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Steil R, Weiss J, Bornefeld-Ettmann P, Priebe K, Kleindienst N, Müller-Engelmann M. A preliminary study on the effect of trauma-focused therapies on sexual dysfunctions in women with PTSD after childhood abuse. J Psychiatr Res 2024; 170:340-347. [PMID: 38211457 DOI: 10.1016/j.jpsychires.2024.01.013] [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: 08/21/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is often associated with female sexual dysfunctions (FSD). However, little is known about the impact of therapies for PTSD on FSD according to DSM-5 criteria. AIM/OBJECTIVE To examine if sexual functioning diagnosed according to DSM-5 criteria improves after treatment for PTSD in women with a PTSD diagnosis after interpersonal child abuse. METHOD FSD according to DSM-5 criteria were assessed with the structured clinical interview SISEX in N = 152 female participants (mean age = 36.5 years) of a large randomized controlled trial three months into treatment and after 15 months of receiving either dialectical behavior therapy for PTSD or cognitive processing therapy. Number of fulfilled FSD criteria and diagnostic status were compared from pre-to post-treatment using Poisson and negative binomial regression analyses and the McNemar test. The effect of treatment type on reduction of FSD symptoms and the association between reduction in PTSD symptoms and reduction in FSD symptoms were assessed. RESULTS From pre-to post-treatment, the number of fulfilled criteria for each FSD decreased (Incident rate ratios between 0.60 and 0.71, p between <. 001 and <0 .05). Less women met criteria for genito-pelvic pain/penetration disorder at post-treatment compared to pre-treatment (11.8 % vs. 6.6 %, p < .05). No difference was found between treatments in reduction of FSD symptoms. Reduction of PTSD symptoms was associated with greater decrease in FSD symptoms. CONCLUSIONS Our results suggest a positive association between effective PTSD treatments and improvements in sexual functioning of women with PTSD after child abuse.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany.
| | - Judith Weiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany
| | - Pia Bornefeld-Ettmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany
| | - Kathlen Priebe
- Faculty of Life Sciences, Department of Psychology, Humboldt-University of Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany; Faculty of Human Sciences, Department of Psychology, Medical School Hamburg, Germany
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2
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Broekhof R, Nordahl HM, Eikenæs IUM, Selvik SG. Adverse Childhood Experiences Are Associated With Personality Disorder: A Prospective, Longitudinal Study. J Pers Disord 2024; 38:19-33. [PMID: 38324247 DOI: 10.1521/pedi.2024.38.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
There is a lack of studies that have prospectively examined adverse childhood experiences (ACEs) in association with a personality disorder (PD). Data from a sample of 8,199 adolescents first assessed for ACEs were linked with subsequent data from the Norwegian Patient Register in order to obtain diagnoses of a PD in adulthood (after a 14-year follow-up). We used logistic regression analysis. Any type of ACE gave a 3.8-fold higher risk of developing a PD. Abuse, more specifically emotional abuse, came out as one of the strongest predictors. Of the adolescents who developed a PD, approximately 90% had a history of ACE. The results of this study support the importance of assessing ACEs, such as abuse, neglect, and household dysfunction, in the diagnostic procedure and treatment for PD.
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Affiliation(s)
| | - Hans M Nordahl
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Ingeborg Ulltveit-Moe Eikenæs
- National Advisory Unit for Personality Psychiatry (NAPP), Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
| | - Sara G Selvik
- Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
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3
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Weiss J, Steil R, Priebe K, Lindauer P, Kleindienst N, Fydrich T, Müller-Engelmann M. Sexual Dysfunctions in Women with Posttraumatic Stress Disorder Following Childhood Sexual Abuse: Prevalence Rates According to DSM-5 and Clinical Correlates. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3365-3378. [PMID: 37468726 PMCID: PMC10703738 DOI: 10.1007/s10508-023-02652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023]
Abstract
Many women with posttraumatic stress disorder (PTSD) after child sexual abuse (CSA) suffer from sexual problems. However, little is known about the frequency of female sexual dysfunctions (FSD) as defined by DSM-5 among women with PTSD due to CSA. Furthermore, factors related to FSD in this patient population are understudied. To assess prevalence rates and clinical correlates of FSD according to DSM-5 criteria in women with PTSD after CSA, a structured clinical interview for sexual dysfunctions according to DSM-5 criteria was administered in a sample of 137 women with PTSD after CSA. Participants also completed measures for PTSD, depression symptoms, and borderline personality disorder symptoms. The association between FSD, severity of abuse, PTSD-, depression-, borderline symptom severity, and age was examined. In a second step, the association between FSD and PTSD-clusters was assessed. Diagnostic criteria of female sexual interest/arousal disorder (FSIAD) were met by 2.6% of women in our sample. 5.2% met criteria of female orgasmic disorder (FOD), and 11.8% those of genito-pelvic pain/penetration disorder (GPPPD). PTSD symptom severity predicted number of fulfilled criteria of FSIAD and FOD, the cluster "negative alterations in cognition and mood," was associated with more fulfilled criteria in FSIAD and FOD. The majority of women reported sexual problems, but diagnostic criteria of FSD were met by only a small number of participants. PTSD symptoms, especially the cluster "negative alterations in cognition and mood," seem to be related to female sexual functioning after CSA.
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Affiliation(s)
- Judith Weiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Varrentrappstr. 40-42, 60486, Frankfurt Main, Germany.
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Varrentrappstr. 40-42, 60486, Frankfurt Main, Germany
| | - Kathlen Priebe
- Faculty of Life Sciences, Department of Psychology, Humboldt-University of Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Lindauer
- Psychology School, Hochschule Fresenius, Cologne, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Thomas Fydrich
- Faculty of Life Sciences, Department of Psychology, Humboldt-University of Berlin, Berlin, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Varrentrappstr. 40-42, 60486, Frankfurt Main, Germany
- Faculty of Human Sciences, Department of Psychology, Medical School Hamburg, Hamburg, Germany
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4
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Steil R, Weiss J, Müller-Engelmann M, Dittmann C, Priebe K, Kleindienst N, Fydrich T, Stangier U. Is adherence to dialectic behaviour therapy for post-traumatic stress disorder (PTSD) and cognitive processing therapy related to treatment outcome in PTSD after childhood abuse? Eur J Psychotraumatol 2023; 14:2260293. [PMID: 37860858 PMCID: PMC10591525 DOI: 10.1080/20008066.2023.2260293] [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: 08/26/2022] [Accepted: 07/04/2023] [Indexed: 10/21/2023] Open
Abstract
Background: Literature on the association between therapist adherence and treatment success in the treatment of post-traumatic stress disorder (PTSD) is scarce, and the results are mixed.Objective: To examine the relationship between therapist adherence to dialectical behaviour therapy for PTSD (DBT-PTSD) and cognitive processing therapy (CPT) on treatment outcome in women with PTSD and emotion regulation difficulties after interpersonal childhood abuse.Method: Videotaped therapy sessions from 160 female participants of a large randomized controlled trial [Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., Fydrich, T., Kuehner, C., Resick, P. A., Stiglmayr, C., Schmahl, C., & Priebe, K. (2020). Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse. JAMA Psychiatry, 77(12), 1235. jamapsychiatry.2020.2148] were rated. Adherence to CPT and DBT-PTSD was assessed using two specifically developed rating scales.Results: Higher therapist adherence was associated with a greater reduction of clinician-rated PTSD symptom severity. This effect was more pronounced in the CPT group than in the DBT-PTSD group. Adherence was also related to a greater reduction of self-rated PTSD symptoms, borderline symptoms, and dissociation intensity.Conclusion: Our results indicate that higher therapist adherence can lead to better treatment outcomes in PTSD treatments, especially in CPT.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Judith Weiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
- Department of Psychology, Medical School Hamburg, Faculty Human Sciences, Hamburg, Germany
| | - Clara Dittmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Kathlen Priebe
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Thomas Fydrich
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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5
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Cavicchioli M, Ogliari A, Maffei C, Mucci C, Scalabrini A. Dissociative Dimensions and Their Implications for Emotional Dysregulation Underlying Borderline Personality Disorder Features. J Nerv Ment Dis 2023; 211:742-751. [PMID: 37734116 DOI: 10.1097/nmd.0000000000001707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
ABSTRACT Emotion dysregulation is considered a core feature of borderline personality disorder (BPD). The role of dissociation in BPD has been discussed from different perspectives. Nevertheless, implications of dissociation for BPD features are not clear. The current study estimated mediation effects of dissociative dimensions on the relationships between several emotion regulation strategies (ERSs) and BPD features among 281 adults recruited from the general population. The online survey administered a comprehensive self-report battery for the assessment of maladaptive and adaptive ERSs together with dissociative dimensions. Borderline personality disorder features were also self-report screened. Results showed significant indirect effects of dissociation on the relationships between ERSs and BPD features. Dissociation was a full mediator of the relationship between deficits with problem-solving skills and BPD criteria. The study confirmed that emotion dysregulation is a core feature of BPD and that the dissociative dimensions should be included as relevant maladaptive mechanisms sustaining BPD emotional difficulties.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy
| | | | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy
| | - Clara Mucci
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | - Andrea Scalabrini
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
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6
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Steil R, Weiss J, Müller-Engelmann M, Dittmann C, Priebe K, Kleindienst N, Fydrich T, Stangier U. Does treatment specific-, disorder specific- or general therapeutic competence predict symptom reduction in posttraumatic stress disorder? Eur J Psychotraumatol 2023; 14:2257434. [PMID: 37753639 PMCID: PMC10538459 DOI: 10.1080/20008066.2023.2257434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/13/2023] [Indexed: 09/28/2023] Open
Abstract
Background: Literature on the association between therapist competence and treatment success in posttraumatic stress disorder (PTSD) treatments is scarce and results are mixed.Aims/Objective: The relationship between different types of therapeutic competence, therapeutic alliance, and PTSD symptom reduction in patients treated with Dialectical Behaviour Therapy for PTSD (DBT-PTSD) or Cognitive Processing Therapy (CPT) was assessed. Competence types were PTSD-specific competence, treatment specific competence, and general competence in cognitive behaviour therapy (CBT).Method: Videotaped therapy sessions from N = 160 women with PTSD and emotion regulation difficulties after child abuse participating in a large randomised controlled trial (Bohus et al., 2020) were rated. Three therapeutic competence-types were assessed using specifically developed rating scales. Alliance was assessed via patient ratings with the Helping Alliance Questionnaire (HAQ). PTSD symptoms were assessed at pre- and post-treatment via clinician rating with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and via self-rating with the PTSD-Checklist for DSM-5 (PCL-5).Results: No significant association between competence and clinician or self-rated PTSD symptoms was found. PTSD specific competence predicted clinician rated PTSD symptom severity on a trend level. Alliance predicted both clinician and self-rated PTSD symptom reduction.Conclusion: Our results provide a starting point for future research on different competence types and their association with PTSD treatment gains. Therapists were highly trained and received weekly supervision, hence a restricted competence range is a possible explanation for non-existing associations between competence and PTSD symptom reduction in our sample. More research in naturalistic settings, such as dissemination studies, is needed.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Judith Weiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
- Faculty Human Sciences, Department Psychology, Medical School Hamburg, Germany
| | - Clara Dittmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Kathlen Priebe
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Thomas Fydrich
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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7
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Yuan Y, Lee H, Eack SM, Newhill CE. A Systematic Review of the Association Between Early Childhood Trauma and Borderline Personality Disorder. J Pers Disord 2023; 37:16-35. [PMID: 36723424 DOI: 10.1521/pedi.2023.37.1.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Borderline personality disorder (BPD) is a debilitating clinical disorder associated with adverse impacts on multiple levels. While a high prevalence of childhood trauma has been noted, the ways such trauma impacts the development of BPD symptomatology remain unclear. In this systematic review, the authors examine the literature from 2000 to 2020, focusing on the association between trauma and BPD, and offer a comprehensive synthesis of possible etiological implications related to either one specific or multiple trauma types. In addition, results are analyzed based on commonly tested trauma parameters, including repeated exposure, polytrauma, onset, perpetrators, and gender. The authors also note some limitations in areas of sampling, measurement, causal inference methods, and data analyses. Results of this review point to several parameters of trauma that can be used to inform training for practitioners as well as enhance current interventions.
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Affiliation(s)
- Yan Yuan
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hyunji Lee
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shaun M Eack
- University of Pittsburgh, Pittsburgh, Pennsylvania
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8
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Siehl S, Sicorello M, Herzog J, Nees F, Kleindienst N, Bohus M, Müller-Engelmann M, Steil R, Priebe K, Schmahl C, Flor H. Neurostructural associations with traumatic experiences during child- and adulthood. Transl Psychiatry 2022; 12:515. [PMID: 36517466 PMCID: PMC9751132 DOI: 10.1038/s41398-022-02262-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Adverse experiences can lead to severe mental health problems, such as posttraumatic stress disorder (PTSD), throughout the lifespan. In individuals with PTSD, both global and local brain volume reductions have been reported-especially in the amygdala and hippocampus-while the literature on childhood maltreatment suggests a strong dependency on the timing of adverse events. In the present study, we pooled data from two studies to contrast the effects of reported trauma exposure during neurodevelopmentally sensitive periods in early life with trauma exposure during adulthood. A total of 155 women were allocated into one of six age-matched groups according to the timing of traumatization (childhood vs adulthood) and psychopathology (PTSD vs trauma-exposed healthy vs trauma-naïve healthy). Volumes of the amygdala and hippocampus were compared between these groups. Six additional exploratory regions of interest (ROI) were included based on a recent meta-analysis. Amygdala volume was strongly dependent on the timing of traumatization: Smaller amygdala volumes were observed in participants with childhood trauma and PTSD compared to the healthy control groups. In contrast, larger amygdala volumes were observed in both groups with trauma exposure during adulthood compared to the trauma-naïve control group. Hippocampal volume comparisons revealed no statistically significant differences, although the descriptive pattern was similar to that found for the amygdala. The remaining exploratory ROIs showed significant group effects, but no timing effects. The timing might be an important moderator for adversity effects on amygdala volume, potentially reflecting neurodevelopmental factors. Albeit confounded by characteristics like trauma type and multiplicity, these findings pertain to typical childhood and adulthood trauma as often observed in clinical practice and speak against a simple association between traumatic stress and amygdala volume.
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Affiliation(s)
- Sebastian Siehl
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany. .,Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany.
| | - Maurizio Sicorello
- grid.7700.00000 0001 2190 4373Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Julia Herzog
- grid.7700.00000 0001 2190 4373Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Frauke Nees
- grid.412468.d0000 0004 0646 2097Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Nikolaus Kleindienst
- grid.7700.00000 0001 2190 4373Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Martin Bohus
- grid.7700.00000 0001 2190 4373Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Meike Müller-Engelmann
- grid.7839.50000 0004 1936 9721Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Regina Steil
- grid.7839.50000 0004 1936 9721Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Kathlen Priebe
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin, Berlin, Germany
| | - Christian Schmahl
- grid.7700.00000 0001 2190 4373Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Herta Flor
- grid.7700.00000 0001 2190 4373Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
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Hawn SE, Hawrilenko M, McDowell Y, Campbell S, Garcia NM, Simpson TL. An in-depth look at latent classes of DSM-5 psychiatric comorbidity among individuals with PTSD: Clinical indicators and treatment utilization. J Clin Psychol 2022; 78:2214-2244. [PMID: 35973077 PMCID: PMC9561047 DOI: 10.1002/jclp.23429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 04/25/2022] [Accepted: 07/26/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with high comorbidity rates across the full range of psychiatric disorders. However, little is known about how psychiatric comorbidity manifests among people with PTSD, particularly with regard to concurrent diagnoses. METHOD Latent class analysis (LCA) was used to characterize discrete classes of PTSD comorbidity using past year DSM-5 diagnostic standards among a large nationally representative epidemiologic sample of U.S. adults. Follow-up analyses compared participant characteristics across latent classes. RESULTS The LCA was best characterized by five classes: low comorbidity, distress-fear, distress-externalizing, mania-fear-externalizing, and mania-externalizing. Excluding the low comorbidity class, proportions of borderline and schizotypal personality disorder were high across classes. CONCLUSION Participant characteristics across classes of past year PTSD comorbidity are explored through the lens of case conceptualization and treatment planning utility.
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Affiliation(s)
- Sage E. Hawn
- National Center for PTSD, Boston VA Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Matthew Hawrilenko
- VA Puget Sound Healthcare System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | | | - Sarah Campbell
- VA Puget Sound Healthcare System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | | | - Tracy L. Simpson
- VA Puget Sound Healthcare System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Efficacy and Risk Factor Analysis of DBT Therapy for PTSD-Related Symptoms in Mainland Chinese College Students Based on Data Mining. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:3829623. [PMID: 36188700 PMCID: PMC9522495 DOI: 10.1155/2022/3829623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a mental disorder characterized by a delayed onset and long-lasting psychiatric disorder in an individual due to unusual threatening or catastrophic stressful events, characterized by repeated experiences of the situation, avoidant behaviors, emotional numbness, hypervigilance, and other mental symptoms. It seriously affects the occupational, psychological, and social functions of the human body, leads to a decrease in the quality of life, and brings a greater economic burden to the patients themselves, their families, and the society. It has attracted widespread attention worldwide. Due to social transformation and fierce competition, college students are increasingly exposed to various stressful or traumatic events, and PTSD is becoming more and more obvious. Therefore, this study took a university student as the research object, analyzed the risk factors of PTSD, and used the method of data mining to analyze the effectiveness of DBT therapy and completed the following work: (1) this paper introduces the research status of PTSD pathogenesis at home and abroad and expounds the treatment methods and research results of DBT. (2) The basic principle of BPNN is introduced, the weight and threshold of BPNN are screened by genetic algorithm, and the best weight and threshold after screening are given to BPNN. A GA-BP model is constructed to improve the learning quality of BPNN. (3) The optimal parameters of the model are selected through experiments, and the model is verified by the collected data. The results show that the model has superiority in evaluating the effectiveness of DBT therapy. Then, it was proved by experiments that DBT therapy has a good effect in the treatment of PTSD. Finally, the influencing factors of PTSD were analyzed one by one through the experimental results.
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11
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Maercker A, Cloitre M, Bachem R, Schlumpf YR, Khoury B, Hitchcock C, Bohus M. Complex post-traumatic stress disorder. Lancet 2022; 400:60-72. [PMID: 35780794 DOI: 10.1016/s0140-6736(22)00821-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 12/21/2022]
Abstract
Complex post-traumatic stress disorder (complex PTSD) is a severe mental disorder that emerges in response to traumatic life events. Complex PTSD is characterised by three core post-traumatic symptom clusters, along with chronic and pervasive disturbances in emotion regulation, identity, and relationships. Complex PTSD has been adopted as a new diagnosis in the ICD-11. Individuals with complex PTSD typically have sustained or multiple exposures to trauma, such as childhood abuse and domestic or community violence. The disorder has a 1-8% population prevalence and up to 50% prevalence in mental health facilities. Progress in diagnostics, assessment, and differentiation from post-traumatic stress disorder and borderline personality disorder is reported, along with assessment and treatment of children and adolescents. Studies recommend multicomponent therapies starting with a focus on safety, psychoeducation, and patient-provider collaboration, and treatment components that include self-regulatory strategies and trauma-focused interventions.
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Affiliation(s)
- Andreas Maercker
- Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland.
| | - Marylene Cloitre
- National Center for PTSD Division of Dissemination and Training and Department of Psychiatry and Behavioural Sciences, Stanford University, CA, USA
| | - Rahel Bachem
- Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | | | | | - Caitlin Hitchcock
- MRC Cognition and Brain Science Unit, University of Cambridge, Cambridge, UK; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Martin Bohus
- Heidelberg University, Heidelberg Germany and Ruhr University, Bochum, Germany
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12
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Steil R, Schneider A, Schwartzkopff L. How to Treat Childhood Sexual Abuse Related PTSD Accompanied by Risky Sexual Behavior: A Case Study on the Use of Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD). JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:471-478. [PMID: 35600534 PMCID: PMC9120332 DOI: 10.1007/s40653-021-00421-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 06/15/2023]
Abstract
Childhood and adolescent sexual abuse (CSA) is a traumatic experience associated with a variety of short- and long-term negative consequences. Theoretical models assume that an abuse related and learned distorted image of sexuality might lead CSA survivors to feel obligated to provide sex or engage in unwanted sexual practices in order to gain affection or prevent abandonment. Dialectical behavioral therapy for posttraumatic stress disorder (DBT-PTSD) is tailored to people with PTSD and comorbid emotion regulation deficits. This case study presents the results of an outpatient DBT-PTSD treatment of an adult patient with posttraumatic stress disorder following sexual and physical abuse. DBT-PTSD was used to treat the patient's complex psychopathological problems and to decrease her risky sexual behavior, which manifested itself in highly dangerous sexual practices with her partner. The treatment took place over a period of 18 months, with a total of 72 sessions. At the end of the treatment, the patient no longer met criteria for PTSD as indicated by large reductions in the assessments used. Furthermore, she managed to distance herself from risky sexual practices and to remain in a satisfying relationship.
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Affiliation(s)
- Regina Steil
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt, Frankfurt, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University, Giessen, Germany
| | - Angelina Schneider
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt, Frankfurt, Germany
| | - Laura Schwartzkopff
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt, Frankfurt, Germany
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13
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Lamb R, Crowe A, Stone J, Annetta L, Zambone A, Owens T. Virtual reality enhanced Dialectical behavioural therapy. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2022. [DOI: 10.1080/03069885.2022.2040006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Richard Lamb
- Neurocognition Science Laboratory, College of Education, East Carolina University, Greenville, NC, USA
| | - Allison Crowe
- Department of Interdisciplinary Professions, College of Education, East Carolina University, Greenville, NC, USA
| | - Jessica Stone
- Neurocognition Science Laboratory, College of Education, East Carolina University, Greenville, NC, USA
| | - Leonard Annetta
- Neurocognition Science Laboratory, College of Education, East Carolina University, Greenville, NC, USA
| | - Alana Zambone
- Department of Special Education, Foundations, and Research, College of Education, East Carolina University, Greenville, NC, USA
| | - Tosha Owens
- Department of Special Education, Foundations, and Research, College of Education, East Carolina University, Greenville, NC, USA
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14
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Smits ML, Luyten P, Feenstra DJ, Bales DL, Kamphuis JH, Dekker JJM, Verheul R, Busschbach JJV. Trauma and Outcomes of Mentalization-Based Therapy for Individuals With Borderline Personality Disorder. Am J Psychother 2022; 75:12-20. [PMID: 35099263 DOI: 10.1176/appi.psychotherapy.20210027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent meta-analyses suggest that many patients with borderline personality disorder have a history of complex trauma. Although trauma is central in mentalization-based approaches to the understanding of borderline personality disorder, surprisingly little is known about the effects of trauma on outcomes of mentalization-based treatment (MBT). This article investigates the prevalence and impact of childhood trauma among patients with borderline personality disorder participating in a randomized controlled trial (RCT) comparing day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP). METHODS All 114 patients from the original multicenter RCT in the Netherlands were included in this study. Childhood trauma was assessed at baseline (with the Childhood Trauma Questionnaire), and its impact on symptom severity, interpersonal functioning, and borderline pathology was investigated through multilevel modeling for 36 months after the start of treatment. RESULTS Childhood trauma was common among patients with borderline personality disorder referred to MBT, with more than 85% meeting cutoff criteria for substantial childhood trauma. Childhood trauma had little impact on outcomes of either MBT-DH or MBT-IOP in terms of improved borderline personality disorder features or interpersonal functioning. However, patients with substantial childhood trauma seemed to improve more rapidly with MBT-DH, as compared with MBT-IOP, in terms of symptom severity. In addition, patients with a history of emotional neglect showed more rapid changes in symptoms of borderline personality disorder with MBT-DH compared with MBT-IOP. CONCLUSIONS Findings are discussed in the context of a social communicative approach to borderline personality disorder, with a focus on the need to address trauma in MBT.
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Affiliation(s)
- Maaike L Smits
- De Viersprong, Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands (Smits, Luyten, Feenstra, Bales); Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London, London (Luyten); Department of Psychology, University of Amsterdam, Amsterdam (Kamphuis); Department of Research, Arkin Mental Health Care, and Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Dekker); Lentis, Groningen, the Netherlands (Verheul); Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands (Busschbach)
| | - Patrick Luyten
- De Viersprong, Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands (Smits, Luyten, Feenstra, Bales); Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London, London (Luyten); Department of Psychology, University of Amsterdam, Amsterdam (Kamphuis); Department of Research, Arkin Mental Health Care, and Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Dekker); Lentis, Groningen, the Netherlands (Verheul); Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands (Busschbach)
| | - Dine J Feenstra
- De Viersprong, Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands (Smits, Luyten, Feenstra, Bales); Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London, London (Luyten); Department of Psychology, University of Amsterdam, Amsterdam (Kamphuis); Department of Research, Arkin Mental Health Care, and Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Dekker); Lentis, Groningen, the Netherlands (Verheul); Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands (Busschbach)
| | - Dawn L Bales
- De Viersprong, Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands (Smits, Luyten, Feenstra, Bales); Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London, London (Luyten); Department of Psychology, University of Amsterdam, Amsterdam (Kamphuis); Department of Research, Arkin Mental Health Care, and Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Dekker); Lentis, Groningen, the Netherlands (Verheul); Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands (Busschbach)
| | - Jan Henk Kamphuis
- De Viersprong, Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands (Smits, Luyten, Feenstra, Bales); Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London, London (Luyten); Department of Psychology, University of Amsterdam, Amsterdam (Kamphuis); Department of Research, Arkin Mental Health Care, and Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Dekker); Lentis, Groningen, the Netherlands (Verheul); Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands (Busschbach)
| | - Jack J M Dekker
- De Viersprong, Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands (Smits, Luyten, Feenstra, Bales); Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London, London (Luyten); Department of Psychology, University of Amsterdam, Amsterdam (Kamphuis); Department of Research, Arkin Mental Health Care, and Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Dekker); Lentis, Groningen, the Netherlands (Verheul); Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands (Busschbach)
| | - Roel Verheul
- De Viersprong, Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands (Smits, Luyten, Feenstra, Bales); Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London, London (Luyten); Department of Psychology, University of Amsterdam, Amsterdam (Kamphuis); Department of Research, Arkin Mental Health Care, and Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Dekker); Lentis, Groningen, the Netherlands (Verheul); Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands (Busschbach)
| | - Jan J V Busschbach
- De Viersprong, Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands (Smits, Luyten, Feenstra, Bales); Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London, London (Luyten); Department of Psychology, University of Amsterdam, Amsterdam (Kamphuis); Department of Research, Arkin Mental Health Care, and Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Dekker); Lentis, Groningen, the Netherlands (Verheul); Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands (Busschbach)
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15
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Steil R, Müller-Engelmann M, Stangier U, Priebe K, Fydrich T, Weiß J, Dittmann C. Scales for assessing therapeutic adherence and competence in dialectical behaviour therapy for PTSD: development and analysis of psychometric properties. Eur J Psychotraumatol 2022; 13:2055293. [PMID: 35386730 PMCID: PMC8979536 DOI: 10.1080/20008198.2022.2055293] [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: 11/15/2022] Open
Abstract
BACKGROUND The assessment of therapeutic adherence and competence is essential to understand mechanisms that contribute to treatment outcome. Nevertheless, their assessment is often neglected in psychotherapy research. AIMS/OBJECTIVE To develop an adherence and a treatment-specific competence rating scale for Dialectical Behaviour Therapy for Posttraumatic Stress Disorder (DBT-PTSD), and to examine their psychometric properties. Global cognitive behavioural therapeutic competence and disorder-specific therapeutic competence were assessed using already existing scales to confirm their psychometric properties in our sample of patients with PTSD and emotion regulation difficulties. METHOD Two rating scales were developed using an inductive procedure. 155 videotaped therapy sessions from a multicenter randomised controlled trial were rated by trained raters using these scales, 40 randomly chosen videotapes involving eleven therapists and fourteen patients were doubly rated by two raters. RESULTS Both the adherence scale (Patient-level ICC = .98; αs = .65; α p = .75) and the treatment-specific competence scale (Patient-level ICC = .98; αs = .78; α p = .82) for DBT-PTSD showed excellent interrater - and good reliability on the patient level. Content validity, including relevance and appropriateness of all items, was confirmed by experts in DBT-PTSD for the new treatment-specific competence scale. CONCLUSION Our results indicate that both scales are reliable instruments. They will be useful to examine possible effects of adherence and treatment-specific competence on DBT-PTSD treatment outcome.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Kathlen Priebe
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Faculty of Life Sciences, Humboldt-University of Berlin, Berlin, Germany
| | - Judith Weiß
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Clara Dittmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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16
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Gidzgier PA, Bari M, López-Atanes M, Lotzin A, Grundmann J, Hiller P, Schneider B, Schäfer I. Improving care for SUD patients with complex trauma-relationships between childhood trauma, dissociation, and suicidal behavior in female patients with PTSD and SUD. Front Psychiatry 2022; 13:1047274. [PMID: 36713892 PMCID: PMC9878321 DOI: 10.3389/fpsyt.2022.1047274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Posttraumatic disorders are among the most frequent co-occurring diagnoses in patients with substance use disorders (SUD). Individuals with this dual diagnosis often present with special treatment needs, especially after childhood traumatic experiences (CT). Along with posttraumatic stress disorder (PTSD) and dissociative symptoms, suicidal behaviors belong to the clinical challenges in this group of patients and may influence the course and outcome of SUD treatment. Therefore, a better understanding of the relationships between different forms of CT, psychopathology and suicidal behaviors seems to be important to tailor adequate concepts of care. MATERIALS AND METHODS We examined 343 female patients with SUD and Posttraumatic stress disorder (PTSD). All patients completed the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale-Taxon (DES-T) and the Structured Clinical Interview Axis I Disorders (SCID-I). To determine relationships between different symptoms with potential importance for concepts of treatment, we conducted analyses of moderated mediation for different models. We examined the direct and indirect effects of associations between the type of CT, dissociation and suicidal behavior, as well as the moderation effect of PTSD. RESULTS All participants met DSM-criteria for either full PTSD (75.2%) or subsyndromal PTSD (24.8%). Almost all (94.5%) received at least one substance dependence diagnosis and the remaining 5.5% met substance abuse criteria. Most participants (93.3%) reported at least one type of childhood trauma. In all models, dissociation was a risk factor for suicidal ideation (SI) and for suicide attempts (SA). In both, participants with subsyndromal PTSD and participants with full PTSD, dissociation mediated the relationship between childhood sexual abuse and SI as well as SA. Moreover, we report direct effects between different childhood traumas and SI and SA. Furthermore, emotional abuse was a significant predictor of dissociation. DISCUSSION In our sample of female patients with SUD and co-occurring PTSD, dissociation significantly increased suicidal behavior and served as a mediator of the relationship between childhood sexual abuse and suicidal behavior. Our findings underline the need to include interventions to address dissociative symptoms and other more complex consequences of childhood trauma into concepts of care for patients with SUD.
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Affiliation(s)
- Piotr A Gidzgier
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Melav Bari
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mayte López-Atanes
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Grundmann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Hiller
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Schneider
- Department of Addictive Disorders and Psychiatry, LVR-Klinik Cologne, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Friedmann F, Hill H, Santangelo P, Ebner-Priemer U, Neubauer AB, Rausch S, Steil R, Müller-Engelmann M, Lis S, Fydrich T, Priebe K. Women with abuse-related PTSD sleep more fitfully but just as long as healthy controls: an actigraphic study. Sleep 2021; 45:6473455. [PMID: 34932818 DOI: 10.1093/sleep/zsab296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Subjective reports of sleep impairments are common in individuals with posttraumatic stress disorder (PTSD), but objective assessments of sleep have yielded mixed results. METHODS We investigated sleep via actigraphy and e-diary on 6 consecutive nights in a group of 117 women with PTSD after childhood abuse (CA; PTSD group), a group of 31 mentally healthy women with a history of CA (healthy trauma controls, HTC group) and a group of 36 non-traumatized mentally healthy women (healthy controls, HC group). RESULTS The PTSD group reported lower sleep quality, more nights with nightmares, and shorter sleep duration than both HTC and HC. Actigraphic measures showed more and longer sleep interruptions in the PTSD group compared to HTC and HC, but no difference in sleep duration. While the PTSD group underestimated their sleep duration, both HTC and HC overestimated their sleep duration. HTC did not differ from HC regarding sleep impairments. CONCLUSIONS Sleep in women with PTSD after CA seems to be more fragmented but not shorter compared to sleep patterns of mentally healthy control subjects. The results suggest a stronger effect of PTSD psychopathology on sleep compared to the effect of trauma per se.
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Affiliation(s)
- Franziska Friedmann
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
| | - Holger Hill
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Philip Santangelo
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Ulrich Ebner-Priemer
- Mental mHealth Lab, Institute of Sport and Sport Sciences, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim/Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Andreas B Neubauer
- Department of Education and Human Development, DIPF
- Leibniz Institute for Research and Information in Education, P.O. Box 900270, 60442 Frankfurt am Main, Germany
| | - Sophie Rausch
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim/Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, 60323 Frankfurt am Main, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, 60323 Frankfurt am Main, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim/Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
| | - Kathlen Priebe
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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18
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Hennings J. Das Verstärkermodell der Suizidalität: Chronische Suizidalität bei der Borderline-Persönlichkeitsstörung verstehen und behandeln. VERHALTENSTHERAPIE 2021. [DOI: 10.1159/000518239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Trotz großer Fortschritte in der evidenzbasierten Psychotherapie wird unser Versorgungssystem durch chronisch suizidale Patienten mit einer Borderline-Persönlichkeitsstörung (BPS) weiterhin stark herausgefordert. Die BPS ist mit einem hohen Suizidrisiko von 5–10% sowie einem hohen Selbstverletzungsrisiko von bis zu 80% behaftet. Therapeuten wie Angehörige fühlen sich oft überfordert und hilflos, wenn sie mit der Suizidalität der Patienten konfrontiert sind. Immer wieder kommt es so zu Therapieabbrüchen, Vorstellungen in Notaufnahmen oder akut-psychiatrischen Einweisungen. Bei der nichtsuizidalen Selbstverletzung (NSSV) – einem Verhaltensmuster, das gehäuft zusammen mit chronischer Suizidalität bei BPS auftritt – tragen Verstärkermechanismen (z.B. Nachlassen von Anspannung) dazu bei, dass sich Borderline-Patienten trotz längerfristig unangenehmen Folgen immer wieder selbst verletzen. Die Motive für NSSV und suizidales Verhalten können sehr unterschiedlich sein. Es spricht jedoch einiges dafür, dass die zugrunde liegenden Mechanismen ähnlich sind und sich hieraus wichtige therapeutische Interventionsmöglichkeiten ableiten lassen. In dieser Übersichtsarbeit werden die Hintergründe und Unterschiede von NSSV, Suizidideationen sowie Suizidversuchen bei chronisch suizidalen Borderline-Patienten dargestellt. Neuere Erkenntnisse der modernen Neuro- und Verhaltenswissenschaft werden in ein Verstärkermodell der Suizidalität integriert, von dem verhaltenstherapeutische Interventionen abgeleitet werden, die Therapeuten in ihrer Arbeit mit chronisch suizidalen Patienten unterstützen können.
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19
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Cornelisse S, Biermann M, Enning F, Schmahl C, Kleindienst N. [DBT-PTSD-EA: treatment of posttraumatic stress disorder after interpersonal traumatization in childhood in adolescents with borderline personality disorders : A pilot study]. DER NERVENARZT 2021; 92:679-685. [PMID: 34132818 DOI: 10.1007/s00115-021-01151-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent meta-analyses have shown that posttraumatic stress disorder (PTSD) in adolescents and young adults can be effectively treated; however, there is a lack of studies that investigated the efficacy of psychotherapy in the clinically important group of adolescents with PTSD related to childhood sexual and/or physical abuse and co-occurring symptoms of borderline personality disorder (BPD). OBJECTIVE The aim of this study was a first evaluation of the efficacy of a specifically developed trauma-focused treatment (DBT-PTSD-EA) for adolescent patients with PTSD and BPD symptoms after interpersonal violence in childhood and adolescence. METHODS Validated questionnaires including the Davidson trauma scale (DTS), the borderline symptom list (BSL-23) and the Beck depression inventory (BDI-II) were used to assess treatment-related changes in psychopathology in 39 treatment-seeking adolescents with a diagnosis of PTSD and symptoms of BPD after childhood sexual and/or physical abuse. The diagnoses were established from standardized clinical interviews. The analyses were primarily based on pre-to-post comparisons of all patients who were included (intent to treat analyses, ITT). RESULTS AND DISCUSSION Significant improvements were observed in all questionnaires including PTSD severity, intrusive re-experiencing, hyperarousal, PTSD-related avoidance, severity of BPD and depressive symptoms. The pre-post effect sizes were large for the DTS total score (Cohen's d = 1.24) and medium to large for both the BSL-23 (d = 0.69) and the BDI-II (d = 0.72). While these results are very promising, the validity is limited by the lack of a control group.
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Affiliation(s)
- Sven Cornelisse
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, J5, 68159, Mannheim, Deutschland.
| | - Miriam Biermann
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, J5, 68159, Mannheim, Deutschland
| | - Frank Enning
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, J5, 68159, Mannheim, Deutschland.,Klinik für Psychosomatik und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
| | - Christian Schmahl
- Klinik für Psychosomatik und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
| | - Nikolaus Kleindienst
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, J5, 68159, Mannheim, Deutschland
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20
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Euler S, Stalujanis E, Lindenmeyer HJ, Nicastro R, Kramer U, Perroud N, Weibel S. Impact of Childhood Maltreatment in Borderline Personality Disorder on Treatment Response to Intensive Dialectical Behavior Therapy. J Pers Disord 2021; 35:428-446. [PMID: 31887100 DOI: 10.1521/pedi_2019_33_461] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Childhood maltreatment (CM), including emotional, physical, and sexual abuse and emotional and physical neglect, is associated with severity of borderline personality disorder (BPD). However, knowledge on the impact of CM on treatment response is scarce. The authors investigated whether self-reported CM or one of its subtypes affected treatment retention, depressive symptoms, and impulsivity throughout short-term intensive dialectical behavior therapy (I-DBT) in 333 patients with BPD. Data were analyzed with linear and logistic regressions and linear mixed models, using a Bayesian approach. Patients who reported childhood emotional abuse had a higher dropout rate, whereas it was lower in patients who reported childhood emotional neglect. Emotional neglect predicted a greater decrease of depressive symptoms, and global CM predicted a greater decrease of impulsivity. The authors concluded that patients with BPD who experienced CM might benefit from I-DBT in specific symptom domains. Nonetheless, the impact of emotional abuse on higher dropout needs to be considered.
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Affiliation(s)
- Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich, Zurich, Switzerland.,Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Esther Stalujanis
- Psychiatric University Hospital, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany
| | - Hannah J Lindenmeyer
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York, and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rosetta Nicastro
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Ueli Kramer
- Lausanne University Hospital and University of Lausanne, Switzerland, and Department of Psychology, University of Windsor, Windsor, Canada
| | - Nader Perroud
- TRE Unit, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sébastien Weibel
- Department of Psychiatry and Addictology, University Hospital of Strasbourg, Strasbourg, France, and INSERM U1114, Strasbourg, France
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21
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Zeifman RJ, Landy MSH, Liebman RE, Fitzpatrick S, Monson CM. Optimizing treatment for comorbid borderline personality disorder and posttraumatic stress disorder: A systematic review of psychotherapeutic approaches and treatment efficacy. Clin Psychol Rev 2021; 86:102030. [PMID: 33894491 DOI: 10.1016/j.cpr.2021.102030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
Comorbid borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) is a severe and complicated clinical presentation characterized by especially high rates of suicide, healthcare utilization, and psychosocial impairment. Although guidelines exist for treating each of these disorders alone, there remains limited guidance on the optimal treatment in cases where BPD and PTSD co-occur. Therefore, this systematic review synthesizes the existing research on the treatment of BPD-PTSD with the aim of optimizing treatment for this population. First, the prevalence and clinical severity of comorbid BPD-PTSD is reviewed. Next, we describe the results of our systematic review, which identified 21 articles that examined treatment outcomes in the context of BPD-PTSD or subclinical BPD-PTSD. Based on our results, we describe existing psychotherapeutic approaches, including BPD-specific treatments, trauma-focused and non-trauma-focused treatments for PTSD, and stage-based treatments for BPD-PTSD. We also summarize BPD-PTSD treatment outcomes, including whether each disorder interferes with treatment and recovery of the other. Results related to treatment safety and concerns regarding conducting trauma-focused treatment for BPD-PTSD are addressed. We end by highlighting important gaps in the literature and provide recommendations for further research.
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Affiliation(s)
| | - Meredith S H Landy
- Department of Psychology, Ryerson University, Toronto, Canada; Mind Beacon Health Inc., Toronto, Canada
| | - Rachel E Liebman
- Department of Psychology, Ryerson University, Toronto, Canada; Department of Psychology, York University, Toronto, Canada
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22
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Abstract
BACKGROUND The diagnosis of complex posttraumatic stress disorder (CPTSD) was included in the 11th revised edition of the International Classification of Diseases (ICD-11). CPTSD shares trauma-specific symptoms with its sibling disorder PTSD but is additionally characterized by disturbances of the individual's self-organization (DSO). The clinical utility of the CPTSD diagnosis has yet to be thoroughly investigated. OBJECTIVE The current study aimed to examine the clinical utility of the CPTSD diagnosis, considering the upcoming implementation of ICD-11 in clinical practice. METHOD International field studies, construct- and validity analyses leading up to the inclusion in ICD-11 are reviewed, and the diagnostic measures; International Trauma Questionnaire (ITQ) and International Trauma Interview (ITI) are presented. Also, the relationship between CPTSD and borderline personality disorder (BPD) is elaborated in an independent analysis, to clarify their differences in clinical relevance to treatment. Treatment implications for CPTSD are discussed with reference to existing guidelines and clinical needs. RESULTS The validation of ITQ and ITI contributes to the cementation of CPTSD in further clinical practice, providing qualified assessment of the construct, with intended informative value for both clinical communication and facilitation of treatment. CPTSD is found distinguishable from both PTSD and BPD in empirical studies, while the possibility of comorbid BPD/PTSD cases being better described as CPTSD is acknowledged. Practitioners need to employ well-established methods developed for PTSD, while considering additional DSO-symptoms in treatment of CPTSD. CONCLUSIONS The inclusion of CPTSD in ICD-11 may potentially facilitate access to more tailored treatment interventions, as well as contribute to increased research focus on disorders specifically associated with stress. The clinical utility value of this additional diagnosis is expected to reveal itself further after ICD-11 is implemented in clinical practice in 2022 and onwards. Yet, CPTSD's diagnostic inclusion gives future optimism to assessing and treating complex posttraumatic stress symptoms.
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Affiliation(s)
- Åshild Nestgaard Rød
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Casper Schmidt
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
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Becker-Sadzio J, Gundel F, Kroczek A, Wekenmann S, Rapp A, Fallgatter AJ, Deppermann S. Trauma exposure therapy in a pregnant woman suffering from complex posttraumatic stress disorder after childhood sexual abuse: risk or benefit? Eur J Psychotraumatol 2020; 11:1697581. [PMID: 33343833 PMCID: PMC7734094 DOI: 10.1080/20008198.2019.1697581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Mental disorders during pregnancy are common and affect the health of mother and child. Despite a relatively high prevalence rate, treatment options have not been investigated systematically. Particularly symptoms of posttraumatic stress disorder (PTSD) may increase significantly during the course of pregnancy. However, proper guidelines for psychotherapeutic treatment of PTSD during pregnancy do not exist. Objective: In this article, we aimed at discussing the effects of untreated PTSD on pregnancy and postpartum mother-child bonding as well as exposure therapy during pregnancy. Method: To do so, we present the case of a pregnant woman with complex PTSD following childhood sexual abuse. At the time of hospitalization, the patient was pregnant in the second trimester and reported intrusive re-experiencing of the traumatic events, nightmares, anxiety and helplessness as well as an impairing level of irritability during social situations. After a careful discussion of the case within our department and at the annual conference of the German Association of Psychiatry, Psychotherapy and Psychosomatics, we decided to treat the patient with dialectical behavior therapy for PTSD (DBT-PTSD) including exposure therapy under the regular observation of a gynecologist. Psychometric measurements (Davidson Trauma Scale (DTS) and Borderline Symptom- List-23 (BSL-23) were used to observe the course of treatment regarding common PTSD-symptoms and disturbances in self-organization (DSO). Results: The intensity of intrusions and hyperarousal increased from the date of admission, reached the maximum when exposure started and decreased below baseline-level at the end of treatment. Avoidance behavior continually decreased from the beginning until the end of therapy. Decreased BSL-23 values show major improvements regarding DSO. To our knowledge, the course of pregnancy was not affected by treatment-induced psychological and physical symptoms.Conclusions: DBT- PTSD is a potential treatment option for patients suffering from PTSD during pregnancy. Yet, further (epigenetic) research in this field is urgently needed.
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Affiliation(s)
- Julia Becker-Sadzio
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Calwerstr. 14, Tuebingen, Germany
| | - Friederike Gundel
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Calwerstr. 14, Tuebingen, Germany
| | - Agnes Kroczek
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Calwerstr. 14, Tuebingen, Germany
| | - Stefanie Wekenmann
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Calwerstr. 14, Tuebingen, Germany
| | - Alexander Rapp
- Department of Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Calwerstr. 14, Tuebingen, Germany
| | - Saskia Deppermann
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Calwerstr. 14, Tuebingen, Germany
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24
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Bohus M, Kleindienst N, Hahn C, Müller-Engelmann M, Ludäscher P, Steil R, Fydrich T, Kuehner C, Resick PA, Stiglmayr C, Schmahl C, Priebe K. Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:1235-1245. [PMID: 32697288 PMCID: PMC7376475 DOI: 10.1001/jamapsychiatry.2020.2148] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Childhood abuse significantly increases the risk of developing posttraumatic stress disorder (PTSD), often accompanied by symptoms of borderline personality disorder (BPD) and other co-occurring mental disorders. Despite the high prevalence, systematic evaluations of evidence-based treatments for PTSD after childhood abuse are sparse. OBJECTIVE To compare the efficacy of dialectical behavior therapy for PTSD (DBT-PTSD), a new, specifically designed, phase-based treatment program, against that of cognitive processing therapy (CPT), one of the best empirically supported treatments for PTSD. DESIGN, SETTING, AND PARTICIPANTS From January 2014 to October 2016, women who sought treatment were included in a multicenter randomized clinical trial with blinded outcome assessments at 3 German university outpatient clinics. The participants were prospectively observed for 15 months. Women with childhood abuse-associated PTSD who additionally met 3 or more DSM-5 criteria for BPD, including affective instability, were included. Data analysis took place from October 2018 to December 2019. INTERVENTIONS Participants received equal dosages and frequencies of DBT-PTSD or CPT, up to 45 individual sessions within 1 year and 3 additional sessions during the following 3 months. MAIN OUTCOMES AND MEASURES The predefined primary outcome was the course of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) score from randomization to month 15. Intent-to-treat analyses based on dimensional CAPS-5 scores were complemented by categorical outcome measures assessing symptomatic remission, reliable improvement, and reliable recovery. RESULTS Of 955 consecutive individuals assessed for eligibility, 193 were randomized (DBT-PTSD, 98; CPT, 95; mean [SD] age, 36.3 [11.1] years) and included in the intent-to-treat analyses. Analysis revealed significantly improved CAPS-5 scores in both groups (effect sizes: DBT-PTSD: d, 1.35; CPT: d, 0.98) and a small but statistically significant superiority of DBT-PTSD (group difference: 4.82 [95% CI, 0.67-8.96]; P = .02; d, 0.33). Compared with the CPT group, participants in the DBT-PTSD group were less likely to drop out early (37 [39.0%] vs 25 [25.5%]; P = .046) and had higher rates of symptomatic remission (35 [40.7%] vs 52 [58.4%]; P = .02), reliable improvement (53 [55.8%] vs 73 [74.5%]; P = .006), and reliable recovery (34 [38.6%] vs 52 [57.1%]; P = .01). CONCLUSIONS AND RELEVANCE These findings support the efficacy of DBT-PTSD and CPT in the treatment of women with childhood abuse-associated complex PTSD. Results pertaining to the primary outcomes favored DBT-PTSD. The study shows that even severe childhood abuse-associated PTSD with emotion dysregulation can be treated efficaciously. TRIAL REGISTRATION German Clinical Trials Register: DRKS00005578.
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Affiliation(s)
- Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany,McLean Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Christopher Hahn
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Petra Ludäscher
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Regina Steil
- Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Thomas Fydrich
- Department of Psychology, Faculty of Life Sciences, Humboldt University, Berlin, Germany
| | - Christine Kuehner
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | | | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Kathlen Priebe
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany,Department of Psychology, Faculty of Life Sciences, Humboldt University, Berlin, Germany,Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Berlin, Germany
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25
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Snoek A, Beekman ATF, Dekker J, Aarts I, van Grootheest G, Blankers M, Vriend C, van den Heuvel O, Thomaes K. A randomized controlled trial comparing the clinical efficacy and cost-effectiveness of eye movement desensitization and reprocessing (EMDR) and integrated EMDR-Dialectical Behavioural Therapy (DBT) in the treatment of patients with post-traumatic stress disorder and comorbid (Sub)clinical borderline personality disorder: study design. BMC Psychiatry 2020; 20:396. [PMID: 32762677 PMCID: PMC7409691 DOI: 10.1186/s12888-020-02713-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/04/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Comorbidity between Posttraumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD) is high. There is growing motivation among clinicians to offer PTSD treatments - such as Eye Movement Desensitization and Reprocessing (EMDR) - to patients with PTSD and comorbid BPD. However, a large subgroup with comorbid BPD does not sufficiently respond to PTSD treatment and is more likely to be excluded or to dropout from treatment. Dialectical Behaviour Therapy (DBT) for BPD is well established and although there is some evidence that DBT combined with DBT Prolonged Exposure (DBT + DBT PE) is twice as effective in reducing PTSD symptoms than DBT alone, the comparative efficacy of integrated PTSD-DBT and PTSD-only treatment has not been investigated yet. The current study will therefore evaluate the comparative clinical efficacy and cost-effectiveness of EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD. Moreover, it is not clear yet what treatment works best for which individual patient. The current study will therefore evaluate neurobiological predictors and mediators of the individual response to treatment. METHOD A randomized controlled trial comparing the clinical efficacy and cost-effectiveness of integrated EMDR-DBT (n = 63) and EMDR-only (n = 63) in treatment-seeking adult patients with PTSD and comorbid (sub)clinical BPD. In addition, neurobiological predictors and mediators of treatment outcome, such as hair cortisol, FKBP5 and BDNF protein levels and FKBP5 and BDNF methylation status, are measured through hair and blood samples. DISCUSSION This is the first study to compare the clinical efficacy and cost-effectiveness of integrated EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD, while simultaneously identifying individual predictors and mediators of treatment response. Results will reveal which treatment works best for which individual patient, thereby guiding individual treatment choices and personalizing psychiatry. TRIAL REGISTRATION Clinical Trials, NCT03833453 . Retrospectively registered, 15 March 2019.
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Affiliation(s)
- Aishah Snoek
- Arkin Sinai Centrum, Amstelveen, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Aartjan T. F. Beekman
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Jack Dekker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam, the Netherlands
- GGZinGeest, Department of Psychiatry, Amsterdam, the Netherlands
| | - Inga Aarts
- Arkin Sinai Centrum, Amstelveen, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Gerard van Grootheest
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Matthijs Blankers
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam, the Netherlands
- Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Chris Vriend
- Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam, the Netherlands
- Trimbos Institute, Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Odile van den Heuvel
- Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam, the Netherlands
- Trimbos Institute, Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Kathleen Thomaes
- Arkin Sinai Centrum, Amstelveen, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam, the Netherlands
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26
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Bohus M, Biermann M, Vonderlin R, Priebe K, Kleindienst N. Traumaspezifische Ausrichtung in der Behandlung von Borderline-Störungen mit komorbider Posttraumatischer Belastungsstörung. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00441-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Friedmann F, Santangelo P, Ebner-Priemer U, Hill H, Neubauer AB, Rausch S, Steil R, Müller-Engelmann M, Kleindienst N, Bohus M, Fydrich T, Priebe K. Life within a limited radius: Investigating activity space in women with a history of child abuse using global positioning system tracking. PLoS One 2020; 15:e0232666. [PMID: 32392213 PMCID: PMC7213734 DOI: 10.1371/journal.pone.0232666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/20/2020] [Indexed: 02/07/2023] Open
Abstract
Early experiences of childhood sexual or physical abuse are often associated with functional impairments, reduced well-being and interpersonal problems in adulthood. Prior studies have addressed whether the traumatic experience itself or adult psychopathology is linked to these limitations. To approach this question, individuals with posttraumatic stress disorder (PTSD) and healthy individuals with and without a history of child abuse were investigated. We used global positioning system (GPS) tracking to study temporal and spatial limitations in the participants’ real-life activity space over the course of one week. The sample consisted of 228 female participants: 150 women with PTSD and emotional instability with a history of child abuse, 35 mentally healthy women with a history of child abuse (healthy trauma controls, HTC) and 43 mentally healthy women without any traumatic experiences in their past (healthy controls, HC). Both traumatized groups—i.e. the PTSD and the HTC group—had smaller movement radii than the HC group on the weekends, but neither spent significantly less time away from home than HC. Some differences between PTSD and HC in movement radius seem to be related to correlates of PTSD psychopathology, like depression and physical health. Yet group differences between HTC and HC in movement radius remained even when contextual and individual health variables were included in the model, indicating specific effects of traumatic experiences on activity space. Experiences of child abuse could limit activity space later in life, regardless of whether PTSD develops.
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Affiliation(s)
| | | | | | - Holger Hill
- Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Andreas B. Neubauer
- DIPF | Leibniz Institute for Research and Information in Education, Frankfurt, Germany
| | - Sophie Rausch
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
| | | | | | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
- McLean Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Kathlen Priebe
- Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité –Universitätsmedizin Berlin, Berlin, Germany
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28
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Lu JY, Tung TH, Shen SA, Huang C, Chen PS. The effects of psychotherapy for depressed or posttraumatic stress disorder women with childhood sexual abuse history: Meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19776. [PMID: 32332620 PMCID: PMC7220744 DOI: 10.1097/md.0000000000019776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Depression and posttraumatic stress disorder (PTSD) are the most common mental disorders of women suffered from childhood sexual abuse histories. It has been widely recognized that depression and PTSD may decrease patients' quality of life. The objective of this study is conducted to explore the effects of psychotherapy for depressed or PTSD women with childhood sexual abuse history. METHODS We searched the PubMed and Cochrane Library from inception to June 30, 2019. The search strategy is (sexual assault OR sexual crime OR sexual abuse) AND (depression OR PTSD) AND (treatment OR intervention OR psychotherapy) with no restriction on language. Two authors independently selected the studies, assessed the quality of the included studies, and extracted data. RESULTS Nine randomized control trials with 761 participants met the inclusion criteria. There were 340 participants in the psychotherapy group and 421 participants in the control group (usual treatment or waiting list). Compared to usual care, improvements were significantly greater in the psychotherapy group. The Beck depression inventory score for depression diagnosis of the psychotherapy group is lower from 4.27 to 8.96 (P < .05) than the control group. The client assessment protocols for PTSD, the diagnosis is also lower from 12.4 to 13.71 than the control group (P < .05). CONCLUSION The results suggested that psychotherapy is effective in reducing depressed or PTSD women with childhood sexual abuse. Further large-scale high-quality randomized controlled trials with long-term follow-up are warranted for confirming this finding.
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Affiliation(s)
- Jhih-Yuan Lu
- Taiwan Joint Commission on Hospital Accreditation, Taipei
- Department of Public Health, Kaohsiung Medical University, Kaohsiung
| | - Tao-Hsin Tung
- Department of Crime Prevention and Correction, Central Police University, Taoyuan
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei
| | - Sheng-Ang Shen
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei
- Department of Clinical Psychology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Chien Huang
- Department of Clinical Psychology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Pei-Shih Chen
- Department of Public Health, Kaohsiung Medical University, Kaohsiung
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29
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Hennings JM. Function and Psychotherapy of Chronic Suicidality in Borderline Personality Disorder: Using the Reinforcement Model of Suicidality. Front Psychiatry 2020; 11:199. [PMID: 32256412 PMCID: PMC7093558 DOI: 10.3389/fpsyt.2020.00199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/02/2020] [Indexed: 12/12/2022] Open
Abstract
Although great advancements in evidence-based therapies, chronic suicidal patients with borderline personality disorder (BPD) still challenge our mental health system. While BPD patients continue suffering from distress and aversive emotions, therapists and relatives feel often stunned and helpless when confronted with suicidality resulting in interruption of therapies, repeated presentations to emergency rooms and referrals to hospitals. Reviewing the current knowledge of the functions and background of non-suicidal self-injury, we learned that reinforcement mechanisms play an important role to understand why individuals act in deliberate self-mutilation. While individual motives for non-suicidal self-injury and suicidal behavior including suicidal ideations can differ, the principle mechanisms appear to be transferrable. Elucidating the individual motives and function of suicidal behavior is an important therapeutic step, giving us access to very central maladaptive schemes and false believes that we need to address in order to reduce chronic suicidality in BPD patients. This Perspective article aims to give a better idea of what is behind and what are the differences between non-suicidal self-injury, suicidal ideations and suicide attempts. It further integrates recent developments of behavioral science in a reinforcement model of suicidality that can provide therapists a practical armamentarium in their work with chronic suicidal clients.
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Affiliation(s)
- Johannes M. Hennings
- Department of Dialectical Behavioral Therapy, kbo-Isar-Amper-Klinikum Munich-East, Munich, Germany
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30
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Kaess M. Childhood adversity in borderline personality disorder-a call for a more systemic approach to early intervention and prevention. Acta Psychiatr Scand 2020; 141:3-5. [PMID: 31867711 DOI: 10.1111/acps.13138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- M Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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31
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De Jongh A, Groenland GN, Sanches S, Bongaerts H, Voorendonk EM, Van Minnen A. The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder. Eur J Psychotraumatol 2020; 11:1721142. [PMID: 32128048 PMCID: PMC7034475 DOI: 10.1080/20008198.2020.1721142] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/08/2020] [Accepted: 01/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background: It is generally recommended to exercise caution in applying trauma-focused treatment to individuals with posttraumatic stress disorder (PTSD) and comorbid borderline personality disorder (BPD). Objective: To investigate the effects of a brief, intensive, direct trauma-focused treatment programme for individuals with PTSD on BPD symptom severity. Methods: Individuals (n = 72) with severe PTSD (87.5% had one or more comorbidities; 52.8% fulfilled the criteria for the dissociative subtype of PTSD) due to multiple traumas (e.g. 90.3% sexual abuse) participated in an intensive eight-day trauma-focused treatment programme consisting of eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE) therapy, physical activity, and psychoeducation. Treatment did not include any form of stabilization (e.g. emotion regulation training) prior to trauma-focused therapy. Assessments took place at pre- and post-treatment (Borderline Symptom List, BSL-23; PTSD symptom severity, Clinician Administered PTSD Scale for DSM-5, CAPS-5), and across the eight treatment days (PTSD Checklist, PCL-5). Results: Treatment resulted in significant decreases of BPD symptoms (Cohen's d = 0.70). Of the 35 patients with a positive screen for BPD at pre-treatment, 32.7% lost their positive screen at post-treatment. No adverse events nor dropouts occurred during the study time frame, and none of the patients experienced symptom deterioration in response to treatment. Conclusion: The results suggest that an intensive trauma-focused treatment is a feasible and safe treatment for PTSD patients with clinically elevated symptoms of BPD, and that BPD symptoms decrease along with the PTSD symptoms.
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Affiliation(s)
- A De Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,Psychotrauma Expertise Centre (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
| | - G N Groenland
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, The Netherlands
| | - S Sanches
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, The Netherlands
| | - H Bongaerts
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, The Netherlands
| | - E M Voorendonk
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, The Netherlands.,Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - A Van Minnen
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, The Netherlands.,Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
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32
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Brakemeier EL, Herpertz SC. [Innovative psychotherapy research: towards an evidence-based and process-based individualized and modular psychotherapy]. DER NERVENARZT 2019; 90:1125-1134. [PMID: 31659372 DOI: 10.1007/s00115-019-00808-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Psychotherapy has been proven to be effective; however, this statement applies in particular to the "average patient" in randomized controlled trials. As a considerable proportion of patients do not show any benefits despite the constant development of new therapy methods and the mechanisms of action are still too little understood, innovative psychotherapy research has to address both problems. In addition, the idea of personalization that originated in somatic medicine or - from our point of view more appropriately - individualization or person-centering should be taken up. After providing an overview of further developments in psychotherapy beyond disorder-specific methods, this article presents an evidence- and process-based individualized and modular psychotherapy as a visionary goal of psychotherapeutic research: Beyond syndromes and disorders, as many biopsychosocial characteristics as possible and the processes and mechanisms underlying the mental problems should be analyzed and bundled in an individual comprehensive functional analysis. Based on this functional analysis, evidence-based techniques and modules should be selected. The individual response during the course of therapy should be continuously documented, so that feedback helps to determine the further therapeutic procedure. In order to pursue this vision, studies are needed that are oriented towards the individual patient, investigate the central mechanisms of action and generate large translational datasets. These should be analyzed by ideographic analyses and reduce the gap between research and practice, thus contributing to the paradigm of a practice research network, which is now consistently moving to the centre of research.
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Affiliation(s)
- E-L Brakemeier
- Lehrstuhl Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Greifswald, Franz-Mehring-Straße 47, 17489, Greifswald, Deutschland.
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Gutenbergstr. 18, 35037, Marburg, Deutschland.
- Schön Klinik Bad Arolsen, Bad Arolsen, Deutschland.
| | - S C Herpertz
- Klinik für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Görg N, Böhnke JR, Priebe K, Rausch S, Wekenmann S, Ludäscher P, Bohus M, Kleindienst N. Changes in Trauma-Related Emotions Following Treatment With Dialectical Behavior Therapy for Posttraumatic Stress Disorder After Childhood Abuse. J Trauma Stress 2019; 32:764-773. [PMID: 31476252 DOI: 10.1002/jts.22440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 03/11/2019] [Accepted: 03/16/2019] [Indexed: 01/13/2023]
Abstract
Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) is a trauma-focused therapy shown to reduce core PTSD symptoms, such as intrusions, hyperarousal, and avoidance. Preliminary data indicate effects on elevated trauma-related emotions (e.g., guilt and shame) and possibly radical acceptance of the traumatic event. However, it is unclear if improvements in these variables are significant after controlling for changes in core PTSD symptoms and to what extent nonclinical levels are obtained. In the current study, 42 individuals who met criteria for PTSD after childhood abuse and were participating in a 3-month residential DBT-PTSD program were evaluated at the start of the exposure phase of DBT-PTSD and the end of treatment; a nonclinical sample with a history of childhood abuse was the reference group. Multivariate analyses of variance and multivariate analyses of covariance controlling for change in core PTSD symptoms were used to evaluate changes in several elevated trauma-related emotions (fear, anger, guilt, shame, disgust, sadness, and helplessness) and in radical acceptance. In a repeated measures multivariate analyses of variance, both elevated trauma-related emotions and radical acceptance significantly improved during DBT-PTSD, λ = 0.34, p < .001; η2 = .56; t(40) = -5.66, p < .001, SMD = 0.88, even after controlling for changes in PTSD symptoms, λ = 0.35, p < .001, η2 = .65; Λ = 0.86, p = .018, η2 = .14, respectively. Posttreatment, 31.0% (for acceptance) to 76.2% (for guilt) of participants showed nonclinical levels of the investigated outcomes, suggesting that both trauma-related emotions and radical acceptance changed after the 3-month residential DBT-PTSD program.
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Affiliation(s)
- Nora Görg
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany.,Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University, Frankfurt am Main, Germany
| | - Jan R Böhnke
- Dundee Centre for Health and Related Research, School of Nursing and Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Kathlen Priebe
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
| | - Sophie Rausch
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
| | - Stefanie Wekenmann
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Petra Ludäscher
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany.,Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany
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34
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Lis S, Thome J, Kleindienst N, Mueller-Engelmann M, Steil R, Priebe K, Schmahl C, Hermans D, Bohus M. Generalization of fear in post-traumatic stress disorder. Psychophysiology 2019; 57:e13422. [PMID: 31206738 DOI: 10.1111/psyp.13422] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 12/29/2022]
Abstract
Overgeneralization (i.e., the transfer of fear to stimuli not related to an aversive event) is part of alterations in associative fear learning in mental disorders. In the present experimental study, we investigated whether this holds true for post-traumatic stress disorder (PTSD) related to childhood abuse. We expected that fear generalization under experimental conditions reflects generalization of aversive stimuli to different social domains in real life. Sixty-four women with PTSD after childhood abuse and 30 healthy participants (HC) underwent a differential fear conditioning and generalization paradigm. Online risk ratings, reaction time, and fear-potentiated startle served as dependent variables. Based on the subjectively assessed generalization of triggered intrusions across different domains of life, PTSD participants were split into two groups reporting low (low-GEN) and high (high-GEN) generalization. PTSD patients reported a higher expectation of an aversive event. During fear conditioning, they assessed the risk of danger related to a safety cue slower and showed a blunted fear-potentiated startle toward the danger cue. During generalization testing, reaction time increased in the high-GEN patients and decreased in the HC group with increasing similarity of a stimulus with the conditioned safety cue. Alterations of fear learning in PTSD suggest impaired defensive responses in case of a high threat probability. Moreover, our findings bridge the gap between the generalization of aversive cues during everyday life and laboratory-based experimental parameters: impairments in the processing of cues signaling safety generalize particularly in those patients who report a spreading of PTSD symptoms across different domains of everyday life.
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Affiliation(s)
- S Lis
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - J Thome
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychiatry, Western University, London, Canada.,Department of Theoretical Neuroscience, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - N Kleindienst
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Mueller-Engelmann
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University, Frankfurt, Frankfurt, Germany
| | - R Steil
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University, Frankfurt, Frankfurt, Germany
| | - K Priebe
- Department of Psychology, Faculty of Life Sciences, Humboldt University Berlin, Berlin, Germany
| | - C Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - D Hermans
- Faculty of Psychology and Educational Sciences, Leuven University, Flanders, Belgium
| | - M Bohus
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,McLean Hospital, Harvard Medical School, Boston, Massachusetts
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