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Kratzer L, Tschöke S, Schröder J, Shevlin M, Hyland P, Eckenberger C, Heinz P, Karatzias T. Severe Dissociative Experiences beyond Detachment in a Large Clinical Sample of Inpatients with Post-Traumatic Stress Disorder: Diagnostic and Treatment Implications. Psychopathology 2024:1-9. [PMID: 39038445 DOI: 10.1159/000539740] [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: 08/22/2023] [Accepted: 02/12/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) contains a dissociative subtype of post-traumatic stress disorder (PTSD) characterized by depersonalization and derealization. Yet, there is evidence that dissociative symptoms in PTSD go beyond this kind of detachment dissociation and that some patients present with additional compartmentalization dissociation in the form of auditory-verbal hallucination, amnesia, and identity alteration. METHODS Hence, in this study, we examined latent profiles of childhood trauma (Childhood Trauma Questionnaire), PTSD (Impact-of-Event Scale-Revised), and pathological dissociation (Dissociative Experiences Scale-Taxon; DES-T) in a large sample of severely traumatized inpatients with PTSD (N = 1,360). RESULTS Results support a three-class solution of the latent profile analysis with a PTSD class, a dissociative subtype class, and a third class characterized by more complex and more severe dissociative symptoms. Importantly, in our inpatient sample of patients with severe PTSD, the latter class was found to be the most prevalent. Both the exploratory character of our retrospective analysis of clinical routine data and the use of the DES-T limit the generalizability of our findings, which require methodologically more rigorous replication. CONCLUSION In severe PTSD, dissociative symptoms beyond detachment are highly prevalent. Diagnostic and treatment implications are discussed.
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Affiliation(s)
- Leonhard Kratzer
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany,
| | - Stefan Tschöke
- Clinic for Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany
- Centre for Psychiatry Südwürttemberg, Ravensburg, Germany
| | - Johanna Schröder
- Department for Psychology, Medical School Hamburg, Institute for Clinical Psychology and Psychotherapy, Hamburg, Germany
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, UK
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Peter Heinz
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
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Adrien V, Bosc N, Peccia Galletto C, Diot T, Claverie D, Reggente N, Trousselard M, Bui E, Baubet T, Schoeller F. Enhancing Agency in Posttraumatic Stress Disorder Therapies Through Sensorimotor Technologies. J Med Internet Res 2024; 26:e58390. [PMID: 38742989 PMCID: PMC11250045 DOI: 10.2196/58390] [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: 03/14/2024] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
Posttraumatic stress disorder (PTSD) is a significant public health concern, with only a third of patients recovering within a year of treatment. While PTSD often disrupts the sense of body ownership and sense of agency (SA), attention to the SA in trauma has been lacking. This perspective paper explores the loss of the SA in PTSD and its relevance in the development of symptoms. Trauma is viewed as a breakdown of the SA, related to a freeze response, with peritraumatic dissociation increasing the risk of PTSD. Drawing from embodied cognition, we propose an enactive perspective of PTSD, suggesting therapies that restore the SA through direct engagement with the body and environment. We discuss the potential of agency-based therapies and innovative technologies such as gesture sonification, which translates body movements into sounds to enhance the SA. Gesture sonification offers a screen-free, noninvasive approach that could complement existing trauma-focused therapies. We emphasize the need for interdisciplinary collaboration and clinical research to further explore these approaches in preventing and treating PTSD.
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Affiliation(s)
- Vladimir Adrien
- Department of Infectious and Tropical Diseases, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
- Institute of Psychiatry and Neuroscience of Paris, Inserm UMR-S 1266, Université Paris Cité, Paris, France
- Department of Psychopathology, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Nicolas Bosc
- Department of Psychopathology, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Thomas Diot
- Department of Adult Psychiatry, Impact, Mondor Hospital, AP-HP, Université Paris-Est Créteil, Créteil, France
| | - Damien Claverie
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
| | - Nicco Reggente
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States
| | - Marion Trousselard
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
- INSPIIRE, Inserm UMR 1319, Université de Lorraine, Nancy, France
- ADES, CNRS UMR 7268, Aix-Marseille Université, Marseille, France
| | - Eric Bui
- Department of Psychiatry, Caen Normandy University Hospital, Normandie Université, Caen, France
- Physiopathology and Imaging of Neurological Disorders, UNICAEN, Inserm UMR-S 1237, Normandie Université, Caen, France
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Thierry Baubet
- Department of Psychopathology, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
- Unité Transversale de Psychogénèse et Psychopathologie, Université Sorbonne Paris Nord, Villetaneuse, France
- Centre National de Ressources et de Résilience, Lille, France
| | - Félix Schoeller
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
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Burback L, Forner C, Winkler OK, Al-Shamali HF, Ayoub Y, Paquet J, Verghese M. Survival, Attachment, and Healing: An Evolutionary Lens on Interventions for Trauma-Related Dissociation. Psychol Res Behav Manag 2024; 17:2403-2431. [PMID: 38912158 PMCID: PMC11193433 DOI: 10.2147/prbm.s402456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Dissociation is a necessary part of our threat response system, common to all animal species, normally temporarily activated under conditions of extreme or inescapable threat. Pathological dissociation, however, continues to occur after the initial threat has passed, in response to reminders or inaccessibility of safety and security. Present across the spectrum of psychiatric diagnoses, recurrent dissociative symptoms are linked to severe trauma exposure, insecure attachment, treatment non-response, and maladaptive coping behaviors such as substance use, suicidality, and self-harm. However, empirical studies testing treatments specific to dissociative processes remain scarce. This narrative review summarizes existing studies and provides theoretical, neurobiological, and evolutionary perspectives on dissociative processes and treatments for pathological dissociation. Methods A systematic search of five databases (MEDLINE, EMBASE, APA PsycINFO, CINAHL plus, Scopus) was conducted on April 13, 2023. Peer-reviewed clinical studies with adult participants, assessing intervention effects on dissociative symptoms, were included. Results were thematically analyzed and summarized. Results Sixty-nine studies were identified, mainly focused on posttraumatic stress disorder, trauma-exposed populations, and borderline personality disorder. Psychotherapy was studied in 72.5% of studies; other interventions included medications and neurostimulation. The majority reported positive outcomes, despite the heterogeneous spectrum of interventions. However, treatment of dissociative symptoms was the primary objective in only a minority. Conclusion Pathological dissociation is a complex phenomenon involving brain and body systems designed for perceiving and responding to severe threats, requiring an individualized approach. A literature is emerging regarding potentially evidence-based treatments to help those impacted by recurrent dissociative symptoms. When contextualized within a neurobiological and evolutionary perspective, these treatments can be understood as facilitating an internal and/or relational sense of safety, resulting in symptom reduction. Further studies are needed to explore effective treatments for dissociative symptoms.
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Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
- Neuroscience and Mental Health Institute (NMHI), University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Huda F Al-Shamali
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Yahya Ayoub
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Jacquelyn Paquet
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Myah Verghese
- Department of Neuroscience, University of Alberta, Edmonton, Alberta, Canada
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Misitano A, Moro AS, Ferro M, Forresi B. The Dissociative Subtype of Post-Traumatic Stress Disorder: A Systematic Review of the Literature using the Latent Profile Analysis. J Trauma Dissociation 2024; 25:349-365. [PMID: 36062756 DOI: 10.1080/15299732.2022.2120155] [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: 05/19/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
A PTSD subtype with dissociative symptoms (D-PTSD) was included in the DSM-5 recognizing the existence of a more severe form of PTSD, associated to past trauma, high comorbidity, and complex clinical management. As research is rapidly growing and results are inconsistent, a better investigation of this subtype is of primary importance. We conducted a systematic review of studies using Latent Profile Analysis to investigate the existence of a D-PTSD subtype. Covariates of D-PTSD were included, to understand additional symptoms, risk factors and comorbidities. The search was performed on PubMed, EBSCOHost, and PTSDPubs according to 2020 PRISMA guidelines. Eligible articles assessed trauma exposure, PTSD symptoms and diagnosis, and dissociation, in adult samples. 13 of 165 articles met the inclusion criteria. All identified a dissociative subtype of PTSD, mainly characterized by higher levels of depersonalization and derealization. D-PTSD profile sometimes presented other dissociative symptoms, such as gaps in awareness and memory, other comorbid disorders, and a history of abuse. Despite some limitations, this review supports the existence of a dissociative subgroup of individuals among those with PTSD. More rigorous studies are needed to clarify these findings and their clinical implications.
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Affiliation(s)
- Alberto Misitano
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Andrea Stefano Moro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Ferro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | - Barbara Forresi
- Department of Psychology, Sigmund Freud University, Milan, Italy
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5
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De Jongh A, Hafkemeijer LCS. Trauma-focused treatment of a client with Complex PTSD and comorbid pathology using EMDR therapy. J Clin Psychol 2024; 80:824-835. [PMID: 37058521 DOI: 10.1002/jclp.23521] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE Complex post-traumatic stress disorder (CPTSD) is a classification within the International Classification of Diseases, 11th Revision (ICD-11) that, besides the DSM-5 symptom clusters of post-post-traumatic stress disorder (PTSD), includes the presence of negative self-concept, difficulties in regulating emotions and relationship skills. The purpose of the present study was to provide guidance on how to deliver Eye Movement Desensitization and Reprocessing (EMDR) therapy in the context of CPTSD, based on current clinical knowledge and the latest scientific research findings. METHOD This paper describes the treatment of a 52-year-old woman with CPTSD and borderline personality disorder for which immediate trauma-focused EMDR therapy was used. RESULTS First, a description of what EMDR therapy entails and some important treatment strategies that the therapist may employ to assist in trauma-focused treatment of clients with CPTSD using EMDR therapy are outlined. CONCLUSION The treatment results are in line with mounting evidence supporting the notion that EMDR therapy is a safe and potentially effective treatment alternative for individuals with CPTSD or personality problems.
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Affiliation(s)
- A De Jongh
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Research Department PSYTREC, Bilthoven, The Netherlands
- School of Health Sciences, Salford University, Manchester, UK
- Institute of Health and Society, University of Worcester, Worcester, UK
- School of Psychology, Queen's University, Belfast, Northern Ireland
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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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7
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Hyland P, Hamer R, Fox R, Vallières F, Karatzias T, Shevlin M, Cloitre M. Is Dissociation a Fundamental Component of ICD-11 Complex Posttraumatic Stress Disorder? J Trauma Dissociation 2024; 25:45-61. [PMID: 37401797 DOI: 10.1080/15299732.2023.2231928] [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: 06/29/2022] [Accepted: 05/09/2023] [Indexed: 07/05/2023]
Abstract
ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) is a disorder of six symptom clusters including reexperiencing, avoidance, sense of threat, affective dysregulation, negative self-concept, and disturbed relationships. Unlike earlier descriptions of complex PTSD, ICD-11 CPTSD does not list dissociation as a unique symptom cluster. We tested whether the ICD-11 CPTSD symptoms can exist independently of dissociation in a nationally representative sample of adults (N = 1,020) who completed self-report measures. Latent class analysis was used to identify unique subsets of people with distinctive symptom profiles. The best fitting model contained four classes including a "low symptoms" class (48.9%), a "PTSD" class (14.7%), a "CPTSD" class (26.5%), and a "CPTSD + Dissociation" class (10.0%). These classes were related to specific adverse childhood experiences, notably experiences of emotional and physical neglect. The "PTSD," "CPTSD," and "CPTSD + Dissociation" classes were associated with a host of poor health outcomes, however, the "CPTSD + Dissociation" class had the poorest mental health and highest levels of functional impairment. Findings suggest that ICD-11 CPTSD symptoms can occur without corresponding dissociative experiences, however, when CPTSD symptoms and dissociative experiences occur together, health outcomes appear to be more severe.
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Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Ruby Hamer
- Department of Medicine, Monash University, Melbourne, Australia
| | - Robert Fox
- School of Business, National College of Ireland, Dublin, Ireland
| | | | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- NHS Lothian Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern, Ireland
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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8
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van der Linde RPA, Huntjens RJC, Bachrach N, Rijkeboer MM, de Jongh A, van Minnen A. The role of dissociation-related beliefs about memory in trauma-focused treatment. Eur J Psychotraumatol 2023; 14:2265182. [PMID: 37846662 PMCID: PMC10583636 DOI: 10.1080/20008066.2023.2265182] [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: 07/13/2023] [Accepted: 09/16/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms. METHOD Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. RESULTS Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome. CONCLUSION The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.
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Affiliation(s)
- Robin P. A. van der Linde
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
- GGZ Oost Brabant, Boekel, the Netherlands
| | - Rafaële J. C. Huntjens
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Nathan Bachrach
- GGZ Oost Brabant, Boekel, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Marleen M. Rijkeboer
- Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, the Netherlands
| | - Ad de Jongh
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
- School of Psychology, Queen’s University, Belfast, Northern Ireland
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
- School of Health Sciences, Salford University, Manchester, United Kingdom
| | - Agnes van Minnen
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Behavioural Science Institute (BSI), Radboud University, Nijmegen, the Netherlands
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9
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Verdi EK, Katz AC, Gramlich MA, Rothbaum BO, Reger GM. Impact of dissociation on exposure therapy for PTSD outcomes and Adherence among U.S. Military service members. J Psychiatr Res 2023; 166:86-91. [PMID: 37751659 DOI: 10.1016/j.jpsychires.2023.09.011] [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: 04/14/2023] [Revised: 07/28/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
Emotional engagement is necessary for successful exposure therapy for posttraumatic stress disorder (PTSD), but dissociation is considered a barrier to emotional engagement. Virtual reality exposure therapy (VRE) uses multi-sensory virtual environments to increase emotional engagement during exposure therapy, and average treatment outcomes are comparable to traditional exposure therapy. However, individual factors (e.g., depression) can predict differential responses to VRE. Studies have yet to investigate whether VRE would be more effective in treating patients with dissociation compared to traditional PE. This secondary analysis of a randomized clinical trial explores whether dissociation predicts treatment outcomes to exposure therapy among active-duty soldiers (N = 108) diagnosed with PTSD. We also examine whether individuals reporting dissociative symptoms demonstrated differential treatment responses to VRE and PE. Results indicated a significant two-way interaction between dissociation and time in treatment, such that dissociation blunted the negative relationship between time and PTSD symptoms. Dissociation was not associated with treatment session attendance or drop out. Results also revealed no significant effect of treatment group (PE or VRE) on the relationship between dissociation and PTSD symptoms. Findings contribute to a body of literature supporting the potential clinical and research utility of a dissociative subtype of PTSD.
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Affiliation(s)
- Erin K Verdi
- VA Puget Sound Health Care System, American Lake Division, 9600 Veterans Drive Southwest, Tacoma, WA, 98493, USA.
| | - Andrea C Katz
- VA Puget Sound Health Care System, Seattle Division, 1660 S Columbian Way, Seattle, WA, 98174, USA.
| | - Michael A Gramlich
- VA Puget Sound Health Care System, American Lake Division, 9600 Veterans Drive Southwest, Tacoma, WA, 98493, USA.
| | - Barbara O Rothbaum
- Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA, 30307, USA.
| | - Greg M Reger
- VA Puget Sound Health Care System, American Lake Division, 9600 Veterans Drive Southwest, Tacoma, WA, 98493, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.
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10
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Perry EW, Osborne MC, Kinnish K, Lee N, Self-Brown SR. The PTSD Symptom Presentation and the Effect of Polytrauma on PTSD Symptom Clusters Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:81-93. [PMID: 36776638 PMCID: PMC9908799 DOI: 10.1007/s40653-022-00474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 06/18/2023]
Abstract
Purpose The purpose of this study was to describe the PTSD symptom presentation (including dissociative symptoms) of PTSD using the Diagnostic and Statistical Manual of Mental Disorders 5 th Edition diagnostic criteria and explore associations between the symptom severity for each of the four PTSD symptom clusters and polytrauma, defined as multiple exposures to different categories of potentially traumatic events. Methods This is a secondary analysis of cross-sectional program evaluation data among 95 young people (aged 11-19) at therapy initiation in a southeastern state in the U.S. We used descriptive statistics and multivariable linear regression to test study objectives. Results Eighty-one respondents (90.0%) experienced a potentially traumatic event in ≥ 2 trauma categories, in addition to experiencing CSE/T. Approximately two-thirds of respondents experienced clinically significant PTSD symptoms for each symptom cluster. Of the 31 young people who met full criteria for PTSD, 9 met criteria for the standard PTSD diagnosis, while 22 met criteria for the dissociative subtype of PTSD. On average, experiencing additional trauma categories was associated with substantively higher PTSD symptom cluster scores for each cluster. Conclusions These findings support the need for a comprehensive assessment of trauma symptoms that includes cluster-specific PTSD symptoms. They also underscore the need to assess the full breadth and chronicity of trauma experiences to guide treatment planning and delivery, targeting specific domains of trauma impact. These findings can also inform the tailoring and adaptation of evidence-based interventions and strategies to better meet the needs of young people who have experienced CSE/T.
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Affiliation(s)
- Elizabeth W. Perry
- School of Public Health, Georgia State University, Atlanta, GA USA
- National SafeCare Training and Research Center, Georgia State University, Atlanta, GA USA
- Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA USA
| | - Melissa C. Osborne
- Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA USA
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA USA
| | - Kelly Kinnish
- School of Public Health, Georgia State University, Atlanta, GA USA
- National Center On Child Trafficking, Georgia State University, Atlanta, GA USA
| | - NaeHyung Lee
- School of Public Health, Georgia State University, Atlanta, GA USA
| | - Shannon R. Self-Brown
- School of Public Health, Georgia State University, Atlanta, GA USA
- National SafeCare Training and Research Center, Georgia State University, Atlanta, GA USA
- Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA USA
- National Center On Child Trafficking, Georgia State University, Atlanta, GA USA
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11
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Jo Y, Choi H. Factor Structure and Clinical Correlates of The Dissociative Symptoms Scale (DSS) Korean Version Among Community Sample With Adverse Childhood Experiences. J Trauma Dissociation 2023; 24:380-394. [PMID: 36809920 DOI: 10.1080/15299732.2023.2181474] [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: 02/24/2023]
Abstract
This study examined the factor structure and psychometric properties of the Dissociative Symptoms Scale (DSS) among the Korean community adult population with adverse childhood experiences (ACE). Data were drawn from community sample data sets collected from an online panel investigating the impact of ACE and ultimately consisted of data from a total of 1304 participants. A confirmatory factor analysis revealed a bi-factor model with a general factor and four sub-factors such as depersonalization/derealization, gaps in awareness and memory, sensory misperceptions, and cognitive behavioral reexperiencing, which are the four factors that correspond to the original DSS. The DSS showed good internal consistency as well as convergent validity with clinical correlates such as posttraumatic stress disorder, somatoform dissociation, and emotion dysregulation. The high-risk group with more ACE was associated with increased DSS. These findings support the multidimensionality of dissociation and the validity of Korean DSS scores in a general population sample.
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Affiliation(s)
- Yoonhyoung Jo
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
| | - Hyunjung Choi
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
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12
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Sauer KS, Wendler-Bödicker C, Boos A, Niemeyer H, Palmer S, Rojas R, Hoyer J, Hitzler M. Treatment of Comorbid Disorders, Syndromes, and Symptoms of Posttraumatic Stress Disorder Related to Childhood Maltreatment with STAIR-NT. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2023. [DOI: 10.1026/1616-3443/a000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Abstract. Background: Early interpersonal traumatic events, such as childhood maltreatment, increase the risk of developing complex posttraumatic stress symptoms. The biphasic treatment program STAIR-NT (Skills Training for Affective and Interpersonal Regulation with Narrative Therapy), developed specifically for this patient group, combines interventions to improve emotion regulation and interpersonal skills with narrative therapy. Objective: Many affected patients with PTSD after childhood maltreatment also suffer from various comorbid mental disorders and symptoms that can affect and impede the course and outcome of treatment with STAIR-NT. Method: Based on experience from a current treatment study, we provide recommendations for integrating treatment of comorbid mental symptoms into STAIR-NT. Results / Conclusion: Training affective and interpersonal regulation skills in the first treatment phase offers various interventions to efficiently adapt transdiagnostic mechanisms such as emotion dysregulation. In cases of severe comorbid mental disorders or symptoms, adding disorder-specific interventions to STAIR-NT may be indicated.
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Affiliation(s)
- Karoline Sophie Sauer
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Germany
| | | | - Anne Boos
- Psychotherapy Practice in Großhartau, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Sebastian Palmer
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Gießen, Germany
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Melissa Hitzler
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
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13
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Stechler N, Henton I. “If only he were blind”: Shame, trauma, and dissociation among women with body dysmorphic disorder in physically intimate relationships. Int J Qual Stud Health Well-being 2022; 17:2015871. [PMID: 35037584 PMCID: PMC8774146 DOI: 10.1080/17482631.2021.2015871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Body Dysmorphic Disorder (BDD) involves a debilitating preoccupation with one’s appearance and associated difficulties in social and interpersonal relationships, according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). Quantitative research has investigated the severity of relationship difficulties in BDD, while qualitative research has primarily focused on intrapersonal phenomena, although interpersonal difficulties, including with physical intimacy, have frequently emerged from these studies. Aims This study explores how women with BDD make sense of their lived experiences of physical intimacy in the context of current partner relationships. Method Six adult women participated in individual semi-structured interviews. The data was analysed using Interpretative Phenomenological Analysis. Results The analysis generated three superordinate themes: 1) The shame in being seen, 2) Disgust and detachment during intimacy, and 3) A flawed self, unworthy of relationships. Conclusions This study demonstrates how appearance-related concerns filter into the cognitive, behavioural, and emotional intersubjective spaces of physically intimate partnerships. Shame or trauma may be triggered and may be managed through disengagement or dissociation. Clinical implications These findings support calls for a full psychological assessment of the contextual and interpersonal components of BDD, and further suggest that psychological interventions for shame, trauma, and dissociation, such as compassion-focused therapy, imagery rescripting, or body-focused therapies, may be helpful additions to cognitive-behavioural or exposure and response prevention interventions for practitioners working with BDD.
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Affiliation(s)
- Natalie Stechler
- Department of Counselling Psychology, Regent's University London, Inner Circle, Regent's Park, London, NW1 4NS
| | - Isabel Henton
- Department of Counselling Psychology, Regent's University London, Inner Circle, Regent's Park, London, NW1 4NS
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14
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Roullet P, Taïb S, Thalamas C, Vaiva G, El Hage W, Yrondi A, Birmes P. Efficacy of traumatic memory reactivation with or without propranolol in PTSD with high dissociative experiences. Eur J Psychotraumatol 2022; 13:2151098. [PMID: 38872596 PMCID: PMC9718563 DOI: 10.1080/20008066.2022.2151098] [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: 01/13/2022] [Accepted: 10/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) with dissociative symptoms is now a full-fledged subtype of this disorder. The dissociative subtype is associated with a greater number of psychiatric comorbidities. To date, the impact of dissociation on the efficacy of PTSD treatment remains unclear.Objective: The aim of this study was to compare the efficacy of a traumatic memory reactivation procedure with the administration of propranolol or a placebo once a week for six consecutive weeks in reducing PTSD and MDE symptoms between PTSD subjects with or without high dissociative symptoms.Method: For that, we conducted a randomized clinical trial in 66 adults diagnosed with longstanding PTSD and measured the SCID PTSD module, the PTSD Checklist (PCL-S), Beck's Depression Inventory-II (BDI-II), and the Dissociative Experiences Scale (DES).Results: Patients with and without high dissociative experience had significant improvement in their PCL-S scores over the 6 treatment sessions, and PCL-S scores continued to decline in all patients during the post-treatment period. However, there was no correlation between the presence/absence of high dissociative experiences and no specific effect of propranolol treatment. We found exactly the same results for MDE symptoms. Interestingly, patients with high dissociative experiences before treatment exhibited very significant improvement in their DES scores after the 6 treatment sessions, and patients maintained this improvement 3 months post-treatment.Conclusions: The traumatic memory reactivation procedure is an effective way to treat dissociative symptoms in patients with PTSD, and improvement of these dissociative symptoms was associated with a decrease in both PTSD and depression severity.
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Affiliation(s)
- Pascal Roullet
- University of Toulouse, UPS, Toulouse, France
- Centre Régional Psychotraumatisme Occitanie, Toulouse University Hospital, France
| | - Simon Taïb
- Centre Régional Psychotraumatisme Occitanie, Toulouse University Hospital, France
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Claire Thalamas
- Clinical Investigation Center 1436, Toulouse University Hospital, INSERM, Toulouse, France
| | - Guillaume Vaiva
- University of Lille 2 Droit et Santé, CNRS UMR 9193- PsyCHIC-SCALab, CHU Lille, Lille, France
| | - Wissam El Hage
- University of Tours, iBrain, INSERM U1253; CHRU Tours, CIC 1415, Tours, France
| | - Antoine Yrondi
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
- Service Universitaire de Psychiatrie et Psychologie Médicale, Toulouse University Hospital, Toulouse, France
| | - Philippe Birmes
- Centre Régional Psychotraumatisme Occitanie, Toulouse University Hospital, France
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
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15
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Fung HW, Ross CA, Lam SKK, Hung SL. Recent research on the interventions for people with dissociation. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Abstract
Therapist cognitions about trauma-focused psychological therapies can affect our implementation of evidence-based therapies for posttraumatic stress disorder (PTSD), potentially reducing their effectiveness. Based on observations gleaned from teaching and supervising one of these treatments, cognitive therapy for PTSD (CT-PTSD), ten common 'misconceptions' were identified. These included misconceptions about the suitability of the treatment for some types of trauma and/or emotions, the need for stabilisation prior to memory work, the danger of 'retraumatising' patients with memory-focused work, the risks of using memory-focused techniques with patients who dissociate, the remote use of trauma-focused techniques, and the perception of trauma-focused CBT as inflexible. In this article, these misconceptions are analysed in light of existing evidence and guidance is provided on using trauma-focused CT-PTSD with a broad range of presentations.
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17
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Krause-Utz A. Dissociation, trauma, and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:14. [PMID: 35440020 PMCID: PMC9020027 DOI: 10.1186/s40479-022-00184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
Dissociation is a complex phenomenon, which occurs in various clinical conditions, including dissociative disorders, (complex) post-traumatic stress disorder (CPTSD, PTSD), and borderline personality disorder (BPD). Traumatic stress is considered an important risk factor, while the etiology of dissociation is still debated. Next to traumatic experiences, temperamental and neurobiological vulnerabilities seem to contribute to the development of dissociation. Stress-related dissociation is a prevalent symptom of BPD, which may interfere with psychosocial functioning and treatment outcome. More research in the field is strongly needed to improve the understanding and management of this complex phenomenon. This article collection brings together research on dissociation and trauma, with a special focus on BPD or sub-clinical expressions of BPD. In this editorial, recent conceptualizations of dissociation and relevant previous research are introduced in order to provide a framework for this novel research.
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Affiliation(s)
- Annegret Krause-Utz
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands. .,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.
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18
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Niwa M, Kato T, Narita-Ohtaki R, Otomo R, Suga Y, Sugawara M, Narita Z, Hori H, Kamo T, Kim Y. Skills Training in Affective and Interpersonal Regulation Narrative Therapy for women with ICD-11 complex PTSD related to childhood abuse in Japan: a pilot study. Eur J Psychotraumatol 2022; 13:2080933. [PMID: 35695843 PMCID: PMC9186357 DOI: 10.1080/20008198.2022.2080933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative Therapy (SNT) has shown efficacy in alleviating symptoms of posttraumatic stress disorder (PTSD) and improving emotion regulation and interpersonal skills among individuals with complex trauma, such as childhood abuse. Although this therapy is expected to be effective for patients with complex PTSD (CPTSD), no study has directly assessed diagnostic and symptom outcomes. Moreover, the potential of therapy to achieve good outcomes in non-Western countries remains unclear. OBJECTIVE This pilot study examined the feasibility, safety, and outcomes of SNT for CPTSD among women with a history of childhood abuse in a Japanese clinical setting. METHODS Ten women aged 21-54 years (M = 29.1 years) with childhood-abuse-related ICD-11 CPTSD were enrolled in this study. The International Trauma Interview and International Trauma Questionnaire were administered to diagnose CPTSD and assess its severity. Symptoms of dissociation and depression, difficulties in emotion regulation and interpersonal relationships, quality of life, and negative cognitions were assessed pretreatment, midtreatment (after the STAIR phase), and immediately posttreatment (after the Narrative Therapy phase), in addition to 3 months after treatment. RESULTS Seven of the 10 participants completed the treatment. The therapists' adherence to the therapy protocol was 96.4%, ranging from 93.6% to 100% across therapists. Serious adverse events were not observed. Among the seven completers, six at posttreatment and all at follow-up no longer met CPTSD diagnosis. Exploratory analyses using the linear mixed-effects model showed significant improvements at posttreatment and follow-up for almost all the variables. CONCLUSIONS The results provide preliminary evidence for the feasibility and safety of SNT for CPTSD in a Japanese clinical setting. This study is the first to report the use of SNT for individuals diagnosed with ICD-11 CPTSD using reliable clinician and self-report measures. HIGHLIGHTS This study examined the feasibility and safety of STAIR Narrative Therapy for women with ICD-11 CPTSD related to childhood abuse in a Japanese clinical setting.High therapy adherence was observed.No serious adverse events occurred.
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Affiliation(s)
- Madoka Niwa
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | | | - Ryoko Narita-Ohtaki
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Yosuke Suga
- Research Department, Hyogo Institute for Traumatic Stress, Hyogo, Japan
| | - Mayumi Sugawara
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Zui Narita
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroaki Hori
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Toshiko Kamo
- Wakamatsu-cho Mental and Skin Clinic, Tokyo, Japan
| | - Yoshiharu Kim
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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19
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Jowett S, Karatzias T, Shevlin M, Hyland P. Psychological trauma at different developmental stages and ICD-11 CPTSD: The role of dissociation. J Trauma Dissociation 2022; 23:52-67. [PMID: 34143729 DOI: 10.1080/15299732.2021.1934936] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Dissociation is commonly reported by individuals who meet criteria for posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD). However, the association between the age of trauma exposure, dissociation, and CPTSD is not well understood. This study aimed to test whether dissociation mediated the relationship between the developmental stage of trauma exposure and CPTSD symptoms.Method: A nationally representative sample from Ireland (N = 1020) completed self-report measures on trauma exposure in childhood, adolescence, adulthood, current trauma symptomatology, and dissociation symptoms. A mediation analysis was conducted.Results: Childhood, adolescent, and adulthood trauma exposure were all related to dissociation and ICD-11 CPTSD symptom clusters. Dissociation mediated the effect of developmental stage of trauma exposure on PTSD and disturbances in self-organization(DSO). The direct and indirect effect models provided the best fit of the data. Childhood trauma exposure was the only developmental stage that was directly associated with both PTSD and DSO symptoms in our sample.Conclusion: Dissociation mediates the relationship between reported trauma exposure and the presence of ICD-11 CPTSD symptom clusters, and this relationship appears at its strongest when trauma occurs in childhood. CPTSD interventions should also promote dissociation management to aid recovery from this debilitating condition.
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Affiliation(s)
- Sally Jowett
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.,NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Mark Shevlin
- Ulster University, School of Psychology, Derry, Northern Ireland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.,Centre for Global Health, Trinity College Dublin, Dublin, Ireland
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20
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Deen A, Biedermann SV, Lotzin A, Krüger-Gottschalk A, Dyer A, Knaevelsrud C, Rau H, Schellong J, Ehring T, Schäfer I. The dissociative subtype of PTSD in trauma-exposed individuals: a latent class analysis and examination of clinical covariates. Eur J Psychotraumatol 2022; 13:2031591. [PMID: 35273782 PMCID: PMC8903748 DOI: 10.1080/20008198.2022.2031591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND A dissociative subtype of posttraumatic stress disorder (D-PTSD) was introduced into the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) but latent profiles and clinical correlates of D-PTSD remain controversial. OBJECTIVE The aims of our study were to identify subgroups of individuals with distinct patterns of PTSD symptoms, including dissociative symptoms, by means of latent class analyses (LCA), to compare these results with the categorization of D-PTSD vs. PTSD without dissociative features according to the CAPS-5 interview, and to explore whether D-PTSD is associated with higher PTSD severity, difficulties in emotion regulation, and depressive symptoms. METHOD A German sample of treatment-seeking individuals was investigated (N = 352). We conducted an LCA on the basis of symptoms of PTSD and dissociation as assessed by the CAPS-5. Moreover, severity of PTSD (PCL-5), difficulties in emotion regulation (DERS), and depressive symptoms (BDI-II) were compared between patients with D-PTSD according to the CAPS-5 interview and patients without dissociative symptoms. RESULTS LCA results suggested a 5-class model with one subgroup showing the highest probability to fulfill criteria for the dissociative subtype and high scores on both BDI and DERS. Significantly higher scores on the DERS, BDI and PCL-5 were found in the D-PTSD group diagnosed with the CAPS-5 (n = 75; 35.7%). Sexual trauma was also reported more often by this subgroup. When comparing the dissociative subtype to the LCA results, only a partial overlap could be found. CONCLUSIONS Our findings suggest that patients with D-PTSD have significantly more problems with emotion regulation, more depressive symptoms, and more severe PTSD-symptoms. Given the results of our LCA, we conclude that the dissociative subtype seems to be more complex than D-PTSD as diagnosed by means of the CAPS-5.
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Affiliation(s)
- Aljosha Deen
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Anne Dyer
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Free University Berlin, Berlin, Germany
| | - Heinrich Rau
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | | | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
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21
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Sommer JL, Blaney C, Mota N, Bilevicius E, Beatie B, Kilborn K, Chang U, Sareen J, El-Gabalawy R. Dissociation as a Transdiagnostic Indicator of Self-Injurious Behavior and Suicide Attempts: A Focus on Posttraumatic Stress Disorder and Borderline Personality Disorder. J Trauma Stress 2021; 34:1149-1158. [PMID: 34426995 DOI: 10.1002/jts.22726] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 12/17/2022]
Abstract
Dissociative symptoms and suicidality are transdiagnostic features of posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). The primary objective of this study was to examine associations between dissociation (i.e., depersonalization and derealization) and suicidality (i.e., self-harm and suicide attempts) among individuals with PTSD and BPD. We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule for DSM-5 was used to assess lifetime PTSD and BPD. Estimated rates of self-harm among individuals who endorsed dissociation were 15.5%-26.2% for those with PTSD and 13.7%-23.5% for those with BPD, and estimates of suicide attempts among individuals who endorsed dissociation were 34.5%-38.1% for those with PTSD and 28.3%-33.1% for those with BPD. Multiple logistic regressions were conducted to examine the associations between dissociation (derealization, depersonalization, and both) and both self-harm and suicide attempts among respondents with PTSD and BPD. The results indicated that dissociation was associated with self-harm and suicide attempts, especially among individuals with BPD, aORs = 1.39-2.66; however, this association may be driven in part by a third variable, such as other symptoms of PTSD or BPD (e.g., mood disturbance, PTSD or BPD symptom severity). These results may inform risk assessments and targeted interventions for vulnerable individuals with PTSD, BPD, or both aimed at mitigating the risk of self-harm and suicide.
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Affiliation(s)
- Jordana L Sommer
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, Perioperative, and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Caitlin Blaney
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, Perioperative, and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elena Bilevicius
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brooke Beatie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kayla Kilborn
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Unice Chang
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, Perioperative, and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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22
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van Minnen A, Tibben M. A brief cognitive-behavioural treatment approach for PTSD and Dissociative Identity Disorder, a case report. J Behav Ther Exp Psychiatry 2021; 72:101655. [PMID: 33848810 DOI: 10.1016/j.jbtep.2021.101655] [Citation(s) in RCA: 6] [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] [Received: 11/18/2020] [Revised: 02/18/2021] [Accepted: 03/30/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES We described a new treatment model for Posttraumatic Stress Disorder (PTSD) and Dissociative Identity Disorder (DID), based on cognitive-behavioural principles. In this model, dissociation is seen as a maladaptive avoidant coping strategy. In addition, we stress that patients have dysfunctional beliefs about dissociation. Both elements, avoidance behaviour and dysfunctional beliefs, are challenged during the brief, intensive trauma-focused treatment. When the PTSD-symptoms decrease, the patient is offered a fare-well ritual to say goodbye to their identities in one or more additional sessions. METHODS We illustrate this treatment approach with a case report of a woman with PTSD as a result of sexual abuse in her childhood, and DID with four identities. Treatment outcome was measured at intake, at pre-treatment, at post-treatment and at 3 and 6 months follow-up. RESULTS After the short treatment of only 2 weeks, she no longer fulfilled the DSM-5 diagnostic criteria for PTSD nor DID. These results were maintained at the follow-ups. LIMITATIONS Although we included a baseline-controlled time phase, it was not a controlled study, and only one patient was treated. CONCLUSIONS This new treatment model for DID-patients is promising but results should be interpreted cautiously since we described only one patient.
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Affiliation(s)
- Agnes van Minnen
- Radboud University Nijmegen, Behavioural Science Institute (BSI), the Netherlands; Research department PSYTREC, Bilthoven, the Netherlands.
| | - Marleen Tibben
- HSK Groep B.V., Centre of Expertise Functional Movement Disorders, Woerden, The Netherlands.
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23
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Thakur A, Choudhary D, Kumar B, Chaudhary A. A review on post-traumatic stress disorder (PTSD): "Symptoms, Therapies and Recent Case Studies". Curr Mol Pharmacol 2021; 15:502-516. [PMID: 34036925 DOI: 10.2174/1874467214666210525160944] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/22/2022]
Abstract
Post-traumatic stress disorder (PTSD), previously known as battle fatigue syndrome or shell shock, is a severe mental disturbance condition that is normally triggered by the experience of some frightening/scary events or trauma where a person undergoes some serious physical or mental harm or threatened. PTSD is a long-life effect of the continuous occurrence of traumatic conditions which, leading the production of feelings of helplessness, intense fear, and horror in the person. There are various examples of events that can cause PTSD, such as physical, mental, or sexual assault at home or working place by others, unexpected death of a loved one, an accidental event, war, or some kind of natural disaster. Treatment of PTSD includes the removal or reduction of these emotional feelings or symptoms with the aim to improve the daily life functioning of a person. Problems which are needed to be considered in case of PTSD like ongoing trauma, abusive or bad relationships. Various drugs which are used for the treatment of PTSD include selective serotonin reuptake inhibitors (SSRIs) (citalopram, fluvoxamine, fluoxetine, etc.); tricyclic antidepressants (amitriptyline and isocarboxazid); mood stabilizers (Divalproex and lamotrigine); atypical antipsychotics (aripiprazole and quetiapine), etc. In this review, we have covered the different risk factors, case studies related to various treatment options with different age group peoples in PTSD and their effects on them. We have also covered the symptoms and associated disorders which can play a key role in the development of PTSD.
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Affiliation(s)
- Amandeep Thakur
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031. Taiwan
| | - Diksha Choudhary
- Department of School of Pharmacy, Abhilashi University, Chail Chowk, tehsil Chachyot, Mandi, Himachal Pradesh 175028, India
| | - Bhupinder Kumar
- Department of Pharmaceutical Chemistry, ISF College of Pharmacy, Ghal Kalan, G.T Road, Moga, Punjab, India
| | - Amit Chaudhary
- Department of School of Pharmacy, Abhilashi University, Chail Chowk, tehsil Chachyot, Mandi, Himachal Pradesh 175028, India
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24
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Hoeboer CM, de Kleine RA, Oprel DAC, Schoorl M, van der Does W, van Minnen A. Does complex PTSD predict or moderate treatment outcomes of three variants of exposure therapy? J Anxiety Disord 2021; 80:102388. [PMID: 33831660 DOI: 10.1016/j.janxdis.2021.102388] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 03/17/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND One reason for the inclusion of Complex Posttraumatic Stress Disorder (CPTSD) in the 11th revision of the International Classification of Diseases (ICD-11) was its suspected relevance for treatment indications. We investigated whether CPTSD predicted and moderated treatment outcomes of Prolonged Exposure (PE), intensified PE (iPE) and Skills Training in Affective and Interpersonal Regulation followed by PE (STAIR + PE). We expected that CPTSD would predict worse treatment outcomes across treatments. Secondly, we expected that CPTSD would lead to better treatment effect in STAIR + PE compared to PE and iPE. METHODS We analyzed 149 patients with childhood-abuse related PTSD from a randomized clinical trial. CPTSD diagnosis and symptom severity were measured with the International Trauma Questionnaire. The main outcome was change in clinician-assessed PTSD symptoms. Assessments took place at baseline, week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. Analyses were based on an intention-to-treat sample using mixed effect models. RESULTS More than half (54 %) of the patients met criteria for CPTSD at baseline. CPTSD was related to more severe PTSD symptoms and higher comorbidity at baseline. CPTSD neither predicted nor moderated treatment outcome. LIMITATIONS Inclusion was limited to patients with PTSD related to childhood abuse. Replication is needed in different samples. CONCLUSIONS CPTSD is associated with more severe PTSD and with higher comorbidity. CPTSD did not predict treatment outcome and did not indicate differential treatment outcome of STAIR + PE compared to PE and iPE.
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Affiliation(s)
- Chris M Hoeboer
- Leiden University, Department of Clinical Psychology, Leiden, the Netherlands; Parnassiagroep, PsyQ The Hague, the Netherlands.
| | - Rianne A de Kleine
- Leiden University, Department of Clinical Psychology, Leiden, the Netherlands.
| | - Danielle A C Oprel
- Leiden University, Department of Clinical Psychology, Leiden, the Netherlands; Parnassiagroep, PsyQ The Hague, the Netherlands.
| | - Maartje Schoorl
- Leiden University, Department of Clinical Psychology, Leiden, the Netherlands.
| | - Willem van der Does
- Leiden University, Department of Clinical Psychology, Leiden, the Netherlands; Parnassiagroep, PsyQ The Hague, the Netherlands; Leiden University Medical Center, Department of Psychiatry, Leiden, the Netherlands.
| | - Agnes van Minnen
- PSYTREC, Bilthoven, the Netherlands; Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands.
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Krause-Utz A, Frost R, Chatzaki E, Winter D, Schmahl C, Elzinga BM. Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment. Curr Psychiatry Rep 2021; 23:37. [PMID: 33909198 PMCID: PMC8081699 DOI: 10.1007/s11920-021-01246-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in order to inform clinicians and to stimulate further research. First, we introduce basic definitions and models that conceptualize dissociation from a transdiagnostic perspective. Then, we discuss recent findings in BPD. RECENT FINDINGS Stress-related dissociation is a key symptom of BPD, closely linked to other core domains of the disorder (emotion dysregulation, identity disturbances, and interpersonal disturbances). The understanding of neurobiological correlates of dissociation across different psychiatric disorders (e.g., dissociative disorders, post-traumatic stress disorder) is steadily increasing. At the same time, studies explicitly focusing on dissociation in BPD are still scarce. There is evidence for adverse effects of dissociation on affective-cognitive functioning (e.g., interference inhibition), body perception, and psychotherapeutic treatment response in BPD. On the neural level, increased activity in frontal regions (e.g., inferior frontal gyrus) and temporal areas (e.g., inferior and superior temporal gyrus) during symptom provocation tasks and during resting state was observed, although findings are still diverse and need to be replicated. Conceptual differences and methodological differences in study designs and sample characteristics (e.g., comorbidities, trauma history) hinder a straightforward interpretation and comparison of studies. Given the potentially detrimental impact of dissociation in BPD, more research on the topic is strongly needed to deepen the understanding of this complex clinical condition.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands.
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands.
| | - Rachel Frost
- Department of Psychology, King's College London, Institute of Psychiatry Psychology & Neuroscience, London, UK
| | - Elianne Chatzaki
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Dorina Winter
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bernet M Elzinga
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
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Somatoform Dissociative Symptoms Have No Impact on the Outcome of Trauma-Focused Treatment for Severe PTSD. J Clin Med 2021; 10:jcm10081553. [PMID: 33917166 PMCID: PMC8067818 DOI: 10.3390/jcm10081553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/29/2022] Open
Abstract
For patients with complex or other severe forms of PTSD, particularly in cases with dissociative symptoms, different treatment approaches have been suggested. However, the influence of somatoform dissociation on the effectiveness of trauma-focused treatment has hardly ever been studied. This study aims to test the hypotheses that (1) PTSD patients reporting a low level and those reporting a high level of somatoform dissociative symptoms would both benefit from an intensive trauma-focused treatment, and that (2) somatoform dissociative symptoms would alleviate. Participants were 220 patients with severe PTSD, enrolled in an intensive treatment program combining EMDR therapy and prolonged exposure therapy, without a preceding stabilization phase. Trauma history was diversified, and comorbidity was high. PTSD symptoms (CAPS-5 and PCL-5) and somatoform dissociative symptoms (SDQ-5 and SDQ-20) were assessed at pre-treatment, post-treatment and at six months after completion of treatment. The course of both PTSD and somatoform dissociative symptoms was compared for individuals reporting low and for those reporting high levels of somatoform dissociative symptoms. Large effect sizes were observed regarding PTSD symptoms reduction for patients with both low and high levels of somatoform dissociation. Somatoform dissociation did not impact improvement in terms of PTSD symptom reduction. The severity of somatoform dissociative symptoms decreased significantly in both groups. This decrease was greater for those with a positive screen for a dissociative disorder. These results add further support to the notion that the presence of strong somatoform dissociative symptoms in patients with PTSD does not necessarily call for a different treatment approach. Clinical implications are discussed.
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Gielkens EMJ, de Jongh A, Sobczak S, Rossi G, van Minnen A, Voorendonk EM, Rozendaal L, van Alphen SPJ. Comparing Intensive Trauma-Focused Treatment Outcome on PTSD Symptom Severity in Older and Younger Adults. J Clin Med 2021; 10:jcm10061246. [PMID: 33802898 PMCID: PMC8002665 DOI: 10.3390/jcm10061246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the treatment outcome of an intensive trauma-focused treatment program for post-traumatic stress disorder (PTSD) in older and younger adults. Methods: A non-randomized outcome study was conducted with 62 consecutively admitted older PTSD patients (60–78 years) and 62 younger PTSD patients (19–58 years), matched on gender and availability of follow-up data. Patients participated in an intensive eight-day trauma-focused treatment program consisting of eye movement desensitization and reprocessing (EMDR), prolonged exposure (PE), physical activity, and group psycho-education. PTSD symptom severity (Clinician-Administered PTSD Scale-5 (CAPS-5)) was assessed, at pre- and post-treatment, and for a subsample (n = 31 older; n = 31 younger patients) at six-month follow-up. Results: A repeated-measures ANCOVA (centered CAPS pre-treatment score as covariate) indicated a significant decrease in CAPS-5-scores from pre- to post-treatment for the total sample (partial η2 = 0.808). The treatment outcome was not significantly different across age groups (partial η2 = 0.002). There were no significant differences in treatment response across age groups for the follow-up subsample (pre- to post-treatment partial η2 < 0.001; post-treatment to follow-up partial η2 = 0.006), and the large decrease in CAPS-5 scores from pre- to post-treatment (partial η2 = 0.76) was maintained at follow-up (partial η2 = 0.003). Conclusion: The results suggest that intensive trauma-focused treatment is applicable for older adults with PTSD with a large within-effect size comparable to younger participants. Further research on age-related features is needed to examine whether these results can be replicated in the oldest-old (>80).
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Affiliation(s)
- Ellen M. J. Gielkens
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- Correspondence:
| | - Ad de Jongh
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, 1081 LA Amsterdam, The Netherlands
- School of Health Sciences, Salford University, Manchester M6 6PU, UK
- Institute of Health and Society, University of Worcester, Worcester WR2 6AJ, UK
- School of Psychology, Queen’s University, 18-30 Malone Road, Belfast BT9 5 BN, UK
| | - Sjacko Sobczak
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, 6226 NB Maastricht, The Netherlands
| | - Gina Rossi
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
| | - Agnes van Minnen
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Behavioural Science Institute (BSI), Radboud University Nijmegen, 6525 HR Nijmegen, The Netherlands
| | - Eline M. Voorendonk
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Behavioural Science Institute (BSI), Radboud University Nijmegen, 6525 HR Nijmegen, The Netherlands
| | - Linda Rozendaal
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
| | - Sebastiaan P. J. van Alphen
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
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Mauritz MW, van Gaal BGI, Goossens PJJ, Jongedijk RA, Vermeulen H. Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder. BJPsych Open 2020; 7:e12. [PMID: 33295271 PMCID: PMC7791562 DOI: 10.1192/bjo.2020.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Interpersonal trauma and post-traumatic stress disorder (PTSD) in patients with severe mental illness (SMI) negatively affect illness course. Narrative exposure therapy (NET) is effective in vulnerable patient groups, but its efficacy and applicability has not been studied in out-patients with SMI. AIMS We aimed to evaluate the efficacy and applicability of NET in SMI on changes in PTSD, dissociation, SMI symptoms, care needs, quality of life, global functioning and care consumption. METHOD The study had a single-group, pre-test-post-test, repeated-measures design and was registered in The Netherlands National Trial Register (identifier TR571). Primary outcomes were assessed at pre-treatment (T0), 1 month post-treatment (T1) and 7 months' follow-up (T2), with a structured interview for PTSD and dissociation screening. Secondary outcomes followed routinely SMI measurements and medical data. Mixed models were used for data analysis. RESULTS The majority of the 23 participants was female (82%). Mean age was 49.9 years (s.d. 9.8) and mean PTSD duration was 24.1 years (s.d. 14.5). Mean PTSD severity decreased from 37.9 at T0 to 31.9 at T1 (-6.0 difference, 95%CI -10.0 to -2.0), and decreased further to 24.5 at T2 (-13.4 difference, 95%CI -17.4 to -9.4). Dissociation, SMI symptoms, duration of contacts, and medication decreased; global functioning increased; and quality of life and perceived needs did not change. Eleven participants were in remission for PTSD at T2, of which five were also in remission for major depression. CONCLUSIONS NET appeared efficacious and applicable to out-patients with SMI and PTSD, and was well tolerated.
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Affiliation(s)
- Maria W Mauritz
- GGNet Center for Mental Health Care, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, The Netherlands
| | - Betsie G I van Gaal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, The Netherlands; HAN University for Applied Sciences, Nursing Studies, Nijmegen, The Netherlands
| | - Peter J J Goossens
- Dimence Group, Center for Mental Health Care, Specialistisch Centrum Bipolaire Stoornissen, The Netherlands; and University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Ruud A Jongedijk
- ARQ Centrum '45; and ARQ National Psychotrauma Center, The Netherlands
| | - Hester Vermeulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, The Netherlands; and HAN University for Applied Sciences, Nursing studies, Nijmegen, The Netherlands
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