Background: Dialectical behaviour therapy for posttraumatic stress disorder (DBT-PTSD), which is tailored to treat adults with PTSD and co-occurring emotion regulation difficulties, has already demonstrated its efficacy, acceptance and safety in an inpatient treatment setting. It combines elements of DBT with trauma-focused cognitive behavioural interventions. Objective: To investigate the feasibility, acceptance and safety of DBT-PTSD in an outpatient treatment setting by therapists who were novice to the treatment, we treated 21 female patients suffering from PTSD following childhood sexual abuse (CSA) plus difficulties in emotion regulation in an uncontrolled clinical trial. Method: The Clinician Administered PTSD Symptom Scale (CAPS), the Davidson Trauma Scale (DTS), the Borderline Section of the International Personality Disorder Examination (IPDE) and the Borderline Symptom List (BSL-23) were used as primary outcomes. For secondary outcomes, depression and dissociation were assessed. Assessments were administered at pretreatment, post-treatment and six-week follow-up. Results: Improvement was significant for PTSD as well as for borderline personality symptomatology, with large pretreatment to follow-up effect sizes for completers based on the CAPS (Cohens d = 1.30), DTS (d = 1.50), IPDE (d = 1.60) and BSL-23 (d = 1.20). Conclusion: The outcome suggests that outpatient DBT-PTSD can safely be used to reduce PTSD symptoms and comorbid psychopathology in adults who have experienced CSA.

The Clinician-Administered PTSD Scale (CAPS) is a widely used diagnostic interview for posttraumatic stress disorder (PTSD). Following fundamental modifications in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5), the CAPS had to be revised. This study examined the psychometric properties (internal consistency, interrater reliability, convergent and discriminant validity, and structural validity) of the German version of the CAPS-5 in a trauma-exposed sample ( n = 223 with PTSD; n =51 without PTSD). The results demonstrated high internal consistency (αs = .65-.93) and high interrater reliability (ICCs = .81-.89). With regard to convergent and discriminant validity, we found high correlations between the CAPS severity score and both the Posttraumatic Diagnostic Scale sum score ( r = .87) and the Beck Depression Inventory total score ( r = .72). Regarding the underlying factor structure, the hybrid model demonstrated the best fit, followed by the anhedonia model. However, we encountered some nonpositive estimates for the correlations of the latent variables (factors) for both models. The model with the best fit without methodological problems was the externalizing behaviors model, but the results also supported the DSM-5 model. Overall, the results demonstrate that the German version of the CAPS-5 is a psychometrically sound measure.

The adherence rating scale for the adapted version of CPT is a reliable instrument that can be helpful for interpreting treatment effects, analysing possible relationships between therapeutic adherence and treatment outcomes and teaching therapeutic skills.

Although the assessment of therapeutic competence in psychotherapy research is essential for examining its possible associations with treatment outcomes, it is often neglected due to high costs and a lack of valid instruments. This study aimed to develop two therapeutic competence scales that assess disorder-specific and treatment-specific therapeutic competence, and to examine these scales' psychometric properties along with those of the already established Cognitive Therapy Scale (CTS) in a posttraumatic stress disorder (PTSD) sample. Using an inductive procedure, two rating scales for assessing disorder-specific and treatment-specific competence were constructed. The psychometric properties of these scales and those of the CTS were assessed in a sample of 30 videotaped sessions of eight patients from a multicenter study in which PTSD related to child abuse was treated using cognitive processing therapy. Two raters assessed therapeutic competence in 30 videotaped psychotherapy sessions. Interrater reliability, internal consistency, and content validity were determined. The scales (all items and total scores) demonstrated good to excellent interrater reliability, intraclass correlation coefficients (ICCs) = .67 to .97, and internal consistency, Cronbach's α = .73 to .92. The PTSD experts' ratings confirmed good internal validity. We found statistically significant associations with therapeutic adherence, r = .62 to .85; p < .001; and therapeutic alliance, r = .47, p < .001. These preliminary data imply that the two newly developed competence scales and the CTS can be reliably used to assess different types of therapeutic competence in PTSD samples and may be useful as possible predictors of treatment outcomes.

Hintergrund: Das Störungsbild der komplexen Posttraumatischen Belastungsstörung (PTBS) tritt häufig nach wiederholten Gewalterfahrungen in der Kindheit und Jugend auf und zeichnet sich neben den Kernsymptomen der PTBS durch Störungen der Emotionsregulation, instabile Beziehungen sowie hohe Komorbiditäten aus. Viele Behandler haben Bedenken, bei dieser Patientengruppe expositionsbasierte Methoden anzuwenden. Die Cognitive Prozessing Therapy (CPT; [Resick et al., 2007]) stellt in ihrer rein kognitiven Variante (CPT-C) eine wirksame alternative Methode dar, die ohne formale Expositionselemente auskommt. Neben der Vorstellung dieser Behandlung wird ein Überblick über Evaluationsstudien gegeben sowie die Anwendung anhand eines Fallbeispiels beschrieben. Fallbericht: Die Patientin kam nach sexueller Gewalt im Kindesalter in die Behandlung. Neben einer PTBS wurde eine emotional instabile Persönlichkeitsstörung (Borderline-Typus) diagnostiziert. Die durchgeführten CPT-C-Interventionen, der Therapieverlauf sowie das Behandlungsergebnis werden beschrieben und Besonderheiten bei der Behandlung der komplexen PTBS aufgezeigt. Schlussfolgerungen: Die kognitive Variante der CPT, die CPT-C, ermöglicht es, auf eine formale Exposition zu verzichten, und zeigt dennoch eine genauso gute Wirksamkeit wie expositionsbasierte Methoden. Sie sollte deshalb in der Versorgung traumatisierter Patientinnen und Patienten und besonders auch zur Behandlung der komplexen PTBS eine größere Beachtung und Verbreitung finden.