Routineversorgung für Jugendliche und junge Erwachsene mit Posttraumatischer Belastungsstörung nach sexualisierter und physischer Gewalt in Deutschland

Feasibility of a trauma-focused internet- and mobile-based intervention for youth with posttraumatic stress symptoms

Background: Many youth with posttraumatic stress symptoms (PTSS) do not receive evidence-based care. Internet- and Mobile-Based Interventions (IMIs) comprising evidence-based trauma-focused components can address this gap, but research is scarce. Thus, we investigated the feasibility of a trauma-focused IMI for youth with PTSS.Methods: In a one-arm non-randomized prospective proof-of-concept study, 32 youths aged 15-21 years with clinically relevant PTSS (CATS ≥ 21) received access to a trauma-focused IMI with therapist guidance, comprising nine sessions on an eHealth platform accessible via web-browser. We used a feasibility framework assessing recruitment capability, sample characteristics, data collection, satisfaction, acceptability, study management abilities, safety aspects, and efficacy of the IMI in PTSS severity and related outcomes. Self-rated assessments took place pre-, mid-, post-intervention and at 3-month follow-up and clinician-rated assessments at baseline and post-intervention.Results: The sample mainly consisted of young adult females with interpersonal trauma and high PTSS levels (CATS, M = 31.63, SD = 7.64). The IMI sessions were found useful and comprehensible, whereas feasibility of trauma processing was perceived as difficult. Around one-third of participants (31%) completed the IMI's eight core sessions. The study completer analysis showed a significant reduction with large effects in self-rated PTSS at post-treatment [t(21) = 4.27; p < .001; d = 0.88] and follow-up [t(18) = 3.83; p = .001; d = 0.84], and clinician-rated PTSD severity at post-treatment [t(21) = 4.52; p < .001; d = 0.93]. The intention-to-treat analysis indicated significant reductions for PTSS at post-treatment and follow-up with large effect sizes (d = -0.97- -1.02). All participants experienced at least one negative effect, with the most common being the resurfacing of unpleasant memories (n = 17/22, 77%).Conclusion: The study reached highly burdened young adults. The IMI was accepted in terms of usefulness and comprehensibility but many youths did not complete all sessions. Exploration of strategies to improve adherence in trauma-focused IMIs for youth is warranted, alongside the evaluation of the IMI's efficacy in a subsequent randomized controlled trial.

Gewalterfahrungen und Traumafolgestörungen bei Kindern und Jugendlichen

Zusammenfassung. Ein substantieller Teil der Kinder und Jugendlichen erlebt in ihrer Kindheit und Jugend Gewalt. Diese ist ein Unrecht gegenüber den Kindern und Jugendlichen und kann eine Vielzahl von langanhaltenden und schwerwiegenden Folgen haben. Das aktuelle Versorgungssystem wird seiner Aufgabe, die psychischen Folgen so gut wie möglich zu behandeln, nur eingeschränkt gerecht. In diesem Themenschwerpunkt werden aktuelle Forschungen zu diagnostischen und störungsspezifischen Grundlagen der Posttraumatischen Belastungsstörung (PTBS), Behandlungsleitlinien und ihre Umsetzung in der Routineversorgung sowie zu Einstellungen von Behandler_innen vorgestellt. Es wird deutlich, dass in diesem Bereich noch große Aufgaben und Herausforderungen liegen. Um die Situation zu verbessern müssen gefährdete Kinder und Jugendliche besser identifiziert werden und ihnen wirksame Verfahren angeboten werden, die eine schnelle und effektive Entlastung bewirken. Dabei hilft es, wenn wir Versorgungsangebote niedrigschwellig gestalten und den Kindern und Jugendlichen die Möglichkeit geben, diese auch selbst und unkompliziert in Anspruch nehmen zu können. Dazu braucht es eine Zusammenarbeit mit der Familie und allen Hilfesystemen.

How do licensed psychotherapists in Germany feel about treating patients with posttraumatic stress symptoms? - an experimental study based on case vignettes

BACKGROUND

Previous research indicates that not all children, adolescents and adults suffering from PTSD receive psychotherapy and if they do, trauma is not always considered during therapy. One reason for this undertreatment might be a limited readiness of licenced psychotherapists (LPTs) to treat patients who have experienced a trauma and thus suffer from PTSD symptoms.

OBJECTIVE

The aim of this study is to explore the association between the readiness of LPTs to treat patients with PTSD symptoms and different patients' and therapists' characteristics.

METHOD

We used case vignettes to assess the readiness of LPTs in Germany in a nationwide online survey (N = 768). The vignettes described patients with PTSD and were adapted to the age group mainly treated by the therapists (children/adolescents vs. adults). The patients' characteristics in the otherwise identical vignettes were randomized for patient gender (female vs. male) and symptom cluster (internalizing vs. externalizing). Rating scales were used to assess readiness. Additionally, therapists' characteristics (age, trauma-specific training, perceived fears/doubts, and objective barriers to treating the vignette patient) were assessed.

RESULTS

The patients' characteristics did not influence the treatment readiness of the LPTs. Regarding therapists' characteristics, LPTs working mainly with children and adolescents, and those who had completed trauma-specific training reported a higher readiness to treat the vignette patient.

CONCLUSIONS

Regarding the treatment of patients suffering from PTSD symptoms of different ages, our study indicated that the assessed therapists' characteristics were more relevant for the treatment readiness of LPTs than the patients' characteristics of age or symptom type.