A research programme to evaluate DBT-PTSD, a modular treatment approach for Complex PTSD after childhood abuse

Abstract

Background: Posttraumatic stress disorder (PTSD) after childhood abuse (CA) is often related to severe co-occurring psychopathology, such as symptoms of borderline personality disorder (BPD). The ICD-11 has included Complex PTSD as a new diagnosis, which is defined by PTSD symptoms plus disturbances in emotion regulation, self-concept, and interpersonal relationships. Unfortunately, the empirical database on psychosocial treatments for survivors of CA is quite limited. Furthermore, the few existing studies often have either excluded subjects with self-harm behaviour and suicidal ideationwhich is common behaviour in subjects suffering from Complex PTSD. Thus, researchers are still trying to identify efficacious treatment programmes for this group of patients. We have designed DBT-PTSD to meet the specific needs of patients with Complex PTSD. The treatment programme is based on the rules and principles of dialectical behavioural therapy (DBT), and adds interventions derived from cognitive behavioural therapy, acceptance and commitment therapy and compassion-focused therapy. DBT-PTSD can be provided as a comprehensive residential programme or as an outpatient programme. The effects of the residential programme were evaluated in a randomised controlled trial. Data revealed significant reduction of posttraumatic symptoms, with large between-group effect sizes when compared to a treatment-as-usual wait list condition (Cohen's d = 1.5). The first aim of this project on hand is to evaluate the efficacy of the outpatient DBT-PTSD programme. The second aim is to identify the major therapeutic variables mediating treatment efficacy. The third aim is to study neural mechanisms and treatment sensitivity of two frequent sequelae of PTSD after CA: intrusions and dissociation. Methods: To address these questions, we include female patients who experienced CA and who fulfil DSM-5 criteria for PTSD plus borderline features, including criteria for severe emotion dysregulation. The study is funded by the German Federal Ministry of Education and Research, and started in 2014. Participants are randomised to outpatient psychotherapy with either DBT-PTSD or Cognitive Processing Therapy. Formal power analysis revealed a minimum of 180 patients to be recruited. The primary outcome is the change on the Clinician-Administered PTSD Scale for DSM-5. Discussion: The expected results will be a major step forward in establishing empirically supported psychological treatments for survivors of CA suffering from Complex PTSD. Trial registration: German Clinical Trials Register: registration number DRKS00005578, date of registration 19 December 2013.

Changes in Trauma‐Related Emotions Following Treatment With Dialectical Behavior Therapy for Posttraumatic Stress Disorder After Childhood Abuse

“…The large effects with respect to shame and guilt in our study may reflect the attention to these emotions in DBT‐PTSD. Guilt is addressed as a secondary emotion, which helps to reduce the experience of helplessness (Bohus & Priebe, ). In particular, DBT‐PTSD applies both cognitive interventions according to Ehlers et al.…”

“…Patients were treated between 2014 and 2016 at the specialized trauma unit of the Central Institute for Mental Health in Mannheim, Germany. All participants received residential DBT‐PTSD, which has been described in detail elsewhere (Bohus et al., ; Bohus & Priebe, ). In short, DBT‐PTSD consists of several phases spread over 12 weeks.…”

“…Treatments for abuse‐related PTSD (Cloitre, Petkova, Wang, & Lu, ; Harned, Korslund, & Linehan, ; Steil, Dyer, Priebe, Kleindienst, & Bohus, ) emphasize the use of emotion regulation strategies. In particular, dialectical behavior therapy for CPTSD (DBT‐PTSD) was tailored for patients with CPTSD related to CA (i.e., patients with severe emotion dysregulation and high levels of guilt, shame, self‐contempt, self‐harm, suicidal ideation, dissociation, and interpersonal problems) (Bohus et al., ). The treatment principles further described by Bohus and Priebe () are as follows: DBT‐PTSD is a multicomponent treatment that follows algorithms derived from DBT (Linehan, ).…”

“…In particular, dialectical behavior therapy for CPTSD (DBT‐PTSD) was tailored for patients with CPTSD related to CA (i.e., patients with severe emotion dysregulation and high levels of guilt, shame, self‐contempt, self‐harm, suicidal ideation, dissociation, and interpersonal problems) (Bohus et al., ). The treatment principles further described by Bohus and Priebe () are as follows: DBT‐PTSD is a multicomponent treatment that follows algorithms derived from DBT (Linehan, ). It includes clear structures and a dynamic hierarchization of treatment focuses.…”

Function and Psychotherapy of Chronic Suicidality in Borderline Personality Disorder: Using the Reinforcement Model of Suicidality

“…As proposed in ACT, so-called defusion techniques (i.e., distancing and disconnecting techniques from thoughts and feelings) can be a highly relevant addressing negative judgements and believes, too (33). Given the high prevalence of traumatization and substantial invalidation experiences in chronic suicidal individuals, exposure-based trauma therapy has an important impact on suicidal symptoms and, according to recent developments in DBT for posttraumatic stress disorder can (and most likely should) start as soon as possible (45,46). Within this confrontation, time for the grieving process and finally acceptance of what has happened in the past is inevitable.…”