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Ernst M, Beutel ME, Zwerenz R, Krakau L. Seeing the past in a new light: change in reports of childhood abuse and neglect before and after inpatient psychotherapy and its relevance for change in depression symptoms. Psychother Res 2023; 33:222-234. [PMID: 35790188 DOI: 10.1080/10503307.2022.2088313] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE As changes in mental representations have been discussed as mechanisms of change in psychotherapy, the question arises whether recollections of childhood abuse and neglect are altered as well and how they relate to symptom changes. METHOD Individuals in psychosomatic inpatient treatment (N = 488, 60.5% women) filled out the Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-9). Changes in both were investigated with correlations and t-tests. Linear regression analysis was used to test whether CTQ changes predicted symptom changes. Network analysis was performed to ascertain structural connections between somatic and emotional-cognitive depression symptoms and CTQ subscales before and after treatment. RESULTS After treatment (duration in days: M = 52.83, SD = 20.94), patients reported fewer depression symptoms (d = 0.84), while CTQ scores increased slightly (d = 0.11). Changes in the CTQ predicted recovery from depression symptoms in a statistically significant way (β = .133, p = .001). We did not observe changes in the overall network structure between baseline assessment and discharge. CONCLUSION The findings suggest that the evaluation of past experiences can change over multiple weeks of psychotherapy. Further, these updated mental representations, indicating a greater recognition of past adversity, may contribute to symptom relief.
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Affiliation(s)
- Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lina Krakau
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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2
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Elkjær HK, Lau M, Mortensen EL, Kristensen E, Poulsen S. Psychodynamic and systemic group treatment for women with a history of childhood sexual abuse: five-year follow-up of a randomized controlled trial. Eur J Psychotraumatol 2021; 12:1855887. [PMID: 33680345 PMCID: PMC7875047 DOI: 10.1080/20008198.2020.1855887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: Childhood sexual abuse (CSA) is a significant trauma that may have lifelong impact. Due to the long-term negative personal and societal consequences of CSA, it is crucial to find treatments with enduring outcomes. Objective: The aim of this study was to determine the relative long-term efficacy of psychodynamic and systemic group therapy for adult women exposed to CSA. Method: A prospective randomized controlled trial was conducted with outcomes assessed at pre- and post-treatment, and 1 and 5 years post-treatment. All analyses were intention-to-treat. One hundred and six women with sequelae from childhood sexual abuse were treated with psychodynamic or systemic group therapy. Primary outcome was Global Severity Index (GSI) of SCL-90-R. Secondary outcomes included symptoms of PTSD and depression and psycho-social functioning. Results: Treatment was completed by 81% of participants; 64% completed the 1-year follow-up and 60% completed the 5-year follow-up. Completion rates did not differ between treatments. Significant reduction in symptoms measured on GSI and improvement of psychosocial functioning was found for both interventions at all measurement points after treatment (ES range = 0.68-1.19). However, different trajectories were observed: while outcome at end of treatment was significantly better in the systemic group, no differences in gains were observed at the 1- and 5-year follow-ups when controlling for baseline differences. Conclusions: The findings add to the evidence base for psychodynamic and systemic group therapy, but the result also underscores the importance of taking post-treatment trajectories into account in evidence-based research, in the continued efforts to improve treatment for this population.
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Affiliation(s)
- Henriette K Elkjær
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.,Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Denmark
| | - Marianne Lau
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Denmark
| | - Erik L Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Ellids Kristensen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Sexological Research, Psychiatric Centre Copenhagen, Copenhagen, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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3
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Karatzias T, Murphy P, Cloitre M, Bisson J, Roberts N, Shevlin M, Hyland P, Maercker A, Ben-Ezra M, Coventry P, Mason-Roberts S, Bradley A, Hutton P. Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis. Psychol Med 2019; 49:1761-1775. [PMID: 30857567 DOI: 10.1017/s0033291719000436] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions. METHODS We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality. RESULTS Fifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = -0.90 (CBT; k = 27, 95% CI -1.11 to -0.68; moderate quality) to g = -1.26 (EMDR; k = 4, 95% CI -2.01 to -0.51; low quality). CBT and EA each had moderate-large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate-large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome. CONCLUSIONS The development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.
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Affiliation(s)
- Thanos Karatzias
- Edinburgh Napier University, School of Health & Social Care,Edinburgh,UK
| | - Philip Murphy
- Edinburgh Napier University, School of Health & Social Care,Edinburgh,UK
| | - Marylene Cloitre
- Department of Psychiatry and Behavioral Sciences,Stanford University,California,USA
| | | | - Neil Roberts
- Cardiff University, School of Medicine,Cardiff,UK
| | - Mark Shevlin
- Ulster University, School of Psychology,Derry,UK
| | - Philip Hyland
- National College of Ireland, School of Business,Dublin,Ireland
| | - Andreas Maercker
- Department of Psychology, Psychopathology and Clinical Interventions,University of Zurich,Zurich,Switzerland
| | | | - Peter Coventry
- Department of Health Sciences and Centre for Reviews and Dissemination,University of York,York,UK
| | | | - Aoife Bradley
- Edinburgh Napier University, School of Health & Social Care,Edinburgh,UK
| | - Paul Hutton
- Edinburgh Napier University, School of Health & Social Care,Edinburgh,UK
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4
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Mahoney A, Karatzias T, Hutton P. A systematic review and meta-analysis of group treatments for adults with symptoms associated with complex post-traumatic stress disorder. J Affect Disord 2019; 243:305-321. [PMID: 30261446 DOI: 10.1016/j.jad.2018.09.059] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/23/2018] [Accepted: 09/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND No previous meta-analyses have specifically investigated the effectiveness of psychological group therapy for symptoms associated with complex interpersonal trauma, including whether trauma memory processing (TMP) therapies are superior to psychoeducational approaches alone. METHODS A systematic review identified 36 randomised control trials (RCTs) which were included in the meta-analysis. RESULTS Large significant effect sizes were evident for TMP interventions when compared to usual care for three outcome domains including: PTSD (k = 6, g = -0.98, 95% CI -1.53, -0.43), Depression (k = 7, g = -1.12, 95% CI -2.01, -0.23) and Psychological Distress (k = 6, g = -0.98, 95% CI 1.66, -0.40). When TMP and psychoeducation interventions were directly compared, results indicated a small non-significant effect in favour of the former for PTSD symptoms, (k = 4, g = -0.34, 95% CI -1.05, 0.36) and small non-significant effect sizes in favour of the latter for Depression (k = 3, g = 0.29, 95% CI -0.83, 1.4) and Psychological Distress (k = 6, g = 0.19, 95% CI -0.34, 0.71). LIMITATIONS Heterogeneity and a limited number of high quality RCTs, particularly in the Substance Misuse and Dissociation domains, resulted in uncertainty regarding meta-analytical estimates and subsequent conclusions. CONCLUSIONS Results suggest that TMP interventions are useful for traumatic stress whereas non-TMP interventions can be useful for symptoms of general distress (e.g. anxiety and depression). Thus, both TMP and psychoeducation can be useful for the treatment of complex interpersonal trauma symptoms and further research should unravel appropriate sequencing and dose of these interventions.
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Affiliation(s)
- Adam Mahoney
- Psychology Department, HMP & YOI Cornton Vale, Stirling, UK; School of Health & Social Science, Edinburgh Napier University, UK.
| | - Thanos Karatzias
- School of Health & Social Science, Edinburgh Napier University, UK; Rivers Centre for Traumatic Stress, NHS Lothian, UK
| | - Paul Hutton
- School of Health & Social Science, Edinburgh Napier University, UK
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5
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Hadanny A, Bechor Y, Catalogna M, Daphna-Tekoah S, Sigal T, Cohenpour M, Lev-Wiesel R, Efrati S. Hyperbaric Oxygen Therapy Can Induce Neuroplasticity and Significant Clinical Improvement in Patients Suffering From Fibromyalgia With a History of Childhood Sexual Abuse-Randomized Controlled Trial. Front Psychol 2018; 9:2495. [PMID: 30618929 PMCID: PMC6304433 DOI: 10.3389/fpsyg.2018.02495] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/23/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Fibromyalgia syndrome (FMS), a condition considered to represent a prototype of central sensitization syndrome, can be induced by different triggers including childhood sexual abuse (CSA). Recent studies have demonstrated hyperbaric oxygen therapy (HBOT) can induce neuroplasticity and improve clinical outcome of FMS. The aim of the current study was to evaluate the effect of HBOT on patients suffering from FMS with a history of CSA. Materials and methods: A prospective randomized clinical trial conducted between July 2015 and November 2017 included women with a history of CSA who fulfilled fibromyalgia diagnosis criteria for at least 5 years prior to inclusion. Included participants (N = 30) were randomly assigned to treatment group, treated with 60 HBOT sessions and a control/crossover group received psychotherapy. After the control period, the control/crossover group was crossed to HBOT. Clinical outcomes were assessed using FMS questioners, post-traumatic stress disorder (PTSD) questioners and quality of life questioners. Objective outcome were assessed using brain function and structure imaging. Findings: Following HBOT, there was a significant improvement in all FMS questionnaires (widespread pain index, Fibromyalgia symptoms severity scale, Fibromyalgia functional impairment), most domains of quality of life, PTSD symptoms and psychological distress. The same significant improvements were demonstrated in the control following crossover to HBOT. Following HBOT, brain SPECT imaging demonstrated significant increase in brain activity in the prefrontal cortex, orbital frontal cortex, and subgenual area (p < 0.05). Brain microstructure improvement was seen by MRI-DTI in the anterior thalamic radiation (p = 0.0001), left Insula (p = 0.001), and the right Thalamus (p = 0.001). Conclusion: HBOT induced significant clinical improvement that correlates with improved brain functionality and brain microstructure in CSA related FMS patients. Trial Registration:www.Clinicaltrials.gov, identifier: NCT03376269. url: https://clinicaltrials.gov/show/NCT03376269
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Affiliation(s)
- Amir Hadanny
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.,Galilee Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yair Bechor
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Merav Catalogna
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Shir Daphna-Tekoah
- The Emili Sagol CAT Research Center, University of Haifa, Haifa, Israel.,Faculty of Social-Work, Ashkelon Academic College, Ashkelon, Israel.,Social-Work Service, Kaplan Medical Center, Rehovot, Israel
| | - Tal Sigal
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Radiology Department, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Mehrzad Cohenpour
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Nuclear Medicine Institute, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Rachel Lev-Wiesel
- The Emili Sagol CAT Research Center, University of Haifa, Haifa, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Research and Development Unit, Assaf Harofeh Medical Center, Zerifin, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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6
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Wilen JS, Littell JH, Salanti G. Psychosocial interventions for adults who were sexually abused as children. Hippokratia 2017. [DOI: 10.1002/14651858.cd010099.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jessica S Wilen
- Bryn Mawr College; Graduate School of Social Work and Social Research; 300 Airdale Road Bryn Mawr Pennsylvania USA 19010
| | - Julia H Littell
- Bryn Mawr College; Graduate School of Social Work and Social Research; 300 Airdale Road Bryn Mawr Pennsylvania USA 19010
| | - Georgia Salanti
- University of Bern; Institute of Social and Preventive Medicine (ISPM) & Bern Institute of Primary Care (BIHAM); Finkenhubelweg 11 Bern Switzerland 3005
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7
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Musliner KL, Singer JB. Emotional support and adult depression in survivors of childhood sexual abuse. CHILD ABUSE & NEGLECT 2014; 38:1331-40. [PMID: 24630442 PMCID: PMC4383236 DOI: 10.1016/j.chiabu.2014.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 01/21/2014] [Accepted: 01/30/2014] [Indexed: 05/03/2023]
Abstract
The goals of this study were to evaluate the effects of emotional support from friends and parents at two time points (adolescence and adulthood) on adult depression in a nationally representative sample of survivors of childhood sexual abuse (CSA), and examine whether the associations were moderated by the identity of the perpetrator (parent/caregiver vs. not). Data were taken from Waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health). The study sample included 1,238 Add Health participants with a history of CSA and an equivalently sized comparison group of individuals with no history of CSA. Parental support was measured using four items from each wave that assessed the warmth of participants' relationships with their parents and their satisfaction with those relationships. Friend support in adolescence was measured using participants' perceptions of how much their friends cared about them and in adulthood using participants' self-reported number of close friends. Depression was measured using a 10-item subscale of the CES-D. Logistic regressions showed that support from friends and parents in adulthood were significantly associated with lower odds of adult depression in CSA survivors who reported non-parent/caregiver abuse. Among survivors of parent/caregiver abuse, emotional support was not significantly associated with adult depression regardless of when or by whom it was provided. In conclusion, emotional support in adulthood from friends and parents is associated with reduced odds of adult depression in CSA survivors, but only in cases where the abuse was perpetrated by someone other than a parent or caregiver.
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Affiliation(s)
- Katherine L. Musliner
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Hampton House Room 780, 624 N. Broadway, Baltimore, MD 21202
| | - Jonathan B. Singer
- School of Social Work, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex 5 Floor, Philadelphia, PA 19122
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8
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Elkjaer H, Kristensen E, Mortensen EL, Poulsen S, Lau M. Analytic versus systemic group therapy for women with a history of child sexual abuse: 1-year follow-up of a randomized controlled trial. Psychol Psychother 2014; 87:191-208. [PMID: 24014477 DOI: 10.1111/papt.12011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 05/23/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This randomized prospective study examines durability of improvement in general symptomatology, psychosocial functioning and interpersonal problems, and compares the long-term efficacy of analytic and systemic group psychotherapy in women 1 year after completion of treatment for childhood sexual abuse. DESIGN AND METHODS Women (n = 106) randomly assigned to analytic or systemic psychotherapy completed the Symptom Checklist-90-R, Global Assessment of Functioning, Global Life Quality, Registration Chart Questionnaire, and Flashback Registration at pre-treatment, post-treatment, and at a 1-year follow-up. RESULTS Post-treatment gains were significant for both treatment modalities on all measures, but significantly larger after systemic therapy. Significant treatment response was maintained 1-year post-treatment, but different trajectories were observed: 1 year after treatment completion, improvements for analytic therapy were maintained, whereas they decreased after systemic therapy, resulting in no statistically significant difference in gains between the groups at the 1-year follow-up. Despite maintaining significant gains, more than half of the patients remained above cut-off for caseness concerning general symptomatology at post-treatment and at 1-year follow-up. CONCLUSION The findings stress the importance of long-term follow-up data in effect studies. Different trajectories were associated with the two treatments, but improvement in the two treatment groups did not differ significantly at the 1-year follow-up. Implications of the difference in trajectories for treatment planning are discussed. PRACTITIONER POINTS Both analytic and systemic group therapy proved efficient in improving general symptomatology, psychosocial functioning, and interpersonal problems in women with a history of CSA and gains were maintained at a 1-year follow-up. Despite maintaining statistically significant gains at the 1-year follow-up, 54% of the patients remained above the cut-off for caseness with respect to general symptomatology, which may indicate a need for further treatment. Different pre-post follow-up treatment trajectories were observed between the two treatment modalities. Thus, while systemic group therapy showed a significantly better outcome immediately after termination, gains in the systemic treatment group decreased during follow-up, while gains were maintained during follow-up in analytic group therapy.
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Affiliation(s)
- Henriette Elkjaer
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark; Department of Psychology, University of Copenhagen, Denmark
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9
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Dorrepaal E, Thomaes K, Hoogendoorn AW, Veltman DJ, Draijer N, van Balkom AJLM. Evidence-based treatment for adult women with child abuse-related Complex PTSD: a quantitative review. Eur J Psychotraumatol 2014; 5:23613. [PMID: 25563302 PMCID: PMC4199330 DOI: 10.3402/ejpt.v5.23613] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 07/14/2014] [Accepted: 08/19/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Effective first-line treatments for posttraumatic stress disorder (PTSD) are well established, but their generalizability to child abuse (CA)-related Complex PTSD is largely unknown. METHOD A quantitative review of the literature was performed, identifying seven studies, with treatments specifically targeting CA-related PTSD or Complex PTSD, which were meta-analyzed, including variables such as effect size, drop-out, recovery, and improvement rates. RESULTS Only six studies with one or more cognitive behavior therapy (CBT) treatment conditions and one with a present centered therapy condition could be meta-analyzed. RESULTS indicate that CA-related PTSD patients profit with large effect sizes and modest recovery and improvement rates. Treatments which include exposure showed greater effect sizes especially in completers' analyses, although no differential results were found in recovery and improvement rates. However, results in the subgroup of CA-related Complex PTSD studies were least favorable. Within the Complex PTSD subgroup, no superior effect size was found for exposure, and affect management resulted in more favorable recovery and improvement rates and less drop-out, as compared to exposure, especially in intention-to-treat analyses. CONCLUSION Limited evidence suggests that predominantly CBT treatments are effective, but do not suffice to achieve satisfactory end states, especially in Complex PTSD populations. Moreover, we propose that future research should focus on direct comparisons between types of treatment for Complex PTSD patients, thereby increasing generalizability of results.
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Affiliation(s)
- Ethy Dorrepaal
- GGZ inGeest, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands; PsyQ, Parnassia Groep, The Hague, The Netherlands;
| | - Kathleen Thomaes
- GGZ inGeest, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Dick J Veltman
- GGZ inGeest, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Nel Draijer
- GGZ inGeest, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Anton J L M van Balkom
- GGZ inGeest, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
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10
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Etain B, Mathieu F, Henry C, Raust A, Roy I, Germain A, Leboyer M, Bellivier F. Preferential association between childhood emotional abuse and bipolar disorder. J Trauma Stress 2010; 23:376-83. [PMID: 20564371 DOI: 10.1002/jts.20532] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Childhood trauma has been suggested to be involved in the susceptibility to bipolar disorder. However, case-control studies are lacking, and the preferential implication and the dose-effect of different trauma subtypes remain poorly investigated. Two hundred six bipolar patients and 94 controls completed the Childhood Trauma Questionnaire (CTQ; Bernstein et al., 1994). The CTQ total score was higher for bipolar patients than for controls. The presence of multiple trauma was significantly more frequent in bipolar patients than in controls (63% vs. 33%). Multiple logistic regression suggested that only emotional abuse was associated with bipolar disorder with a suggestive dose-effect. Clinical practice should include systematic assessment of childhood trauma among bipolar patients with a particular focus on emotional abuse.
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Affiliation(s)
- Bruno Etain
- INSERM, Unité 955 and Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Henri Mondor-Albert Chenevier, Pöle de Psychiatrie, Créteil Cedex, France.
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11
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12
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Knijnik DZ, Blanco C, Salum GA, Moraes CU, Mombach C, Almeida E, Pereira M, Strapasson A, Manfro GG, Eizirik CL. A pilot study of clonazepam versus psychodynamic group therapy plus clonazepam in the treatment of generalized social anxiety disorder. Eur Psychiatry 2008; 23:567-74. [PMID: 18774274 PMCID: PMC4389899 DOI: 10.1016/j.eurpsy.2008.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 04/30/2008] [Accepted: 05/30/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Both psychodynamic group therapy (PGT) and clonazepam are used as treatment strategies in reducing symptoms of generalized social anxiety disorder (GSAD). However, many individuals remain symptomatic after treatment with PGT or clonazepam. METHOD Fifty-eight adult outpatients with a diagnosis of GSAD according to DSM-IV were randomized to 12 weeks PGT plus clonazepam or clonazepam. The Clinical Global Impression-Improvement (CGI-I) Scale was the primary efficacy measure. Secondary efficacy measures included the Liebowitz Social Anxiety Scale (LSAS) total score, the World Health Organization Instrument to Assess Quality of Life-Brief (WHOQOL-Bref) Scale and the Beck Depression Inventory (BDI). RESULTS CGI-I data from 57 patients (intent-to-treat population) showed that patients who received PGT plus clonazepam presented significantly greater improvement than those who received clonazepam (P=0.033). There were no significant differences between the two groups in the secondary efficacy measures. CONCLUSIONS Our study suggests that the combination of PGT with clonazepam may be a promising strategy for the treatment of GSAD, regarding gains in the global functioning. However the present study failed to detect more specific changes in social anxiety symptomatology between the two groups.
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Affiliation(s)
- Daniela Z. Knijnik
- Post Graduate Program in Medical Sciences: Psychiatry. School of Medicine, Universidade Federal do Rio Grande do Sul and Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre. Ramiro Barcellos 2350, room 400N, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Carlos Blanco
- Columbia University and New York State Psychiatric Institute, NY, United States of America 1051 Riverside Drive, Unit 69, New York, NY 10032
| | - Giovanni Abrahão Salum
- Post Graduate Program in Medical Sciences: Psychiatry. School of Medicine, Universidade Federal do Rio Grande do Sul and Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre. Ramiro Barcellos 2350, room 400N, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Carolina U. Moraes
- Post Graduate Program in Medical Sciences: Psychiatry. School of Medicine, Universidade Federal do Rio Grande do Sul and Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre. Ramiro Barcellos 2350, room 400N, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Clarissa Mombach
- Post Graduate Program in Medical Sciences: Psychiatry. School of Medicine, Universidade Federal do Rio Grande do Sul and Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre. Ramiro Barcellos 2350, room 400N, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Ellen Almeida
- Post Graduate Program in Medical Sciences: Psychiatry. School of Medicine, Universidade Federal do Rio Grande do Sul and Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre. Ramiro Barcellos 2350, room 400N, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Marília Pereira
- Post Graduate Program in Medical Sciences: Psychiatry. School of Medicine, Universidade Federal do Rio Grande do Sul and Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre. Ramiro Barcellos 2350, room 400N, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Atahualpa Strapasson
- Post Graduate Program in Medical Sciences: Psychiatry. School of Medicine, Universidade Federal do Rio Grande do Sul and Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre. Ramiro Barcellos 2350, room 400N, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Gisele G. Manfro
- Post Graduate Program in Medical Sciences: Psychiatry. School of Medicine, Universidade Federal do Rio Grande do Sul and Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre. Ramiro Barcellos 2350, room 400N, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Cláudio L. Eizirik
- Post Graduate Program in Medical Sciences: Psychiatry. School of Medicine, Universidade Federal do Rio Grande do Sul and Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre. Ramiro Barcellos 2350, room 400N, CEP 90035-003, Porto Alegre, RS, Brazil
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Abstract
The aim of the present study is to investigate the variability in clinical level of psychological distress experienced by mothers of sexually abused children by exploring the role of (a) abuse-related variables (length, severity, and identity of perpetrator), (b) a history of childhood sexual abuse and partner violence experienced in the past year, and (c) mothers' coping and feelings of empowerment. Data were collected through self-report measures completed by 149 French-speaking mothers of girls aged 4 to 12 years disclosing sexual abuse. Results revealed that more than half of the mothers reported clinical levels of psychological distress and experienced child sexual abuse, and 1 of 4 mothers experienced physical partner violence. Logistic regression analysis revealed that mother's sexual abuse and partner violence as well as avoidance coping and empowerment contributed to scores reaching clinical levels of psychological distress. In addition, mothers of child victims of intrafamilial sexual abuse are more likely to report clinical levels of distress. Results underscore the importance of evaluating for trauma history and taking coping strategies and empowerment into account in treatment interventions.
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14
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Lau M, Kristensen E. Outcome of systemic and analytic group psychotherapy for adult women with history of intrafamilial childhood sexual abuse: a randomized controlled study. Acta Psychiatr Scand 2007; 116:96-104. [PMID: 17650270 DOI: 10.1111/j.1600-0447.2006.00977.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Research suggests that group psychotherapy for adults with a history of child sexual abuse (CSA) is generally beneficial. Only few studies have included random assignment. This study compared the effects of analytic (A) and systemic group psychotherapy (S) on CSA. METHOD One hundred and fifty-one women with intrafamilial CSA were randomly allocated to A or S. Quality of life, psychosocial function, psychological distress, and flashbacks were assessed before and after treatment. Both completer analyses and intent-to-treat analyses were carried out. RESULTS Eighty-two patients completed group therapy. Both therapies led to the improved quality of life, fewer psychopathological symptoms, and better overall functioning, but overall the outcome of S was significantly better than the outcome of A. CONCLUSION Women with CSA sequelae benefit from both A and S. In the short-term, S is both statistically and clinically superior to A. Longer-term follow-up data are required for conclusions on maintenance of therapeutic gains.
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Affiliation(s)
- M Lau
- Stolpegaard Psychotherapy Centre, Copenhagen Council, Gentofte, Denmark.
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15
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Hilsenroth MJ. A programmatic study of short-term psychodynamic psychotherapy: Assessment, process, outcome, and training. Psychother Res 2007. [DOI: 10.1080/10503300600953504] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Hébert M, Bergeron M. Efficacy of a group intervention for adult women survivors of sexual abuse. JOURNAL OF CHILD SEXUAL ABUSE 2007; 16:37-61. [PMID: 18032245 DOI: 10.1300/j070v16n04_03] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study evaluates the effects of a group intervention for women sexually abused in childhood or adulthood. The sample consisted of 41 women involved in a group intervention based on a feminist approach offered by help centers for sexual assault victims in Quebec and 11 women in a wait-list comparison group. Results reveal that the group intervention reduced psychological distress and consequences associated with sexual abuse and that gains were maintained at three-month follow- up. Analyses of potential factors related to differential gains indicated that abuse-related variables and concurrent individual interventions were not linked to outcomes. Exploratory analyses suggested that women experiencing severe physical partner violence showed greater gains with respect to self-blame/stigmatization, sexual anxiety, and anxiety related to assertiveness.
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Affiliation(s)
- Martine Hébert
- Department of Sexology, Université du Québec à Montréal, Montréal Québec, Canada.
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17
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Moura VL. Mind-body skills group experience: a case report. Explore (NY) 2006; 1:459-63. [PMID: 16781591 DOI: 10.1016/j.explore.2005.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Revised: 08/05/2005] [Accepted: 08/18/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Vera Lucia Moura
- University of Michigan Integrative Medicine, Department of Family Medicine, Ann Arbor, MI, USA.
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18
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Abstract
Differences in defensive functioning between those who reported a history of childhood sexual abuse (CSA) and those who did not was examined in a naturalistic treatment-seeking sample of adult outpatients (N = 67). Defensive functioning and childhood sexual abuse history were rated by clinicians and external raters utilizing the DSM-IV Defensive Functioning Scale and the Abuse Dimensions Inventory, respectively, based on information gathered as part of a larger therapeutic assessment. Individuals reporting a history of CSA were found to use more major image-distorting level defenses than the non-CSA group, and abuse severity was also related to greater use of major image-distorting level defenses. Those reporting a history of CSA relied more on defenses indicative of impairment in realistic perception of self and others. This defensive style likely contributes to the greater difficulties in interpersonal functioning and psychological problems in adulthood.
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Affiliation(s)
- Kelley L Callahan
- Victims of Violence Program, Harvard Medical School, the Cambridge Health Alliance, Somerville, MA, USA.
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