | - T. Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - M. Topper
- GGZ-Noord-Holland-Noord, Alkmaar, the Netherlands
| | - A. Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - P. Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Lechner-Meichsner F, Comtesse H, Olk M. Prevalence, comorbidities, and factors associated with prolonged grief disorder, posttraumatic stress disorder and complex posttraumatic stress disorder in refugees: a systematic review. Confl Health 2024; 18:32. [PMID: 38627778 PMCID: PMC11020800 DOI: 10.1186/s13031-024-00586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The number of refugees worldwide is at an all-time high with many being exposed to potentially traumatic events and the loss of loved ones. The 11th revision of the International Statistical Classification of Diseases and Related Health Problems now includes prolonged grief disorder and complex posttraumatic stress disorder and revised criteria for posttraumatic stress disorder. An overview of these stress-related disorders among people who have become refugees is therefore needed. Consequently, we conducted a systematic review to determine prevalence rates, comorbidities, and associated factors for each of the disorders. METHOD We systematically searched PubMed, Web of Science, and PsycArticles to identify studies that reported prevalence rates, predictors or associated factors, and/or comorbid mental disorders for either (1) prolonged grief disorder, (2) posttraumatic stress disorder, or (3) complex posttraumatic stress disorder among refugees. The selection process followed the PRISMA guidelines. RESULTS A total of 36 studies met the inclusion criteria. Most of the studies were of high quality. There was substantial variation in prevalence rates by disorder, with prolonged grief ranging from 6 to 54%, posttraumatic stress disorder ranging from 0.4 to 80%, and complex posttraumatic stress disorder ranging from 3 to 74.6%. Pooled prevalence for posttraumatic stress disorder was estimated at 29.8% in treatment seeking samples and 9.92% in population samples. For complex posttraumatic stress disorder, it was estimated at 57.4% in treatment seeking samples and 7.8% in population samples. Posttraumatic stress disorder was among the most frequent comorbidities for prolonged grief disorder while depressive symptoms were the most frequently occurring co-morbidity across all three disorders. Sociodemographic variables, trauma exposure, and loss characteristics were associated with higher symptom severity. Postmigration living difficulties played an important role in prolonged grief and complex posttraumatic stress disorder. CONCLUSION The review revealed substantial differences in prevalence rates between the three studied disorders but underscored a very high prevalence of ICD-11 stress-related disorders among refugees. The identified associated factors point to subgroups that may be particularly at risk and establishes a foundational basis for targeted interventions and potential policy changes. Future research should incorporate longitudinal investigations and emphasize culturally sensitive assessments.
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Affiliation(s)
- Franziska Lechner-Meichsner
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany.
- Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, Netherlands.
| | - Hannah Comtesse
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Ostenstraße 26, 85072, Eichstätt, Germany
| | - Marie Olk
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany
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Biscoe N, New E, Murphy D. Complex PTSD symptom clusters and executive function in UK Armed Forces veterans: a cross-sectional study. BMC Psychol 2024; 12:209. [PMID: 38622745 PMCID: PMC11020799 DOI: 10.1186/s40359-024-01713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Less is known about complex posttraumatic stress disorder (CPTSD) than postrraumatic stress disorder (PTSD) in military veterans, yet this population may be at greater risk of the former diagnosis. Executive function impairment has been linked to PTSD treatment outcomes. The current study therefore aimed to explore possible associations between each CPTSD symptom cluster and executive function to understand if similar treatment trajectories might be observed with the disorder. METHODS A total of 428 veterans from a national charity responded to a self-report questionnaire which measured CPTSD symptom clusters using the International Trauma Questionnaire, and executive function using the Adult Executive Function Inventory. Single and multiple linear regression models were used to analyse the relationship between CPTSD symptom clusters and executive function, including working memory and inhibition. RESULTS Each CPTSD symptom cluster was significantly associated with higher executive function impairment, even after controlling for possible mental health confounding variables. Emotion dysregulation was the CPTSD symptom cluster most strongly associated with executive function impairment. CONCLUSIONS This is the first study to explore the relationship between executive function and CPTSD symptom clusters. The study builds on previous findings and suggests that executive function could be relevant to CPTSD treatment trajectories, as is the case with PTSD alone. Future research should further explore such clinical implications.
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Affiliation(s)
| | - Emma New
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Dominic Murphy
- Combat Stress, Leatherhead, Surrey, KT22 0BX, UK
- King's Centre for Military Health Research, King's College London, London, SE5 9PR, UK
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Lampe A, Riedl D, Kampling H, Nolte T, Kirchhoff C, Grote V, Fischer MJ, Kruse J. Improvements of complex post-traumatic stress disorder symptoms during a multimodal psychodynamic inpatient rehabilitation treatment - results of an observational single-centre pilot study. Eur J Psychotraumatol 2024; 15:2333221. [PMID: 38577992 PMCID: PMC11000601 DOI: 10.1080/20008066.2024.2333221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Background: Complex post-traumatic stress disorder (CPTSD) describes chronic disturbances in self-organization (i.e. affect dysregulation; negative self-concept; severe difficulties in relationships) which are frequently observed in survivors of prolonged, repeated or multiple traumatic stressors. So far, evidence of psychodynamic treatment approaches for CPTSD is scarce.Methods: In this single-centre observational pilot study, symptom change during a 6-week psychodynamic inpatient treatment in a multimodal psychosomatic rehabilitation centre was evaluated using repeated measures analyses of variance (ANOVAs). Patients completed questionnaires on PTSD and CPTSD symptoms (ITQ), anxiety, depression and somatization (BSI-18), functional impairment (WHODAS) and epistemic trust, mistrust and credulity (ETMCQ) before (T1) and at the end of treatment (T2). A hierarchical linear regression analysis was calculated to identify factors associated with improved CPTSD symptoms.Results: A total of n = 50 patients with CPTSD were included in the study, of whom n = 40 (80%) completed treatment. Patients reported a significant reduction of CPTSD symptoms during treatment with a large effect size (-3.9 points; p < .001; η2 = .36), as well as a significant reduction of psychological distress (p < .001; η2 = .55) and functional impairment (p < .001; η2 = .59). At the end of treatment, 41.0% of patients no longer fulfilled the diagnostic criteria for CPTSD. Changes in epistemic stance included improved epistemic trust (β = -.34, p = .026) and decreased epistemic credulity (β = .37, p = .017), which together with lower age (β = .43, p = .012) and lower depression levels at baseline (β = .35, p = .054) were significantly associated with baseline adjusted mean change of CPTSD symptoms during therapy and explained 48% of its variance.Discussion: In our study, patients reported a significant reduction of CPTSD symptoms and comorbid symptoms during a multimodal psychodynamic inpatient rehabilitation treatment. Improved epistemic trust may facilitate the establishment of a trusting therapeutic relationship, thus fostering an environment of openness for knowledge transfer (i.e. social learning) and the exploration of diverse viewpoints and perspectives in the therapeutic process.
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Affiliation(s)
- A. Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Montafon, Schruns, Austria
| | - D. Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - H. Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - T. Nolte
- Anna Freud National Centre for Children and Families, London, UK
- Research Department for Clinical, Educational and Heath Psychology, UCL, London, UK
| | - C. Kirchhoff
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - V. Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - M. J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Center Kitzbuehel, Kitzbuehel, Austria
| | - J. Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
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Blackie M, De Boer K, Seabrook L, Bates G, Nedeljkovic M. Digital-Based Interventions for Complex Post-Traumatic Stress Disorder: A Systematic Literature Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241238760. [PMID: 38533796 DOI: 10.1177/15248380241238760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Research has shown that complex post-traumatic stress disorder (cPTSD) differs from post-traumatic stress disorder (PTSD) on core symptoms relating to the individual's sense of self, and this has driven the need for treatment approaches to address these specific features of cPTSD. The COVID-19 pandemic has led to the increased use of digital-based interventions (DBIs) to treat mental illnesses, including trauma-related disorders. However, while evidence for the use of DBIs for PTSD has previously been synthesized, the current review is the first synthesis of research on the use of DBIs for cPTSD. A systematic search of Scopus, PsychINFO, and EBSCOhost was conducted, using search terms targeting "cPTSD" and "DBIs," to identify research on the use of DBIs to treat cPTSD symptoms. Ten papers were identified, which provided preliminary evidence for the efficacy of DBIs to reduce cPTSD symptoms. Further, DBIs were reported as acceptable by individuals with a history of complex trauma. The paper also provides insight into the therapeutic approaches adopted, digital modalities utilized, safety measures included, and whether/to what degree support was provided. While DBIs show promise for treating cPTSD, there is substantial room for advancement of the empirical evidence base for these approaches. Both clinical and research-based recommendations are provided separately.
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Affiliation(s)
- Meg Blackie
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | - Liz Seabrook
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Glen Bates
- Swinburne University of Technology, Hawthorn, VIC, Australia
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Iazzolino AM, Valenza M, D'Angelo M, Longobardi G, Di Stefano V, Luca S, Scuderi C, Steardo L. How effective are mood stabilizers in treating bipolar patients comorbid with cPTSD? Results from an observational study. Int J Bipolar Disord 2024; 12:9. [PMID: 38530497 DOI: 10.1186/s40345-024-00330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Multiple traumatic experiences, particularly in childhood, may predict and be a risk factor for the development of complex post-traumatic stress disorder (cPTSD). Unfortunately, individuals with bipolar disorder (BP) are more likely to have suffered traumatic events than the general population. Consequently, cPTSD could be comorbid with BD, and this may negatively affect psychopathological manifestations. To date, no one has explored whether such comorbidity also affects the response to treatment with mood stabilizers in BD patients. RESULTS Here, a cross-sectional study was carried out by comparing the response to treatment, measured by the Alda scale, in a cohort of 344 patients diagnosed with BD type I and II, screened for the presence (or absence) of cPTSD using the International Trauma Questionnaire. The main result that emerged from the present study is the poorer response to mood stabilizers in BD patients with comorbid cPTSD compared with BD patients without cPTSD. CONCLUSIONS The results collected suggest the need for an add-on therapy focused on trauma in BD patients. This could represent an area of future interest in clinical research, capable of leading to more precise and quicker diagnoses as well as suggesting better tailored and more effective treatments.
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Affiliation(s)
- Anna Maria Iazzolino
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, 88100, Italy
| | - Marta Valenza
- Department of Physiology and Pharmacology "Vittorio Erspamer", SAPIENZA University of Rome, Rome, Italy
| | - Martina D'Angelo
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, 88100, Italy
| | - Grazia Longobardi
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, 88100, Italy
| | - Valeria Di Stefano
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, 88100, Italy
| | - Steardo Luca
- Department of Physiology and Pharmacology "Vittorio Erspamer", SAPIENZA University of Rome, Rome, Italy
- Università Giustino Fortunato, Benevento, 82100, Italy
| | - Caterina Scuderi
- Department of Physiology and Pharmacology "Vittorio Erspamer", SAPIENZA University of Rome, Rome, Italy
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, 88100, Italy.
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O'Donald F, Gunter E, Castle A, Warner R, Moore F. An evaluation of survive and thrive: a 10-week group psychoeducational course for adult interpersonal trauma survivors in Scotland. Cogn Behav Ther 2024:1-18. [PMID: 38525889 DOI: 10.1080/16506073.2024.2333961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
Emerging evidence supports a phased approach to trauma treatment, including manualised group-based interventions, to facilitate symptom reduction resulting from complex trauma sequelae. This study investigates the efficacy of Survive and Thrive, a 10-week group psychoeducational course for adult survivors of interpersonal trauma. Between August 2019 and February 2022, participants were enrolled on the course. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and Difficulties in Emotion Regulation Scale-Short Form (DERS-SF) were administered pre-intervention and immediately post-intervention. In addition, thematic analysis was applied to qualitative feedback. Results revealed significant reductions in CORE-OM and DERS-SF scores post-intervention, with minimal variability in scores attributed to group delivery (either face-to-face or online). The thematic analysis demonstrated that normalising trauma symptoms and providing coping skills positively impacted participants' experiences. At the same time, the breadth and nature of the content were observed to be an occasional barrier to engagement. In summary, this study proposes that group-based psychoeducational interventions are generally effective for those with mild-to-moderate symptoms of complex trauma. However, further evidence is needed to offer more nuanced recommendations for identifying individuals who may benefit the most from these interventions.
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Affiliation(s)
- Frederick O'Donald
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
- School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Elise Gunter
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
| | - Ailie Castle
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
| | - Rachel Warner
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
| | - Fhionna Moore
- Department of Clinical Psychology, NHS Tayside, Dundee, Scotland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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Kim JW, Nam CS, Choi H. The effect of complex posttraumatic stress and poverty on quality of life among adult survivors of childhood institutional maltreatment: evidence from survivors of the 'Hyeongje Welfare Institution' in South Korea. Eur J Psychotraumatol 2024; 15:2328505. [PMID: 38502029 PMCID: PMC10953780 DOI: 10.1080/20008066.2024.2328505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
Background: Childhood institutional maltreatment (IM) is associated with both complex posttraumatic stress disorder (CTPSD) and poverty in adulthood life, each of which may impact an individual's quality of life (QoL). To find implications for clinical practice and policy making for adult survivors with childhood IM experiences, it is necessary to conduct research examining their current QoL and identifying related factors.Objective: By applying the model of the conservation of resources theory, we focused on how adulthood QoL can be indicated by childhood IM as well as the life outcomes of IM such as additional lifetime trauma, CPTSD, and poverty.Methods: In a cross-sectional study, self-report data were collected from 127 adults who were survivors of the 'Hyeongje' childhood IM in South Korea. We conducted regression analyses of childhood IM experiences, trauma experiences after escape from the institution, current CPTSD symptoms, and current poverty experiences on current QoL.Results: The duration of placement at the 'Hyeongje' (β = .24, p = .009) was associated with trauma experiences after escape from the institution. Trauma experiences after escape from the institution (β = .25, p = .007) were associated with CPTSD symptoms. CPTSD symptoms (β = .26, p = .005) were associated with poverty, and both CPTSD symptoms (β = -.52, p < .001) and poverty (β = -.26, p = .003) were negatively associated with current QoL.Conclusions: Prolonged childhood IM brings about loss spirals by increasing an individual's exposure to experiences of further cumulative trauma, CPTSD, and poverty. There is a need for due diligence-based policy making and public support from the government to help create upward spirals for QoL. This may include the imminent detection and rescue of children as well as providing a safe environment, offering multidisciplinary interventions including evidence-based treatment for CPTSD, and considering economic support including collective reparations.
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Affiliation(s)
- Jae-Woong Kim
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
| | - Chan Seob Nam
- Department of Social Welfare, Dong-A University, Busan, South Korea
| | - Hyunjung Choi
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
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Samson JA, Newkirk TR, Teicher MH. Practitioner Review: Neurobiological consequences of childhood maltreatment - clinical and therapeutic implications for practitioners. J Child Psychol Psychiatry 2024; 65:369-380. [PMID: 37609790 DOI: 10.1111/jcpp.13883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Childhood maltreatment is one of the most important preventable risk factors for a wide variety of psychiatric disorders. Further, when psychiatric disorders emerge in maltreated individuals they typically do so at younger ages, with greater severity, more psychiatric comorbid conditions, and poorer response to established treatments, resulting in a more pernicious course with an increased risk for suicide. Practitioners treating children, adolescents, and young adults with psychiatric disorders will likely encounter the highest prevalence of clients with early-onset maltreatment-associated psychiatric disorders. These may be some of their most challenging cases. METHOD In this report, we explore key validated alterations in brain structure, function, and connectivity associated with exposure to childhood maltreatment as potential mechanisms behind their patients' clinical presentations. RESULTS We then summarize key behavioral presentations likely associated with neurobiological alterations and propose a toolkit of established trauma and skills-based strategies that may help diminish symptoms and foster recovery. We also discuss how some of these alterations may serve as latent vulnerability factors for the possible development of future psychopathology. CONCLUSIONS Research on the neurobiological consequences of childhood adversity provides a vastly enriched biopsychosocial understanding of the developmental origins of health and pathology that will hopefully lead to fundamental advances in clinical psychology and psychiatry.
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Affiliation(s)
- Jacqueline A Samson
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
| | - Thatcher R Newkirk
- Department of Psychiatry, Geisel School of Medicine, Dartmouth Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Martin H Teicher
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
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Hoppen TH, Meiser-Stedman R, Kip A, Birkeland MS, Morina N. The efficacy of psychological interventions for adult post-traumatic stress disorder following exposure to single versus multiple traumatic events: a meta-analysis of randomised controlled trials. Lancet Psychiatry 2024; 11:112-122. [PMID: 38219762 DOI: 10.1016/s2215-0366(23)00373-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/17/2023] [Accepted: 10/31/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Previous meta-analyses of psychological interventions for adult post-traumatic stress disorder (PTSD) did not investigate whether efficacy is diminished in individuals with PTSD related to multiple (vs single) traumatic events. We aimed to assess whether treatment efficacy would be lower in randomised controlled trials involving multiple-event-related PTSD versus single-event-related PTSD. METHODS For this meta-analysis, we searched PsycINFO, MEDLINE, Web of Science, and PTSDpubs from database inception to April 18, 2023. Randomised controlled trials involving adult clinical samples (≥70% meeting full PTSD criteria) with adequate size (≥10 participants per arm) were included. We extracted data on trial characteristics, demographics, and outcome data. Random-effects meta-analyses were run to summarise standardised mean differences (Hedges' g). Trials involving 100% of participants with single-event-related PTSD versus at least 50% of participants with multiple-event-related PTSD (ie, associated with ≥two traumatic events) were categorised. Quality of evidence was assessed using the Cochrane criteria. The review protocol was registered in PROSPERO (CRD42023407754). FINDINGS Overall, 137 (85%) of 161 randomised controlled trials were included in the quantitative synthesis, comprising 10 684 participants with baseline data and 9477 with post-treatment data. Of those randomly assigned, 5772 (54%) of 10 692 participants identified as female, 4917 (46%) as male, and three (<1%) as transgender or other. 34 (25%) of 137 trials exclusively involved women, 15 (11%) trials exclusively involved men, and the remainder were mixed samples. Mean age across the trials was 40·2 years (SD 9·0) ranging from 18·0 years to 65·4 years. 23 (17%) of 137 trials involved participants from low-income and middle-income countries (23 [17%] of 137). Data on ethnicity were not extracted. At treatment endpoint, psychological interventions were highly effective for PTSD when compared with passive control conditions in both samples with single-event-related PTSD (Hedges' g 1·04 [95% CI 0·77-1·31]; n=11; I2=43%) and multiple-event-related PTSD (Hedges' g 1·13 [0·90-1·35]; n=55, I2=87%), with no efficacy difference between these categories (p=0·48). Heterogeneity between studies was substantial but outlier-corrected analysis yielded similar results. Moderate-sized effects were found compared with active control conditions with no significant difference between single-trauma and multiple-trauma trials. Results were robust in various sensitivity analyses (eg, 90% cutoff for multiple-trauma trials) and analyses of follow-up data. The quality of evidence was moderate to high. INTERPRETATION Contrary to our hypothesis, we found strong evidence that psychological interventions are highly effective treatments for PTSD in patients with a history of multiple traumatic events. Results are encouraging for clinical practice and could counteract common misconceptions regarding treatment and treatment barriers. FUNDING None.
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Affiliation(s)
- Thole H Hoppen
- Institute of Psychology, University of Münster, Münster, Germany.
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ahlke Kip
- Institute of Psychology, University of Münster, Münster, Germany
| | | | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
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Kleva CS, Keeley JW, Evans SC, Maercker A, Cloitre M, Brewin CR, Roberts M, Reed GM. Examining accurate diagnosis of complex PTSD in ICD-11. J Affect Disord 2024; 346:110-114. [PMID: 37918575 DOI: 10.1016/j.jad.2023.10.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Complex posttraumatic stress disorder (complex PTSD), the most frequently suggested new category for inclusion by mental health professionals, has been included in the Eleventh Revision of the World Health Organization's International Classification of Diseases (ICD-11). Research has yet to explore whether clinicians' recognition of the distinct complex PTSD symptoms predicts giving the correct diagnosis. The present study sought to determine if international mental health professionals were able to accurately diagnose complex PTSD and identify the shared PTSD features and three essential diagnostic features, specific to complex PTSD. METHODS Participants were randomly assigned to view two vignettes and tasked with providing a diagnosis (or indicating that no diagnosis was warranted). Participants then answered a series of questions regarding the presence or absence of each of the essential diagnostic features specific to the diagnosis they provided. RESULTS Clinicians who recognized the presence or absence of complex PTSD specific features were more likely to arrive at the correct diagnostic conclusion. Complex PTSD specific features were significant predictors while the shared PTSD features were not, indicating that attending to each of the specific symptoms was necessary for diagnostic accuracy of complex PTSD. LIMITATIONS The use of written case vignettes including only adult patients and a non-representative sample of mental health professionals may limit the generalizability of the results. CONCLUSIONS Findings support mental health professionals' ability to accurately identify specific features of complex PTSD. Future work should assess whether mental health providers can effectively identify symptoms of complex PTSD in a clinical setting.
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Affiliation(s)
- Christopher S Kleva
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Spencer C Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Marylene Cloitre
- National Center for PTSD, Division of Dissemination and Training, VA Palo Alto Health Care System, CA, USA; Department of Psychiatry and Behavioral Sciences, Standford University, Stanford, CA, USA
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Michael Roberts
- Office of Graduate Studies and Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Iazzolino AM, Valenza M, D’Angelo M, Longobardi G, Stefano VD, Visalli G, Steardo L, Scuderi C, Steardo L. The Impact of Complex PTSD on Suicide Risk in Patients with Bipolar Disorder: A Cross-Sectional Study. J Clin Med 2024; 13:673. [PMID: 38337367 PMCID: PMC10856776 DOI: 10.3390/jcm13030673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Patients with bipolar disorder (BD) are more likely than the general population to experience traumatic events, particularly during childhood, and these may predict and be a risk factor for the development of complex PTSD (cPTSD). The presence of multiple traumas plays a relevant role from a psychopathological point of view, but little is known about the effect this may have on suicide attempts in patients with BD. METHODS A cross-sectional study was conducted comparing socio-demographic and clinical characteristics, recruiting 344 patients diagnosed with BD I and II, screened for the presence (or absence) of cPTSD using the International Trauma Questionnaire (ITQ). Suicide attempts were assessed directly during the clinical interview and from the patient's medical record. RESULTS The results emerging from the study indicate that cPTSD can be considered a risk factor for suicide attempts in patients with BD. Furthermore, evidence is provided to support the idea that cPTSD is highly prevalent in patients with BD and is related to a higher psychopathological burden. CONCLUSIONS The results recommend an urgent and comprehensive assessment of suicidal risk in patients with comorbidity of both bipolar disorder and cPTSD. There is a crucial demand for early intervention initiatives and proactive prevention strategies to address the intricate intersection of these mental health challenges.
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Affiliation(s)
- Anna Maria Iazzolino
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
| | - Marta Valenza
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (L.S.); (C.S.)
| | - Martina D’Angelo
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
| | - Grazia Longobardi
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
| | - Valeria Di Stefano
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
| | - Giulia Visalli
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
| | - Luca Steardo
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (L.S.); (C.S.)
- University Giustino Fortunato, 82100 Benevento, Italy
| | - Caterina Scuderi
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Sapienza University of Rome, 00185 Rome, Italy; (M.V.); (L.S.); (C.S.)
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy; (M.D.); (G.L.); (V.D.S.); (G.V.); (L.S.J.)
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25
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van Vliet NI, Huntjens RJC, van Dijk MK, Huisman M, Bachrach N, Meewisse ML, van Haren S, de Jongh A. Predictors and moderators of treatment outcomes in phase-based treatment and trauma-focused treatments in patients with childhood abuse-related post-traumatic stress disorder. Eur J Psychotraumatol 2024; 15:2300589. [PMID: 38230608 PMCID: PMC10795775 DOI: 10.1080/20008066.2023.2300589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024] Open
Abstract
Background: Knowledge of treatment predictors and moderators is important for improving the effectiveness of treatment for PTSD due to childhood abuse.Objective: The first aim of this study was to test the potential predictive value of variables commonly associated with PTSD resulting from a history of repeated childhood abuse, in relation to treatment outcomes. The second aim was to examine if complex PTSD symptoms act as potential moderators between treatment conditions and outcomes.Method: Data were obtained from a randomized controlled trial comparing a phase-based treatment (Skills Training in Affect and Interpersonal Regulation [STAIR] followed by Eye Movement Desensitization and Reprocessing [EMDR] therapy; n = 57) with a direct trauma-focused treatment (EMDR therapy only; n = 64) in people with PTSD due to childhood abuse. The possible predictive effects of the presence of borderline personality disorder, dissociative symptoms, and suicidal and self-injurious behaviours were examined. In addition, it was determined whether symptoms of emotion regulation difficulties, self-esteem, and interpersonal problems moderated the relation between the treatment condition and PTSD post-treatment, corrected for pre-treatment PTSD severity.Results: Pre-treatment PTSD severity proved to be a significant predictor of less profitable PTSD treatment outcomes. The same was true for the severity of dissociative symptoms, but only post-treatment, and not when corrected for false positives. Complex PTSD symptoms did not moderate the relationship between the treatment conditions and PTSD treatment outcomes.Conclusions: The current findings suggest that regardless of the common comorbid symptoms studied, immediate trauma-focused treatment is a safe and effective option for individuals with childhood-related PTSD. However, individuals experiencing severe symptoms of PTSD may benefit from additional treatment sessions or the addition of other evidence-based PTSD treatment approaches. The predictive influence of dissociative sequelae needs further research.The study design was registered in The Dutch trial register (https://www.trialregister.nl/trialreg/admin/rctview.asp?TC = 5991) NTR5991 and was approved by the medical ethics committee of Twente NL 56641.044.16 CCMO.
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Affiliation(s)
| | - Rafaele J. C. Huntjens
- Department of Experimental Psychotherapy and Psychopathology, University of Groningen, Groningen, the Netherlands
| | | | - Mark Huisman
- Department of Sociology, University of Groningen, Groningen, the Netherlands
| | - Nathan Bachrach
- GGZ Oost Brabant, Helmond, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | | | | | - Ad de Jongh
- Department of Oral public health, Academic Centre of Dentistry (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
- School of Health Sciences, Salford University, Manchester, United Kingdom
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
- School of Psychology, Queen's University, Belfast, Northern, Ireland
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26
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Bachem R, Levin Y, Yuval K, Langer NK, Solomon Z, Bernstein A. Complex posttraumatic stress disorder in intergenerational trauma transmission among Eritrean asylum-seeking mother-child dyads. Eur J Psychotraumatol 2024; 15:2300588. [PMID: 38190253 PMCID: PMC10776052 DOI: 10.1080/20008066.2023.2300588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
Background: Traumatic stress among forcibly displaced people has a variety of adverse consequences beyond individual mental health, including implications for poor socioemotional developmental outcomes for their children post-displacement.Objective: This study explored the intergenerational transmission of maternal ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) and depression among asylum-seeking mothers for their children's internalizing and externalizing difficulties.Method: Participants were 127 trauma-affected Eritrean mothers of preschool-aged children in Israel. The severity of child difficulties was compared between mothers with probable ICD-11 CPTSD (94.5% comorbid depression), ICD-11 PTSD (48.5% comorbid depression), unimorbid depression, and healthy mothers, using multivariate analyses of variance, while controlling for children's direct exposure to adverse life experiences.Results: Probable ICD-11 CPTSD and PTSD were present in 23.6% and 26.0% of mothers, respectively. Relative to maternal PTSD, CPTSD was significantly and strongly associated with elevated child internalizing symptoms (d = 2.44) and marginally significantly, although strongly, associated with child externalizing symptoms (d = 1.30). Post-hoc exploratory analyses documented that, relative to maternal PTSD and depression, CPTSD and depression comorbidity was marginally significantly but strongly associated with child internalizing (SMD = .67), but not externalizing symptoms (SMD = .35).Conclusions: Findings implicate maternal CPTSD and comorbid depression in child socio-emotional development and inform clinical assessment, prevention, and intervention to attenuate poor development among children in unstable post-displacement settings.
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Affiliation(s)
- Rahel Bachem
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Yafit Levin
- School of Social Work, Ariel University, Ariel, Israel
| | - Kim Yuval
- Observing Minds Lab, Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Nora Korin Langer
- Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
- the I-Core Research Center for Mass Trauma, Tel-Aviv, Israel
| | - Amit Bernstein
- Observing Minds Lab, Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
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27
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Fine NB, Helpman L, Armon DB, Gurevitch G, Sheppes G, Seligman Z, Hendler T, Bloch M. Amygdala-related electroencephalogram neurofeedback as add-on therapy for treatment-resistant childhood sexual abuse posttraumatic stress disorder: feasibility study. Psychiatry Clin Neurosci 2024; 78:19-28. [PMID: 37615935 DOI: 10.1111/pcn.13591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
AIM Childhood sexual abuse (CSA) among women is an alarmingly prevalent traumatic experience that often leads to debilitating and treatment-refractory posttraumatic stress disorder (PTSD), raising the need for novel adjunctive therapies. Neuroimaging investigations systematically report that amygdala hyperactivity is the most consistent and reliable neural abnormality in PTSD and following childhood abuse, raising the potential of implementing volitional neural modulation using neurofeedback (NF) aimed at down-regulating amygdala activity. This study aimed to reliably probe limbic activity but overcome the limited applicability of functional magnetic resonance imaging (fMRI) NF by using a scalable electroencephalogram NF probe of amygdala-related activity, termed amygdala electrical-finger-print (amyg-EFP) in a randomized controlled trial. METHOD Fifty-five women with CSA-PTSD who were in ongoing intensive trauma-focused psychotherapy for a minimum of 1 year but still met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD criteria were randomized to either 10 add-on sessions of amyg-EFP-NF training (test group) or continuing psychotherapy (control group). Participants were blindly assessed for PTSD symptoms before and after the NF training period, followed by self-reported clinical follow-up at 1, 3, and 6 months, as well as one session of amygdala real-time fMRI-NF before and after NF training period. RESULTS Participants in the test group compared with the control group demonstrated a marginally significant immediate reduction in PTSD symptoms, which progressively improved during the follow-up period. In addition, successful neuromodulation during NF training was demonstrated. CONCLUSION This feasibility study for patients with treatment-resistant CSA-PTSD indicates that amyg-EFP-NF is a viable and efficient intervention.
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Affiliation(s)
- Naomi B Fine
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Liat Helpman
- Womens' Reproductive Mental Health research Unit, Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Daphna Bardin Armon
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Guy Gurevitch
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gal Sheppes
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Zivya Seligman
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Talma Hendler
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Miki Bloch
- Womens' Reproductive Mental Health research Unit, Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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28
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Israel BS, Belcher AM, Ford JD. A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders. J Dual Diagn 2024; 20:52-85. [PMID: 38165922 DOI: 10.1080/15504263.2023.2295416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.
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Affiliation(s)
- Benjamin S Israel
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
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Expert international trauma clinicians’ views on the definition, composition and delivery of reintegration interventions for complex PTSD. Eur J Psychotraumatol 2023; 14:2165024. [PMID: 37052098 PMCID: PMC9848321 DOI: 10.1080/20008066.2023.2165024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Research has previously distinguished between complex post-traumatic stress disorder (CPTSD) and PTSD, with the former including a range of disturbances in self-regulatory capacities in addition to difficulties associated with PTSD. Clinical guidelines have previously recommended a phase-based approach for the treatment of CPTSD, yet the final 'reintegration' phase of treatment has been overlooked in research, with limited evidence into its value and effectiveness, and inconsistencies in its definitions and understanding.Objective: We set out to define and determine the key principles of 'reintegration' and to specify the components and method of delivery of treatment.Method: Leading national and international clinical and academic experts in CPTSD were interviewed and asked about their views of how 'reintegration' should be defined, its role in the treatment of CPTSD, what it should be composed of, the key principles of its delivery, and how it should be evaluated. We analysed transcripts of the interviews following the principles of Codebook Thematic Analysis.Results: We conducted 16 interviews with leading national and international experts with at least 10 years' experience of treating people with CPTSD. Themes derived from our analysis demonstrated that while the definition and composition of reintegration varied greatly between experts, the key principles in its delivery were consistent across all experts.Conclusions: The results of this study lay the foundation for a framework of what reintegration is and how it can be used in, but also highlight the need for more research to be conducted on the role of reintegration in the treatment of CPTSD. Consensus for the definition and composition of reintegration is still yet to be reached. Possible measures for evaluating reintegration should also be explored in the future.
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Dialectical behaviour therapy for posttraumatic stress disorder (DBT-PTSD): transportability to everyday clinical care in a residential mental health centre. Eur J Psychotraumatol 2023; 14:2157159. [PMID: 37052092 PMCID: PMC9848310 DOI: 10.1080/20008066.2022.2157159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Dialectical Behaviour Therapy for Posttraumatic Stress Disorder (DBT-PTSD) is a phase-based treatment for PTSD. The DBT-PTSD treatment programme's efficacy has not been tested during standard operation, outside of laboratory outcome studies.Objective: The present pilot study investigated the transportability of the DBT-PTSD treatment to a real word clinical setting in a residential mental health centre.Methods: The DBT-PTSD treatment was compared to a treatment as usual (TAU) condition in a non-randomized study. Overall, 156 patients from a residential mental health centre were included. Propensity score matching was used to match participants in the two treatment arms based on baseline characteristics. Primary and secondary outcomes (PTSD and other symptoms) were assessed at the time of admission and at the time of discharge.Results: The DBT-PTSD treatment outperformed the TAU condition in the improvement of all primary outcomes, as indicated by a significant time and group interaction. There were notable differences in the effect sizes between the unmatched and matched sample as well as between the available and the intent-to-treat (ITT) data analyses. The effect sizes in the ITT data analyses were much lower. Both treatment groups showed similar improvements in secondary outcomes.Conclusions: This study provides initial evidence for the transportability of the DBT-PTSD treatment to a naturalistic clinical care setting, but with considerably lower effect sizes than in previously published laboratory RCTs. The higher efficacy of DBT-PTSD compared to TAU may largely depend on patient's adherence to treatment.
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Exposure-based treatments for childhood abuse-related post-traumatic stress disorder in adults: a health-economic evaluation. Eur J Psychotraumatol 2023; 14:2171752. [PMID: 37052103 PMCID: PMC9930771 DOI: 10.1080/20008066.2023.2171752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Background: Prolonged exposure (PE) is an effective treatment for post-traumatic stress disorder (PTSD).Objective: This study aimed to analyse the cost-effectiveness of three exposure-based treatments in patients with childhood abuse-related PTSD.Method: A net-benefit analysis was conducted alongside a pragmatic randomized controlled trial with participants (N = 149) randomized to three conditions: PE (n = 48), intensified PE (i-PE, n = 51), and phase-based PE [Skills Training in Affective and Interpersonal Regulation (STAIR) + PE, n = 50]. Assessments took place at baseline (T0), post-treatment (T3), 6 month follow-up (T4), and 12 month follow-up (T5). Costs stemming from healthcare utilization and productivity losses were estimated using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness. Quality-adjusted life-years (QALYs) were based on the 5-level EuroQoL 5 Dimensions (EQ-5D-5L) using the Dutch tariff. Missing values of costs and utilities were multiply imputed. To compare i-PE to PE and STAIR + PE to PE, pair-wise unequal-variance t-tests were conducted. Net-benefit analysis was used to relate costs to QALYs and to draw acceptability curves.Results: Intervention costs did not differ across the three treatment conditions. Total medical costs, productivity losses, total societal costs, and EQ-5D-5L-based QALYs did not differ between treatment conditions either (all p > .10). At the relevant €50,000/QALY threshold, the probability of one treatment being more cost-effective than another was 32%, 28%, and 40% for PE, i-PE, and STAIR-PE, respectively.Conclusion: Three equally effective treatments were compared and no differences in cost-effectiveness between treatments were found. Therefore, we advocate the implementation and adoption of any of the treatments and endorse shared decision making.
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Bateman A, Rüfenacht E, Perroud N, Debbané M, Nolte T, Shaverin L, Fonagy P. Childhood maltreatment, dissociation and borderline personality disorder: Preliminary data on the mediational role of mentalizing in complex post-traumatic stress disorder. Psychol Psychother 2023. [PMID: 38108566 DOI: 10.1111/papt.12514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Treatments for borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) are less effective for patients with co-occurring symptoms of both disorders, who are considered to have complex PTSD (cPTSD), compared with patients with either condition alone. Evidence suggests that co-occurrence of symptoms indicates greater impairment in mentalizing. This study examines evidence for targeting mentalizing when treating individuals with co-occurring symptoms, irrespective of their exposure to developmental trauma and, for the first time, investigates the mediational role of mentalizing in the associations between BPD symptomatology and cPTSD. DESIGN We identified in a routine clinical service a group of patients with BPD, with or without co-occurring symptoms of PTSD. We hypothesized that patients with co-occurring symptoms and a history of childhood maltreatment will show more severe clinical profiles and greater mentalizing problems, which in turn lead to symptoms consistent with cPTSD. METHOD Clinical profiles of 72 patients with BPD (43 with and 29 without co-occurring symptoms of PTSD; mean age in both groups 28 years, 79% and 83% female, respectively) were identified using the Structured Clinical Interview for DSM-IV Axis II Disorders. Patients completed self-report measures of BPD and PTSD symptoms, well-being, dissociation and reflective functioning. Childhood trauma histories were evaluated. RESULTS Compared with patients with BPD-only, those with co-occurring BPD and PTSD showed greater severity in terms of BPD and dissociative symptoms, met a broader range of BPD diagnostic criteria, had a greater sense of personal worthlessness and self-evaluated their well-being as considerably diminished. This group was also more inclined to recall increased instances of childhood sexual abuse. In a mediation analysis, mentalizing acted as a partial mediator for the relationship between BPD severity and cPTSD, as well as between dissociative symptoms and cPTSD. Interestingly, mentalizing did not mediate the relationship between childhood sexual abuse and cPTSD. CONCLUSIONS Overall, the correlational findings are consistent with an intended focus on mentalizing to treat cPTSD symptoms in individuals who also meet criteria for a diagnosis of BPD.
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Affiliation(s)
- Anthony Bateman
- Department of Clinical, Educational and Health Psychology, Psychoanalysis Unit, University College London, London, UK
| | - Eva Rüfenacht
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Tobias Nolte
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud Centre, London, UK
| | - Lisa Shaverin
- Anna Freud Centre, London, UK
- Tavistock Trauma Service, Tavistock & Portman NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Anna Freud Centre, London, UK
- Division of Psychology and Language Sciences, University College London, London, UK
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Sele P, Hoffart A, Cloitre M, Hembree E, Øktedalen T. Comparing phase-based treatment, prolonged exposure, and skills-training for Complex Posttraumatic Stress Disorder: A randomized controlled trial. J Anxiety Disord 2023; 100:102786. [PMID: 37871452 DOI: 10.1016/j.janxdis.2023.102786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This study examines treatment effects in STAIR Narrative Therapy (SNT), a phase-based treatment where Skills Training in Affective and Interpersonal Regulation (STAIR) precedes Narrative Therapy (NT), compared to Prolonged Exposure (PE) and to STAIR. METHOD Ninety-two adult patients diagnosed with DSM-5 PTSD and ICD-11 CPTSD following childhood abuse were randomly assigned to enhanced versions of SNT (12 group STAIR sessions + 8 individual NT sessions), PE (8-16 individual sessions), or STAIR (12 group STAIR sessions) provided in residential care. Outcome was assessed by mixed models. RESULTS PE produced greater improvements in DSM-5 PTSD symptoms compared to SNT from pre-treatment to post-treatment, but not compared to STAIR. Reductions in ICD-11 CPTSD symptoms were not significantly different among conditions. From pre-treatment to 1 year follow-up, PE produced greater PTSD symptom improvements than SNT and STAIR, and PE and STAIR produced greater CPTSD symptom improvements than SNT. CONCLUSIONS The predicted stronger effect of SNT compared to PE and STAIR on DSM-5 PTSD and ICD-11 CPTSD symptoms was not supported by the findings. The benefits of immediate trauma-focused treatments (TFT) as compared to phase-based treatments, and the potential non-inferiority of skills-training as compared to TFT in CPTSD needs to be further investigated.
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Affiliation(s)
- Peter Sele
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund N-3370, Norway; Department of Psychology, University of Oslo, Norway.
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund N-3370, Norway; Department of Psychology, University of Oslo, Norway
| | - Marylène Cloitre
- National Center for PTSD, Division of Dissemination and Training, VA Palo Alto Health Care System, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Standford University, Stanford, CA 94305, USA
| | - Elizabeth Hembree
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tuva Øktedalen
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund N-3370, Norway
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Bertó C, Almansa-Tomás B, Ferrín M, Livianos L, Rojo L, Barberá M, García-Blanco A. Are Socially Relevant Scenes Abnormally Processed in Complex Trauma-Exposed Children? JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:1031-1040. [PMID: 38045849 PMCID: PMC10689592 DOI: 10.1007/s40653-023-00549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 12/05/2023]
Abstract
Abnormal attentional processes to socially relevant information may underlie behavioral dysfunctional symptoms in children exposed to a complex trauma. Attentional biases to social scenes close to real-world situations and their association with behavioral symptomatology were examined in complex trauma-exposed children. A visual dot-probe task involving neutral versus emotional (i.e., threatening, sad, or happy) scenes was applied to twenty-one maltreated children (mean age 10.43; 42.8% female; 61.1% White). These children were exposed to a complex trauma (i.e., severe, repeated, multiple, prolonged, and interpersonal) and were safeguarded in a juvenile welfare home after all parental responsibility was removed. Twenty-four comparable non-maltreated children (mean age 10.13; 29.2% female; 76% White), served as control group. All participants were at risk of social exclusion and every legal representative completed the Child Behavior Checklist (CBCL). Complex trauma-exposed children showed an attentional bias toward threatening scenes, while the control group showed an attentional bias toward sad scenes. There were no differences for happy scenes between groups. Attentional bias toward threatening scenes was associated with withdrawn symptoms in complex trauma-exposed children. Children exposed to a complex trauma show an abnormal attention to threatening social situations, which can trigger maladaptive behaviors such as withdrawn. The understanding of how complex trauma-exposed children process affective environmental information may provide new targets in the social skills interventions such as diminishing maladaptive behaviors and improving coping strategies to face threatening situations.
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Affiliation(s)
- Clara Bertó
- Department of Psychiatry and Psychology, Hospital Francesc de Borja, Gandía, Spain
| | | | - Maite Ferrín
- University of Southampton, Southampton, UK
- ReCognition Health, London, UK
| | - Lorenzo Livianos
- Department of Psychiatry and Clinical Psychology, University and Polytechnic Hospital La Fe, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Luis Rojo
- Department of Psychiatry and Clinical Psychology, University and Polytechnic Hospital La Fe, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - María Barberá
- Department of Psychiatry and Clinical Psychology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Ana García-Blanco
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain
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Chiu HTS, Alberici A, Claxton J, Meiser-Stedman R. The prevalence, latent structure and psychosocial and cognitive correlates of complex post-traumatic stress disorder in an adolescent community sample. J Affect Disord 2023; 340:482-489. [PMID: 37573893 DOI: 10.1016/j.jad.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/21/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
Complex PTSD has received growing attention in recent years. However, the validity, prevalence and risk factors of this diagnosis remain unclear. This study examined PTSD presentations in adolescents using diagnostic criteria and latent class analysis (LCA). It then explored the role of demographics factors, trauma history factors, psychopathology factors and cognitive factors in predicting different PTSD presentations. A cross-sectional data comprising self-report measures of 342 community adolescents (12-15 years) were collected and analysed. 2.3 %, 5.6 % and 10 % of adolescents met the criteria for PTSD, CPTSD and disturbances in self-organisation (DSO) respectively. A three-class model (healthy class, CPTSD class and DSO class) were generated from LCA. Adolescents with CPTSD were most likely to be female and endorsed the most overall trauma types, interpersonal trauma types, depression, anxiety and maladaptive cognitive processes, followed by adolescents with DSO and subsequently healthy adolescents. CPTSD appeared to be a more common presentation than PTSD among community adolescents. The relatively high prevalence of DSO is noteworthy and suggests that DSO is not necessarily accompanied by PTSD. Given the strong associations between CPTSD and cognitive processes implicated in PTSD, CPTSD as a construct might be conceptually similar to PTSD.
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Affiliation(s)
- Henry Tak Shing Chiu
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
| | - Alice Alberici
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jade Claxton
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Hollins Martin CJ, Reid K. A scoping review of therapies used to treat psychological trauma post perinatal bereavement. J Reprod Infant Psychol 2023; 41:582-598. [PMID: 34989287 DOI: 10.1080/02646838.2021.2021477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Up to 39% of women who experience perinatal bereavement proceed to develop Post-Traumatic-Stress-Disorder (PTSD), with this large proportion meriting treatment. Before setting-up a treatment service for postnatal women who are experiencing psychological trauma, it is important to identify what therapies have been used in-the-past to address this problem. AIM To scope for research that has implemented therapies to treat psychological trauma post perinatal bereavement, for potential inclusion in a flexible treatment package. METHOD A scoping review mapped coverage, range, and type of research that has reported on prior therapies used to treat psychological trauma post perinatal bereavement. FINDINGS Due to the dearth of papers that directly addressed perinatal bereavement, we widened the scope of the review to view what treatments had been used to treat psychological trauma post-childbirth. Out of 23 studies that report on effectiveness of therapies used to treat psychological trauma post-childbirth, only 4-focused upon treating PTSD post perinatal bereavement (3 effective/1 ineffective). Successful treatments were reported by Kersting et al. (2013), who found CBT effective at reducing PTSD symptoms post-miscarriage, termination for medical reasons, and stillbirth (n = 33 & n = 115), and Navidian et al. (2s017)) found that 4-sessions of grief-counselling reduced trauma symptoms post-stillbirth in (n = 50) women. One study by Huberty et al. (2020found on-line yoga to be ineffective at reducing PTSD symptoms post-stillbirth. CONCLUSIONS A dearth of research has explored effectiveness of therapies for treating psychological trauma post perinatal bereavement and post-childbirth, with need to develop and test a research informed flexible counselling package.
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Affiliation(s)
- Caroline J Hollins Martin
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University (Enu), Edinburgh, Scotland, UK
| | - Katrina Reid
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University (Enu), Edinburgh, Scotland, UK
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Fung HW, Chau AKC, Hung SL, Lam SKK, Chien WT, Lee VWP. Persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms: a one-year follow-up study. Eur J Psychotraumatol 2023; 14:2263314. [PMID: 37818716 PMCID: PMC10569344 DOI: 10.1080/20008066.2023.2263314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/04/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Recent studies found that post-traumatic and dissociative symptoms are common in people with depressive symptoms. Although a trauma-related subtype of depression has been proposed, little is known about the persistence and clinical consequences of these symptoms. OBJECTIVE This one-year follow-up study investigated the persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms. METHODS We analyzed longitudinal data from an international sample of people self-reporting depressive emotions (N = 152) (mean Patient Health Questionnaire-9 score = 17.27; SD = 6.31). RESULTS More than half (58.4%) of participants with baseline post-traumatic stress disorder (PTSD) still met the criteria for PTSD after one year. Participants with dissociative symptoms at baseline were significantly more likely to report lifetime psychiatric hospitalization (31.2% vs 14.7%), past-year use of psychiatric hospitalization (10.4% vs 0%) and emergency services (16.9% vs 4%) than those without dissociative symptoms. All post-traumatic and dissociative symptom clusters were cross-sectionally (r = .286 to .528, p < .001) and longitudinally (r = .181 to .462, p < .001) correlated with depressive symptoms. A sense of current threat (β = .146, p < .05) and negative self-concept (β = .173, p < .05) at baseline significantly predicted depressive symptoms after one year. CONCLUSIONS These findings contribute to the increasing body of knowledge regarding the PTSD/dissociation-depression comorbidity. Given their persistence and clinical consequences, we recommend that post-traumatic and dissociative symptoms be regularly screened for in clinical settings. The existence of a possible trauma-related subtype of depression should receive more attention in both research and clinical practice.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong
| | - Anson Kai Chun Chau
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Hong Kong
| | - Stanley Kam Ki Lam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Ghițan AF, Gheorman V, Ciurea ME, Gheorman V, Dinescu VC, Ciurea AM, Militaru F, Popa R, Țenea-Cojan TȘ, Udriștoiu I. Exploring the Prevalence of PTSD in Hand Trauma: A Comprehensive Study. Brain Sci 2023; 13:1438. [PMID: 37891807 PMCID: PMC10605642 DOI: 10.3390/brainsci13101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/30/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
Hand trauma is a common and debilitating condition that can have significant physical, functional, and psychological effects on individuals. This study used a case-control design to investigate the frequency and factors associated with symptoms of post-traumatic stress disorder (PTSD) in a sample of individuals with complex hand and forearm injuries. Our hypothesis suggests that demographic data, among other factors, influences the intensity of PTSD symptoms measured by the PCL-5 scale three months post-surgery. This study included 166 individuals, 142 males and 24 females, with an average age of 42.14 years (SD = 12.71). Our study found significant associations between symptoms of PTSD and various demographic and clinical factors. PTSD symptoms were observed in females, individuals from specific regions, and certain socio-professional groups. Furthermore, educational attainment and personal background have been identified as significant factors in the development of PTSD. The role of trauma type was crucial, amputees and fractures were more prone to developing PTSD. A strong link was found between increased symptoms of PTSD and negative postoperative outcomes, including amputation of necessity and the need for additional surgery. The absence of family support exacerbates the psychological distress of trauma survivors. The findings highlight the intricate nature of PTSD development and underscore the significance of a comprehensive postoperative treatment strategy encompassing psychological assessment and support.
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Affiliation(s)
| | - Veronica Gheorman
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Marius Eugen Ciurea
- Department of Plastic Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Victor Gheorman
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.G.); (F.M.); (I.U.)
| | - Venera Cristina Dinescu
- Department of Health Promotion and Occupational Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ana Maria Ciurea
- Department of Oncology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Felicia Militaru
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.G.); (F.M.); (I.U.)
| | - Romeo Popa
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | | | - Ion Udriștoiu
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.G.); (F.M.); (I.U.)
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Williamson V, Murphy D, Bonson A, Aldridge V, Serfioti D, Greenberg N. Restore and Rebuild (R&R) - a feasibility pilot study of a co-designed intervention for moral injury-related mental health difficulties. Eur J Psychotraumatol 2023; 14:2256204. [PMID: 37732994 PMCID: PMC10515691 DOI: 10.1080/20008066.2023.2256204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/27/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Moral injury can significantly negatively impact mental health, but currently no validated treatment for moral injury-related mental health difficulties exists in a UK context. This study aimed to examine whether the Restore and Rebuild (R&R) treatment was feasible to deliver, acceptable and well tolerated by UK military veterans with moral injury related mental health difficulties. METHOD The R&R treatment was delivered to 20 patients who reported distress related to exposure to a morally injurious event(s) during military service. R&R is a 20-session psychotherapy with key themes of processing the event, self compassion, connecting with others and core values. Treatment was delivered online, weekly, one-to-one by a single therapist. Qualitative interviews with patients and the therapist who delivered R&R were conducted to explore acceptability and analysed using thematic analysis. RESULTS Following treatment, patients experienced a significant reduction in symptoms of post-traumatic stress disorder, depression, alcohol misuse and moral injury related distress. R&R was found to be well tolerated by patients and improved their perceived wellbeing. CONCLUSIONS These results provide preliminary evidence that veterans struggling with moral injury related mental ill health can benefit from R&R treatment.
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Affiliation(s)
- Victoria Williamson
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s Centre for Military Health Research, King’s College London, London, UK
| | | | | | | | - Danai Serfioti
- Institute of Psychiatry, Psychology and Neuroscience, King’s Centre for Military Health Research, King’s College London, London, UK
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Neil Greenberg
- Institute of Psychiatry, Psychology and Neuroscience, King’s Centre for Military Health Research, King’s College London, London, UK
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Askovic M, Soh N, Elhindi J, Harris AW. Neurofeedback for post-traumatic stress disorder: systematic review and meta-analysis of clinical and neurophysiological outcomes. Eur J Psychotraumatol 2023; 14:2257435. [PMID: 37732560 PMCID: PMC10515677 DOI: 10.1080/20008066.2023.2257435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a debilitating condition affecting millions of people worldwide. Existing treatments often fail to address the complexity of its symptoms and functional impairments resulting from severe and prolonged trauma. Electroencephalographic Neurofeedback (NFB) has emerged as a promising treatment that aims to reduce the symptoms of PTSD by modulating brain activity.Objective: We conducted a systematic review and meta-analysis of ten clinical trials to answer the question: how effective is NFB in addressing PTSD and other associated symptoms across different trauma populations, and are these improvements related to neurophysiological changes?Method: The review followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. We considered all published and unpublished randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving adults with PTSD as a primary diagnosis without exclusion by type of trauma, co-morbid diagnosis, locality, or sex. Ten controlled studies were included; seven RCTs and three NRSIs with a total number of participants n = 293 (128 male). Only RCTs were included in the meta-analysis (215 participants; 88 male).Results: All included studies showed an advantage of NFB over control conditions in reducing symptoms of PTSD, with indications of improvement in symptoms of anxiety and depression and related neurophysiological changes. Meta-analysis of the pooled data shows a significant reduction in PTSD symptoms post-treatment SMD of -1.76 (95% CI -2.69, -0.83), and the mean remission rate was higher in the NFB group (79.3%) compared to the control group (24.4%). However, the studies reviewed were mostly small, with heterogeneous populations and varied quality.Conclusions: The effect of NFB on the symptoms of PTSD was moderate and mechanistic evidence suggested that NFB leads to therapeutic changes in brain functioning. Future research should focus on more rigorous methodological designs, expanded sample size and longer follow-up.
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Affiliation(s)
- Mirjana Askovic
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, NSW, Australia
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Nerissa Soh
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - James Elhindi
- Research and Education Network, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anthony W.F. Harris
- Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
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Karatzias T, Mc Glanaghy E, Cloitre M. Enhanced Skills Training in Affective and Interpersonal Regulation (ESTAIR): A New Modular Treatment for ICD-11 Complex Posttraumatic Stress Disorder (CPTSD). Brain Sci 2023; 13:1300. [PMID: 37759901 PMCID: PMC10527561 DOI: 10.3390/brainsci13091300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) is a relatively new condition; therefore, there is limited available evidence for its treatment. Prior to the recognition of CPTSD as a separate trauma condition, people who met criteria were often diagnosed with multiple co-morbid conditions such as PTSD, anxiety, depression, and emotional dysregulation difficulties. In the absence of a coherent evidence base, treatment tended to involve multiple treatments for these multiple conditions or lengthy phase-based interventions, often delivered in an integrative fashion, which was not standardized. In this paper, we present Enhanced Skills Training in Affective and Interpersonal Regulation (ESTAIR), a new flexible multi-modular approach for the treatment of CPTSD and its transdiagnostic symptoms. ESTAIR is consistent with trauma-informed and patient-centered care, which highlights the importance of patient choice in identification and sequencing in targeting CPTSD symptoms. Directions for future research are discussed.
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Affiliation(s)
- Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK
- NHS Lothian Rivers Centre, EH11 1BG, Stanford University, 450 Jane Stanford Way, Stanford, CA 94305, USA
| | - Edel Mc Glanaghy
- NHS Forth Valley, Mayfield Building, Falkirk Community Hospital, Scotland FK1 5QE, UK;
| | - Marylene Cloitre
- National Centre for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA;
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA 94305, USA
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Seiler N, Davoodi K, Keem M, Das S. Assessment tools for complex post traumatic stress disorder: a systematic review. Int J Psychiatry Clin Pract 2023; 27:292-300. [PMID: 37067395 DOI: 10.1080/13651501.2023.2197965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 02/13/2023] [Accepted: 03/26/2023] [Indexed: 04/18/2023]
Abstract
Appropriate screening tools are required to accurately detect complex post traumatic stress disorder (CPTSD). This systematic review aimed to assess and compare measurement tools. A literature search using key words 'complex post traumatic stress disorder', 'PTSD', and 'assessment' was undertaken on Embase and PsychINFO during February 2022 by two reviewers. Inclusion criteria included full text papers between 2002-2022 which evaluated CPTSD using assessment tools. Exclusion criteria included reviews, editorials, meta-analyses, or conference abstracts. Twenty-two papers met selection criteria. Thirteen studies used the International Trauma Questionnaire (ITQ). Two studies each evaluated CPTSD with the International Trauma Interview (ITI) or Symptoms of Trauma Scale (SOTS). The Developmental Trauma Inventory (DTI), Cameron Complex Trauma Interview (CCTI), Complex PTSD Item Set additional to the Clinician Administered PTSD Scale (COPISAC), Complex Trauma Questionnaire (ComplexTQ), and Scale 8 of the Minnesota Multiphasic Personality Inventory Scale (MMPI) were used by a single study each. The ITQ was the most thoroughly investigated, validated across different populations, and is a convenient questionnaire for screening within the clinical setting. Where self-report measures are inappropriate, the ITI, SOTS, and COPISAC are interview tools which detect CPTSD. However, they require further validation and should be used alongside clinical history and examination.
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Affiliation(s)
- Natalie Seiler
- Austin Hospital, Austin Health, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Keivan Davoodi
- Austin Hospital, Austin Health, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Michael Keem
- Northern Area Mental Health Service, Melbourne Health, Melbourne, Australia
| | - Subhash Das
- Northern Area Mental Health Service, Melbourne Health, Melbourne, Australia
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Bremer-Hoeve S, van Vliet NI, van Bronswijk SC, Huntjens RJ, de Jongh A, van Dijk MK. Predictors of treatment dropout in patients with posttraumatic stress disorder due to childhood abuse. Front Psychiatry 2023; 14:1194669. [PMID: 37599872 PMCID: PMC10436563 DOI: 10.3389/fpsyt.2023.1194669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Background Knowledge about patient characteristics predicting treatment dropout for post-traumatic stress disorder (PTSD) is scarce, whereas more understanding about this topic may give direction to address this important issue. Method Data were obtained from a randomized controlled trial in which a phase-based treatment condition (Eye Movement Desensitization and Reprocessing [EMDR] therapy preceded by Skills Training in Affect and Interpersonal Regulation [STAIR]; n = 57) was compared with a direct trauma-focused treatment (EMDR therapy only; n = 64) in people with a PTSD due to childhood abuse. All pre-treatment variables included in the trial were examined as possible predictors for dropout using machine learning techniques. Results For the dropout prediction, a model was developed using Elastic Net Regularization. The ENR model correctly predicted dropout in 81.6% of all individuals. Males, with a low education level, suicidal thoughts, problems in emotion regulation, high levels of general psychopathology and not using benzodiazepine medication at screening proved to have higher scores on dropout. Conclusion Our results provide directions for the development of future programs in addition to PTSD treatment or for the adaptation of current treatments, aiming to reduce treatment dropout among patients with PTSD due to childhood abuse.
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Affiliation(s)
| | | | - Suzanne C. van Bronswijk
- Department of Psychiatry and Neuropsychology, School for Mental health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Rafaele J.C. Huntjens
- Department of Experimental Psychotherapy and Psychopathology, University of Groningen, Groningen, Netherlands
| | - Ad de Jongh
- Department of Social Dentistry and Behavioral Sciences, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
- School of Health Sciences, Salford University, Manchester, United Kingdom
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
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Salome G, Vignaud P, Galia P, Prieto N, Chauliac N. Determinants of Care Pathways for C-PTSD Patients in French Psychotrauma Centers: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6278. [PMID: 37444125 PMCID: PMC10341220 DOI: 10.3390/ijerph20136278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/05/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
In 2018, the International Classification of Diseases (ICD-11) established a novel nosographic category within the stress-specific disorders known as complex post-traumatic stress disorder (C-PTSD). Characterized by distinctive clinical attributes and a limited response to conventional PTSD treatments, C-PTSD has prompted the reconsideration of care methods. Our study's purpose was to explore the intricate factors shaping the care pathways for individuals suffering from C-PTSD. We used a grounded theorization technique involving professionals across a range of specialized French psychotraumatology institutions. The resulting comprehensive theoretical model offers valuable insights into the constitution mechanisms of these pathways, helping elucidate the varying care options. Interestingly, we found that differences in clinical perspectives were determined by the care provider's viewpoint on clinical guidelines, screening tools, and treatment options, but also by structural and organizational factors. The distinctive dynamics and interrelationships identified in our research reveal potential areas of focus for incorporating C-PTSD care more effectively into specialized French trauma centers. This investigation offers a path toward improved understanding and management of C-PTSD, ultimately advancing patient outcomes.
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Affiliation(s)
- Germain Salome
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Philippe Vignaud
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, F-69008 Lyon, France
| | - Perrine Galia
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Nathalie Prieto
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Nicolas Chauliac
- Centre Régional du Psychotraumatisme Auvergne-Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290 & Université Claude Bernard Lyon 1, Domaine Rockefeller, F-69008 Lyon, France
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Folke S, Karstoft KI, Andersen SB, Karatzias T, Nissen LR, Nielsen ABS. Risk factors, comorbidity and social impairment of ICD-11 PTSD and complex PTSD in Danish treatment-seeking military veterans. J Psychiatr Res 2023; 163:247-253. [PMID: 37244062 DOI: 10.1016/j.jpsychires.2023.05.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE While a number of studies have investigated risk factors and comorbidities of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) in various trauma exposed samples, few studies have been conducted in military samples. Existing studies with military samples have included rather small samples. The aim of the present study was to identify risk factors and comorbidities of ICD-11 PTSD and CPTSD in a large sample of previously deployed, treatment-seeking soldiers and veterans. METHODS Previously deployed, treatment-seeking Danish soldiers and veterans (N = 599), recruited from the Military Psychology Department of the Danish Defense, completed the International Trauma Questionnaire (ITQ), as well as questionnaires of common mental health difficulties, trauma exposure, functioning and demographics. Multivariate multinomial logistic regression analysis explored differences in self-reported exposure to adversity and health outcomes between those meeting ICD-11 criteria for probable PTSD, CPTSD and no trauma disorder. RESULTS A total of 13.0% met probable ICD-11 criteria for PTSD and 31.4% for CPTSD. Risk factors for CPTSD (compared to those with no trauma disorder) included exposure to warfare or combat, longer duration since the traumatic event and being single. Those with CPTSD were more likely than those with PTSD or no trauma disorder to endorse symptoms of depression, anxiety, stress, use of psychotropic medication, and suicide attempts. CONCLUSION CPTSD is a more common and debilitating condition compared to PTSD in treatment-seeking soldiers and veterans. Further research should focus on testing existing and novel interventions for CPTSD in the military.
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Affiliation(s)
- Sofie Folke
- Research and Knowledge Centre, The Danish Veterans Centre, Ringsted, Denmark; Department of Military Psychology, The Danish Veterans Centre, Copenhagen, Denmark.
| | - Karen-Inge Karstoft
- Research and Knowledge Centre, The Danish Veterans Centre, Ringsted, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| | - Søren Bo Andersen
- Research and Knowledge Centre, The Danish Veterans Centre, Ringsted, Denmark.
| | - Thanos Karatzias
- School of Health and Social Care, Napier University, Edinburgh, UK; Rivers Centre for Traumatic Stress, NHS, Lothian, Edinburgh, UK.
| | | | - Anni B S Nielsen
- Research and Knowledge Centre, The Danish Veterans Centre, Ringsted, Denmark; The Research Unit and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Bever-Philipps A, Silbermann A, Morawa E, Schäflein E, Stemmler M, Erim Y. Long-term follow-up of a multimodal day clinic, group-based treatment program for patients with very high risk for complex posttraumatic stress disorder, and for patients with non-complex trauma-related disorders. Front Psychiatry 2023; 14:1152486. [PMID: 37398576 PMCID: PMC10311064 DOI: 10.3389/fpsyt.2023.1152486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/19/2023] [Indexed: 07/04/2023] Open
Abstract
Objective The present study examined the follow-up of a multimodal day clinic group-based therapy program for patients with trauma-related disorders and investigated potential differences for patients with classic PTSD versus cPTSD. Method Sixty-six patients were contacted 6 and 12 months after discharge of our 8-week program and completed various questionnaires (Essen Trauma Inventory (ETI), Beck Depression Inventory-Revised (BDI-II), Screening scale of complex PTSD (SkPTBS), Patient Health Questionnaire (PHQ)-Somatization, as well as single items to therapy utilization and life events in the interim period). Due to organizational reasons a control group could not be included. Statistical analyses included repeated-measures ANOVA with cPTSD as between-subject factor. Results The reduction of depressive symptoms at discharge was persistent at 6 and 12 months follow-up. Somatization symptoms were increased at discharge, but were leveled out at 6 months follow-up. The same effect was found for cPTSD symptoms in those patients with non-complex trauma-related disorders: Their increase of cPTSD symptoms was flattened at 6 months follow-up. Patients with a very high risk for cPTSD showed a strong linear reduction of cPTSD symptoms from admission to discharge and 6 months follow-up. cPTSD patients had a higher symptom load compared to patients without cPTSD on all time points and scales. Conclusion Multimodal, day clinic trauma-focused treatment is associated with positive changes even after 6 and 12 months. Positive therapy outcomes (reduced depression, reduced cPTSD symptoms for patients with a very high risk for cPTSD) could be maintained. However, PTSD symptomatology was not significantly reduced. Increases in somatoform symptoms were leveled out and can therefore be regarded as side effects of treatment, which may be connected with actualization of trauma in the intensive psychotherapeutic treatment. Further analyses should be applied in larger samples and a control group.
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Affiliation(s)
- Anke Bever-Philipps
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andrea Silbermann
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Morawa
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Schäflein
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Mark Stemmler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Yesim Erim
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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Simkin DR. Post-Traumatic Stress Disorder/Developmental Trauma Disorder/Complex Post-Traumatic Stress Disorder and Complementary and Integrative Medicine/Functional Medicine. Child Adolesc Psychiatr Clin N Am 2023; 32:317-365. [PMID: 37147042 DOI: 10.1016/j.chc.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Response to PTSD treatments differ based on the age the abuse occurred, the type of abuse, and the chronicity of the abuse. Even when modifications to treatment are made based on the developmental age when the abuse occurred, therapies may be insufficient. In addition, when diagnostic criteria are modified to identify more children, some children continue to escape detection. Developmental Trauma Disorder, (akin to the RDoC), may be more suitable to identify epigenetic and inflammatory effects of early abuse that may be responsible for the nonresponsive to treatment. Complementary and Integrative Medicine interventions (meditation, EFT, EMDR, PUFAs, etc.) may reverse these effects.
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Affiliation(s)
- Deborah R Simkin
- Department of Psychiatry, Emory University School of Medicine, 8955 Highway 98 West, Suite 204, Miramar Beach, FL 32550, USA.
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O'Loghlen E, Galligan R, Grant S. The functions of binge eating scale (FBES): Development and preliminary psychometric validation. Appetite 2023; 183:106479. [PMID: 36736905 DOI: 10.1016/j.appet.2023.106479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Binge eating within binge-eating disorder (BED) is a behaviour widely understood as a response to dietary restraint and emotion dysregulation. However, qualitative literature suggests that a wider range of functions of binge eating exist, with associations between functions of binge eating and adverse childhood experiences highlighted across this research. The present study sought to develop a scale to measure a wide range of functions of binge eating within BED. A secondary aim was to examine the relationship between these functions and adverse childhood experiences (ACEs). METHOD The researchers developed an initial item pool for the Functions of Binge Eating Scale (FBES) and invited experts within the eating disorder (ED) field (n = 22) to review the items. The refined item pool was administered online to adults with self-reported binge eating symptoms (N = 882), along with related measures to establish scale validity. RESULTS Exploratory and confirmatory factor analyses produced an eight-factor structure (emotion regulation, hedonic hunger, compensatory eating, numbness/dissociation, emotion expression, self-punishment, control, self-protection). The scale demonstrated good internal reliability and adequate construct and predictive validity. Results also showed that functions theoretically related to childhood maltreatment were predicted by ACEs. DISCUSSION Findings extend our understanding of the range of functions of binge eating experienced in BED. Additionally, findings indicate that type of adverse childhood experience predicts functions of binge eating. Initial validation of the FBES suggests that functions of binge eating are wider than previously understood. Accordingly, clinicians are encouraged to explore and target more complex processes which might perpetuate binge-eating behaviour.
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Affiliation(s)
- Elyse O'Loghlen
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Roslyn Galligan
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Sharon Grant
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
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Malik N, Facer-Irwin E, Dickson H, Bird A, MacManus D. The Effectiveness of Trauma-Focused Interventions in Prison Settings: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:844-857. [PMID: 34711095 DOI: 10.1177/15248380211043890] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is overrepresented in prison relative to community populations and can be difficult to manage in an environment which can inherently exacerbate trauma-related symptomology. Little is known about the effectiveness of trauma-focused interventions in prison and less is known about factors that moderate the effectiveness of these interventions. AIM/METHODS We examined the effectiveness of trauma-focused interventions in prison relative to prison controls using meta-analytic techniques. We further used meta-regression analysis to examine treatment, methodological and participant-level moderators to determine factors that increased the effectiveness of these interventions. RESULTS From 16 studies eligible for the meta-analysis, we found a small but significant effect size for trauma-focused interventions. Phase 2 trauma processing interventions and interventions delivered individually led to greater reductions in PTSD symptoms. Studies utilizing an active treatment control resulted in smaller effect sizes than those using waitlist or no contact controls. Treatment length, study quality, outcome type, and gender were not significant moderators of treatment effectiveness. CONCLUSION Findings from this review are encouraging but should be interpreted with caution. Results suggest that trauma processing therapies, and individual modality trauma-focused interventions can be effective and delivered successfully in prison. However, inadequate comparison groups do not allow a firm conclusion to be drawn. There is a need for high quality Randomized Controlled Trial's that additionally measure Complex PTSD, utilize a modular treatment approach, and include treatments recommended in the National Institute for health and Care Excellence (NICE) guidelines such as Trauma-focused CBT and Eye Movement Desensitization Reprocessing (EMDR).
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Affiliation(s)
- Nabeela Malik
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Older Adults Psychiatry, North East London Foundation NHS Trust, London, England, United Kingdom
| | - Emma Facer-Irwin
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Clinical Psychology, School of Health and Social Care, University of Essex, Colchester, United Kingdom
- Joint first author
| | - Hannah Dickson
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Annie Bird
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Deirdre MacManus
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Consultant Forensic Psychiatrist; HMP Wandsworth, South London and Maudsley NHS Trust, London, England, United Kingdom
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