An interview study of 81 former political prisoners investigated whether posttraumatic stress disorder (PTSD) is related to the way individuals process the prison experience. In contrast to participants without PTSD, those with chronic or remitted PTSD were more likely to perceive mental defeat and an overall feeling of alienation from other people. Chronic PTSD was also related to perceived negative and permanent change in their personalities or life aspirations. The groups did not differ in their attempts to gain control during imprisonment. Evidence for a relationship between political commitment and PTSD was mixed. The results suggest that mental defeat, alienation, and permanent change are related to PTSD after interpersonal trauma and may need to be addressed in treatment.
Hintergrund: Sexuelle Dysfunktionen sind ein häufiges Problem bei Patientinnen mit posttraumatischer Belastungsstörung (PTB). Kaum untersucht ist, ob ein Zusammenhang zwischen der Art des Traumas (sexuell vs. nichtsexuell) und der Häufigkeit sexueller Dysfunktionen bzw. Zufriedenheit besteht und welche Rolle komorbide Depressionen dabei spielen. Zudem wurden verschiedene Störungsbilder (PTB, Angst, Depression) in Bezug auf sexuelle Funktions-/Zufriedenheitsbeeinträchtigungen vergleichend untersucht (klinische Spezifität). Patientinnen und Methoden: Nach der standardisierten klinischen Diagnostik wurden 351 ambulante Psychotherapiepatientinnen folgenden 3 Gruppen zugeteilt: Patientinnen mit PTB (n = 89), mit anderen Angststörungen (n = 157) und mit depressiven Störungen (n = 105). Informationen zur sexuellen Zufriedenheit und Funktionsfähigkeit wurden mit dem Kurzfragebogen für Sexualität (KFS) erhoben. Die Art des Traumas (sexuell vs. nichtsexuell) wurde per Interview erfasst; Depressivität mit dem Beck-Depressions-Inventar (BDI). Ergebnisse: Sexuell traumatisierte PTB-Patientinnen haben ein 4-fach höheres Risiko, Beeinträchtigungen der sexuellen Funktionsfähigkeit zu erleben als PTB-Patientinnen mit nichtsexuellem Trauma. Bei Vorliegen einer depressiven Störung zusätzlich zur PTB steigt das Risiko für sexuelle Dysfunktionen um das 3-fache gegenüber PTB-Patientinnen ohne komorbide Depression. Mit der sexuellen Zufriedenheit hängt die Art des Traumas hingegen nicht zusammen. Während drei Viertel der PTB- und Depressionspatientinnen sexuelle Dysfunktionen berichten, gilt dies nur für jede zweite Angstpatientin (außer PTB). Diskussion: Sowohl die Art des Traumas als auch komorbide Depressionen stehen im Zusammenhang mit sexuellen Dysfunktionen bei PTB-Patientinnen. Insbesondere bei Patientengruppen mit einem erhöhten Risiko für Beeinträchtigungen der sexuellen Funktionen ist es wichtig, die Thematik bei therapeutischen Interventionen zu berücksichtigen.
Given the high rates of both traumatic events and of resulting posttraumatic stress disorder (PTSD) it is imperative to develop and to evaluate efficacious and cost-effective treatment for these individuals. The clinic for behavioral medicine St. Franziska Stift in Bad Kreuznach, Germany, offers group treatment for traumatized inpatients who suffer from chronic PTSD. The group-therapy is based on cognitive processing therapy (CPT) originally developed by Resick and Schnicke (1993). This approach has been modified according to the demands of an inpatient treatment program and is conducted in a manualized approach by trained clinicians. The format and the therapeutic goals of that group are described. The treatment undergoes evaluation at the moment. 55 inpatients have been treated in the group so far. All but one patient have been severely sexually traumatized either in childhood, adulthood or at several stages in life. All patients suffer from PTB and a high comorbidity of mental disorder. The severity of PTB is assessed before, after group treatment and in a 3-month follow up. Dysfunctional beliefs that are affected by traumatization according to CPT are assessed before and after treatment. Results of 52 patients (pre and post assessment) and 42 patients (katamnestic data) are presented. Results indicate that PTSD declines significantly, furthermore dysfunctional beliefs that are targeted in the treatment change to more functional beliefs. Critical issues that occur in the treatment and difficulties in implementing inpatient treatment for multiple assault victims are discussed.
Elderly patient's preconditions for outpatient psychotherapy are compared with regard to symptom levels, psychological and bodily functioning, and interpersonal problems with groups of younger patients. Based on the Age and Disorder-Specific Model of Psychotherapy (ADS-MP) we predicted that the group of older patients exhibits more favorable preconditions for psychotherapy as well as a shorter duration of treatments than younger groups. A total of 169 outpatients from an university clinic were divided into four groups and compared. Rates of mental disorders did not differ between the groups for all frequent disorders. The group of elderly patients did not show a difference in symptom levels although their psychological functioning was better than in the comparison groups. Two of eight interpersonal problems showed more favorable initial values for the elderly. The number of necessary therapy hours up to the treatment conclusion was significantly smaller in the older group (on average 21 hours) than with young to middle-aged patients groups. The results point to the fact that the psychological preconditions for psychotherapy in old age are good and indicate promising directions for the development of age-appropriate interventions.
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