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Steil R, Maercker A, Jaworski L, Bachem R, Eberle D. [Evidence-based psychotherapy of posttraumatic stress syndrome-An update]. DER NERVENARZT 2024; 95:616-621. [PMID: 38906997 DOI: 10.1007/s00115-024-01694-6] [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: 06/06/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND The aim of this article is to summarize the current state of research on the effectiveness of psychotherapeutic treatment of posttraumatic stress disorder (PTSD). METHODS The results of current meta-analyses and trend-setting individual studies are summarized and the most important forms of intervention are explained. RESULTS The psychotherapeutic treatment methods for PTSD are very effective, the effect sizes are large and superior to those of pharmacotherapy. Trauma exposure and cognitive restructuring are most effective. Trauma-focused procedures are generally superior to other forms of psychotherapy. A range of different cognitive behavioral procedures as well as eye movement desensitization and reprocessing are recommended. The most recent initial findings confirm a very good effectiveness for imagery rescripting methods as protective interventions without a formal confrontation with trauma. Individual therapy works better than group psychotherapy. In the group setting cognitive processing therapy has proven to be the best intervention. Trauma-focused treatment should also be used when comorbid conditions such as schizophrenia, bipolar disorder or addiction are present. DISCUSSION Trauma-focused psychotherapy in an individual setting is the treatment of choice for PTSD. A large selection of effective methods and well-reviewed manuals are available. The German language S3 guidelines are currently being updated.
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Affiliation(s)
- Regina Steil
- Institut für Psychologie, Goethe-Universität Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Deutschland.
| | | | - Lena Jaworski
- Institut für Psychologie, Goethe-Universität Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Deutschland
| | - Rahel Bachem
- Psychologisches Institut, Universität Zürich, Zürich, Schweiz
| | - David Eberle
- Psychologisches Institut, Universität Zürich, Zürich, Schweiz
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Verhaak L, ter Heide JJ. Group Schema Therapy for Refugees with Treatment-Resistant PTSD and Personality Pathology. Case Rep Psychiatry 2024; 2024:8552659. [PMID: 38434423 PMCID: PMC10904674 DOI: 10.1155/2024/8552659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Patients with complex forms of posttraumatic stress disorder (PTSD) may benefit from schema therapy. While a small number of studies point to the effectiveness of individual schema therapy in refugees with PTSD, no evidence on group schema therapy (GST) in refugees exists. To illustrate and advocate for the use of GST in refugee patients with treatment-resistant PTSD and comorbid personality pathology, a case report is presented. Presentation. The case concerned the treatment of an East African female refugee who survived sexual and physical violence and loss as a child, as the hostage of a rebel army, and as a victim of human trafficking. She was diagnosed with PTSD, major depressive disorder, and borderline personality disorder. Trauma-focused therapy was hampered by insufficient treatment attendance due to current stress factors and early destructive coping strategies. One year of GST enabled the patient to overcome treatment-undermining patterns and benefit from subsequent trauma-focused therapy. Conclusion This case suggests that GST may have the potential to improve treatment adherence and the effectiveness of trauma-focused treatment in complex refugee patients. Clinical impressions need to be confirmed in a study that examines the feasibility, acceptability, and preliminary efficacy of GST in refugees with treatment-resistant PTSD and personality pathology.
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Schumm H, Steil R, Lechner-Meichsner F, Morina N, Weise C, Mewes R, Kuck S, Reuter J, Giesebrecht J, Cludius B, Ehring T. Associations between sleep problems and posttraumatic stress symptoms, social functioning, and quality of life in refugees with posttraumatic stress disorder. J Trauma Stress 2023; 36:1176-1183. [PMID: 37883129 DOI: 10.1002/jts.22983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023]
Abstract
Many patients with posttraumatic stress disorder (PTSD) suffer from sleep problems, leading to impairments in social functioning and quality of life. Refugees are at high risk for sleep problems due to stressful life circumstances and a high PTSD prevalence. However, limited data on the frequency of sleep problems in refugees with diagnosed PTSD exist. This study examined the frequency of sleep problems in refugees with PTSD and their associations with symptoms of PTSD. Additionally, we investigated the contribution of sleep problems to social functioning and quality of life. Participants (N = 70) were refugees from different countries of origin currently living in Germany. All participants met the criteria for PTSD and completed measures of PTSD symptom severity, subjective sleep problems, social impairment, and quality of life. There was a very high frequency of sleep problems in the sample (100%), and sleep problems were significantly associated with both clinician-rated, r = .47, and self-rated, r = .30, PTSD symptom severity after controlling for overlapping items. Contrary to expectations, sleep problems did not predict social impairment, d = 0.16, nor quality of life, d = 0.13, beyond the effect of other PTSD symptoms. The findings highlight the widespread frequency of sleep problems among refugees. Future studies should assess the causal nature of the association between sleep problems and measures of psychosocial functioning in more detail and examine its dynamic change over time.
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Affiliation(s)
- Hannah Schumm
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Regina Steil
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Franziska Lechner-Meichsner
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
- Department of Psychology, Utrecht University, Utrecht, Netherlands
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| | - Cornelia Weise
- Department of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Ricarda Mewes
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Sascha Kuck
- Institute of Psychology, University of Münster, Münster, Germany
| | - Julia Reuter
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Julia Giesebrecht
- Department of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Barbara Cludius
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Thomas Ehring
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
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Ten Napel-Schutz MC, Karbouniaris S, Mares SHW, Arntz A, Abma TA. Perspectives of underweight people with eating disorders on receiving Imagery Rescripting trauma treatment: a qualitative study of their experiences. J Eat Disord 2022; 10:188. [PMID: 36451217 PMCID: PMC9710063 DOI: 10.1186/s40337-022-00712-9] [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: 07/21/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The prognosis for underweight individuals with an eating disorder (ED) and posttraumatic stress disorder (PTSD) is worse than for their peers without these comorbid symptoms. This qualitative study explores the experiences of trauma-focused Imagery Rescripting (ImRs) therapy of underweight inpatients being treated for an ED. OBJECTIVE To test the feasibility and to improve ImRs by understanding the experiences and perspectives of people with an ED and PTSD who, when underweight, received ImRs as an adjunct to their inpatient ED treatment. METHOD To explore how underweight people with an ED experience and perceive ImRs, we used a qualitative study design involving semi-structured interviews with 12 participants. After analysis, the data were summarized and classified within a thematic framework that focused on experiences and improving the ImRs method. RESULTS The thematic analysis resulted in the following 6 main themes; (1) Expectations of ImRs; (2) Ability to participate in ImRs; (3) Effect of ImRs; (4) Experience of ImRs technique; (5) Conditions under which ImRs is given; (6) In depth-analysis. The results show that despite the fear of disappointment the participants appreciate addressing the PTSD and ED symptoms simultaneously. Further, results showed that it had been possible for them to attend ImRs but that the effects of ImRs were not uniformly perceived. Also, participants indicated that a caring context is important and that ImRs should not be scheduled immediately before a meal. Finally, the treatment generated hope. CONCLUSIONS The findings of this study demonstrated the feasibility of the integration of ImRs trauma treatment for individuals who are being treated in an ED inpatient treatment setting, and are in contrast to standard practice where the focus of inpatient treatment has been ED-symptom improvement without comprehensively addressing past traumatic experiences during an underweight phase. Trial registration International Clinical Trials Registry Platform (ICTRP) (NTR6094). Date of registration 09/23/2016. https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6094.
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Affiliation(s)
- Marieke C Ten Napel-Schutz
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands. .,Radboud Centre Social Sciences, Radboud University, Nijmegen, The Netherlands.
| | - Simona Karbouniaris
- Utrecht University of Applied Sciences, Utrecht, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Suzanne H W Mares
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Tineke A Abma
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
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Shigemura J, Takahashi S, Komuro H, Suda T, Kurosawa M. Mental health consequences of individuals affected by the 2022 invasion of Ukraine: Target populations in Japanese mental healthcare settings. Psychiatry Clin Neurosci 2022; 76:342-343. [PMID: 35452567 DOI: 10.1111/pcn.13369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Jun Shigemura
- Faculty of Health Sciences, Mejiro University, Saitama
| | - Sho Takahashi
- Department of Disaster and Community Psychiatry, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Hazuki Komuro
- Department of Nursing, Faculty of Health Care, Teikyo Heisei University
| | - Tetsufumi Suda
- Department of Neuropsychiatry, KKR Tachikawa Hospital, Tokyo, Japan
| | - Mie Kurosawa
- Clinical Psychology Center, Musashino University, Tokyo, Japan
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Using Imagery Rescripting to Treat Posttraumatic Stress Disorder in Refugees: A Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Echterhoff G, Becker JC, Knausenberger J, Hellmann JH. Helping in the context of refugee immigration. Curr Opin Psychol 2021; 44:106-111. [PMID: 34610545 DOI: 10.1016/j.copsyc.2021.08.035] [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: 07/26/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/03/2022]
Abstract
We review psychological approaches of helping behavior in the context of refugee immigration. Refugee migration, compared with nonrefugee migration, is characterized by greater forcedness and related perils. Taking into account perceptions of forcedness and perils, we examine potential helpers' responses at each of four successive stages toward helping people in perilous, distressing, or emergency situations: (1) noticing and recognizing distressing, help-demanding conditions; (2) taking responsibility; (3) knowing how to help; and (4) transfer of one's knowledge into action. In so doing, we discuss the role of different motives and functions of providing help (e.g. preserving refugees' dependency or facilitating their autonomy) and implications of unequal power relations between help providers and refugees.
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Affiliation(s)
- Gerald Echterhoff
- University of Münster, Institute of Psychology, Fliednerstr. 21, 48149, Münster, Germany.
| | - Julia C Becker
- University of Osnabrück, Department of Psychology, Seminarstr. 20, 49074, Osnabrück, Germany
| | - Judith Knausenberger
- University of Münster, Institute of Psychology, Fliednerstr. 21, 48149, Münster, Germany
| | - Jens H Hellmann
- University of Münster, Institute of Psychology, Fliednerstr. 21, 48149, Münster, Germany
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Lechner-Meichsner F, Steil R. A clinician rating to diagnose CPTSD according to ICD-11 and to evaluate CPTSD symptom severity: Complex PTSD Item Set additional to the CAPS (COPISAC). Eur J Psychotraumatol 2021; 12:1891726. [PMID: 36877471 PMCID: PMC9754030 DOI: 10.1080/20008198.2021.1891726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Researchers who wish to study stress-related disorders need to use valid, reliable, and sensitive instruments and the Clinician-administered PTSD Scale (CAPS) constitutes the gold standard in the assessment of posttraumatic stress disorder (PTSD). While the CAPS corresponds with PTSD criteria according to the DSM-5, researchers face a challenge with the forthcoming ICD-11: ICD-11 introduces the new diagnosis Complex PTSD (CPTSD) that does not exist in DSM-5.Objective: Researchers as well as clinicians will need to assess the incidence and prevalence of CPTSD and will want to evaluate treatment effects according to both criteria sets. However, using two clinician-rated interviews is often not feasible and a burden to patients, particularly in psychotherapy research.Method & Results: We have therefore developed the Complex PTSD Item Set additional to the CAPS (COPISAC). This clinician rating is an easy-to-use and economic addition to the CAPS that permits assessing diagnosis and evaluating symptom severity of CPTSD. COPISAC consists of three items that assess disturbances in self-regulation including prompts for symptom description and frequency, and two additional items assessing impairment. Diagnostic status and severity ratings for CPTSD are possible. Items that account for the specific forms of trauma which the ICD-11 describes as precursors of CPTSD (e.g. torture, being enslaved) are further suggested as additions to the Life Events Checklist.Conclusion: With an introduction of COPISAC at this point, we aim at suggesting an easy transition into diagnosing CPTSD and evaluating its course over treatment.
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Affiliation(s)
| | - Regina Steil
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany.,Center for Mind, Brain and Behavior, Center for Mind, Brain and Behavior (CMBB, University of Marburg and Justus Liebig University Giessen, Germany
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