Treating Psychosocial and Neural Consequences of Childhood Interpersonal Violence in Adults


Experiences of childhood interpersonal trauma (CIT) such as sexual or physical abuse have powerful and often additive associations with the occurrence of mental disorders throughout the course of life. The highest odds ratios (ORs) in females who have been victims of such experiences are found for alcohol and drug abuse (OR=8.9), borderline personality disorder (BPD; OR=7.6), and post-traumatic stress disorder (PTSD; OR=7.25) (Cutajar et al., 2010). The latter two disorders frequently co-occur, and often result in complex conditions with severe psychopathology, pervasive problems in emotion regulation, non-suicidal self-injurious behaviours, and low remission rates. Unfortunately, the empirical database on psychosocial treatments for survivors of CIT is quite limited. Furthermore, the few existing studies have mostly excluded subjects with current self-harm behaviours, suicidal ideation, dissociative disorders, substance abuse, or BPD—hence, a large group of patients suffering from PTSD after CIT. Thus, researchers are still trying to identify efficacious treatment programmes for this group of patients. We recently developed a three-month residential treatment programme that tailors dialectical behavioural therapy (DBT) to the specific needs of such patients. The effects of this programme, termed DBT-PTSD, were evaluated in a randomised controlled trial (RCT). Data revealed significant reduction of post-traumatic symptoms, with large between-group effect sizes when compared to a treatment-as-usual wait list condition (Cohen’s d=1.5) (Bohus et al., 2012a). However, residential treatment is expensive and can be provided for only a limited number of patients. Therefore, we have modified the DBT-PTSD approach for outpatient conditions, and have collected promising pilot data. The first aim of the research collaboration RELEASE is to evaluate the efficacy of this new outpatient treatment programme. The second aim is to identify the major therapeutic variables mediating treatment efficacy. The third aim is to study the neural mechanisms and treatment sensitivity of two of the most serious sequelae of PTSD after CIT: intrusions and dissociation. To address these questions, we will recruit 180 female patients who experienced CIT and who currently fulfil the DSM-IV criteria for PTSD plus severe emotion dysregulation. Participants will be randomised to one year of outpatient psychotherapy with either DBT-PTSD or cognitive processing therapy (CPT-C; Resick et al. 2008). The primary outcome criterion will be improvement on the Clinician Administered PTSD Scale (CAPS). The expected results of RELEASE will be a major step forward in establishing empirically supported psychological treatments in the German health care system for survivors of CIT.
Experiences of childhood interpersonal trauma (CIT) such as sexual or physical abuse have powerful and often additive associations with the occurrence of mental disorders throughout the course of life. The highest odds ratios (ORs) in females who have been victims of such experiences are found for alcohol and drug abuse (OR=8.9), borderline personality disorder (BPD; OR=7.6), and post-traumatic stress disorder (PTSD; OR=7.25) (Cutajar et al., 2010). The latter two disorders frequently co-occur, and often result in complex conditions with severe psychopathology, pervasive problems in emotion regulation, non-suicidal self-injurious behaviours, and low remission rates. Unfortunately, the empirical database on psychosocial treatments for survivors of CIT is quite limited. Furthermore, the few existing studies have mostly excluded subjects with current self-harm behaviours, suicidal ideation, dissociative disorders, substance abuse, or BPD—hence, a large group of patients suffering from PTSD after CIT. Thus, researchers are still trying to identify efficacious treatment programmes for this group of patients. We recently developed a three-month residential treatment programme that tailors dialectical behavioural therapy (DBT) to the specific needs of such patients. The effects of this programme, termed DBT-PTSD, were evaluated in a randomised controlled trial (RCT). Data revealed significant reduction of post-traumatic symptoms, with large between-group effect sizes when compared to a treatment-as-usual wait list condition (Cohen’s d=1.5) (Bohus et al., 2012a). However, residential treatment is expensive and can be provided for only a limited number of patients. Therefore, we have modified the DBT-PTSD approach for outpatient conditions, and have collected promising pilot data. The first aim of the research collaboration RELEASE is to evaluate the efficacy of this new outpatient treatment programme. The second aim is to identify the major therapeutic variables mediating treatment efficacy. The third aim is to study the neural mechanisms and treatment sensitivity of two of the most serious sequelae of PTSD after CIT: intrusions and dissociation. To address these questions, we will recruit 180 female patients who experienced CIT and who currently fulfil the DSM-IV criteria for PTSD plus severe emotion dysregulation. Participants will be randomised to one year of outpatient psychotherapy with either DBT-PTSD or cognitive processing therapy (CPT-C; Resick et al. 2008). The primary outcome criterion will be improvement on the Clinician Administered PTSD Scale (CAPS). The expected results of RELEASE will be a major step forward in establishing empirically supported psychological treatments in the German health care system for survivors of CIT.


Projektleitung
Fydrich, Thomas Prof. Dr. (Details) (Psychotherapie und Somatopsychologie)

Laufzeit
Projektstart: 09/2013
Projektende: 10/2018

Zuletzt aktualisiert 2020-19-11 um 14:05