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

Bohus, Martin; Kleindienst, Nikolaus; Hahn, Christopher; Müller‐Engelmann, Meike; Ludäscher, Petra; Steil, Regina; Fydrich, Thomas; Kuehner, Christine; Resick, Patricia A.; Stiglmayr, Christian; Schmahl, Christian; Priebe, Kathlen

doi:10.1001/jamapsychiatry.2020.2148

Cited by 146 publications

(110 citation statements)

References 71 publications

(96 reference statements)

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“…Dissociative responses should be closely monitored and targeted in treatment. A combination of trauma-focused interventions (e.g., exposure-based treatment), stabilizing interventions, and skills training (e.g., as in Dialectical Behaviour Therapy) [ 65 ] may be efficient for patients, who have experienced ongoing interpersonal violence [ 66 ].…”

Section: Discussionmentioning

confidence: 99%

Linking experiences of child sexual abuse to adult sexual intimate partner violence: the role of borderline personality features, maladaptive cognitive emotion regulation, and dissociation

Krause-Utz

Dierick

Josef

et al. 2021

bord personal disord emot dysregul

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Background Child sexual abuse (CSA) has been linked to a higher risk of sexual re-victimization, including sexual intimate partner violence (IPV). The aim of this study was to investigate whether borderline personality disorder (BPD) features, dissociation, and maladaptive cognitive emotion regulation mediate the link between self-reported CSA severity and sexual IPV. Specifically, we were interested in the unique effect of each mediator variable, when accounting for the effect of the other variables. Methods Data was assessed in a cross-sectional anonymous online survey, posted on platforms for people affected by domestic violence, and research platforms of Leiden University. Overall, n = 633 participants completed the survey (including n = 100 participants with CSA and n = 345 reporting at least one incidence of sexual IPV). Multivariate regression analyses and path-analytical modelling were performed for hypothesis testing. Results Adult sexual IPV was predicted by more severe CSA, more severe BPD features, higher dissociation, and more maladaptive emotion regulation. Each mediator variable showed a significant effect in the separate mediation models. In the overall model, only dissociation and maladaptive emotion regulation, but not BPD features, mediated the association between CSA and sexual IPV. Conclusions Findings add to the existing literature, suggesting that CSA severity, BPD features, dissociation, and maladaptive emotion regulation are important risk factors for sexual IPV. Given the cross-sectional correlational design of our study, prospective studies are needed to corroborate our findings regarding potential psychological mechanisms underlying sexual re-victimization. Ultimately, this can help developing interventions aimed at breaking the cycle of abuse.

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Section: Discussionmentioning

confidence: 99%

Linking experiences of child sexual abuse to adult sexual intimate partner violence: the role of borderline personality features, maladaptive cognitive emotion regulation, and dissociation

Krause-Utz

Dierick

Josef

et al. 2021

bord personal disord emot dysregul

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“…Heterogeneity was large for both high-and low-quality trials. Three high-quality trials compared active treatment conditions to ACC (Cloitre et al, 2010;Ivarsson et al, 2014;Van der Kolk et al, 2007) and three high-quality trials compared different active treatments (Bohus et al, 2020;Langkaas et al, 2017;Sloan et al, 2018), precluding meta-analytic review due to small number of available trials. We further conducted a series of subgroup analyses to examine whether the following factors were associated with study quality: use of the Clinician-Administered PTSD Scale for DSM (Blake et al, 1995) as treatment outcome, type of treatment (TF-CBT v. other), treatment format (individual v. group), type of control (PCC v. ACC), and total treatment duration in minutes (as a continuous variable).…”

Section: Study Qualitymentioning

confidence: 99%

Study quality and efficacy of psychological interventions for posttraumatic stress disorder: a meta-analysis of randomized controlled trials

2021

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Background Research indicates that higher study quality may be associated with smaller treatment effects. Yet, knowledge about the association between study quality and treatment efficacy for posttraumatic stress disorder (PTSD) is limited. We aimed at evaluating the efficacy of psychological interventions for adult PTSD and the association between study quality and treatment effects. Methods We conducted a systematic search to identify randomized controlled trials (RCTs) that examined the efficacy of psychological interventions for chronic PTSD symptoms in adult samples with at least 70% of patients being diagnosed with PTSD by means of a structured interview. We assessed study quality using the following eight criteria from prior research: N ⩾ 50, all patients met criteria for PTSD, a treatment manual was used, therapists were trained, treatment integrity was checked, intent-to-treat analyses were applied, randomization was conducted by an independent party, and treatment outcome was conducted by blind assessors. Results The search resulted in 136 RCTs with 8978 patients. Active treatment conditions were largely effective in reducing PTSD symptoms at posttreatment and follow-up (Hedges' g = 1.09 and 0.81, respectively) when compared to passive control conditions. The comparison to active control conditions at posttreatment and follow-up resulted in medium effect sizes. A total of 14 trials met all study quality criteria and these trials produced large effect sizes when compared to passive control conditions at posttreatment and follow-up. Conclusions Overall, study quality was not significantly associated with effect size. The findings indicate that psychological interventions can effectively reduce PTSD symptoms irrespective of study quality.

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“…Many patients with severe dissociative symptoms have a long history of hospitalizations, misdiagnoses, and inefficient pharmacological treatment [ 33 ], and it often takes years for patients to find adequate treatment [ 34 ]. Understanding the psychopathological context in which dissociation occurs (e.g., degree of emotion dysregulation and suicidality) may improve its treatment [ 35 , 36 ].…”

Section: Definitions Etiological Models and Clinical Presentation Of mentioning

confidence: 99%

Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment

Krause-Utz

Frost

Chatzaki

et al. 2021

Curr Psychiatry Rep

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Purpose of Review The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in order to inform clinicians and to stimulate further research. First, we introduce basic definitions and models that conceptualize dissociation from a transdiagnostic perspective. Then, we discuss recent findings in BPD. Recent Findings Stress-related dissociation is a key symptom of BPD, closely linked to other core domains of the disorder (emotion dysregulation, identity disturbances, and interpersonal disturbances). The understanding of neurobiological correlates of dissociation across different psychiatric disorders (e.g., dissociative disorders, post-traumatic stress disorder) is steadily increasing. At the same time, studies explicitly focusing on dissociation in BPD are still scarce. Summary There is evidence for adverse effects of dissociation on affective-cognitive functioning (e.g., interference inhibition), body perception, and psychotherapeutic treatment response in BPD. On the neural level, increased activity in frontal regions (e.g., inferior frontal gyrus) and temporal areas (e.g., inferior and superior temporal gyrus) during symptom provocation tasks and during resting state was observed, although findings are still diverse and need to be replicated. Conceptual differences and methodological differences in study designs and sample characteristics (e.g., comorbidities, trauma history) hinder a straightforward interpretation and comparison of studies. Given the potentially detrimental impact of dissociation in BPD, more research on the topic is strongly needed to deepen the understanding of this complex clinical condition.

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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

Cited by 146 publications

References 71 publications

Linking experiences of child sexual abuse to adult sexual intimate partner violence: the role of borderline personality features, maladaptive cognitive emotion regulation, and dissociation

Linking experiences of child sexual abuse to adult sexual intimate partner violence: the role of borderline personality features, maladaptive cognitive emotion regulation, and dissociation

Study quality and efficacy of psychological interventions for posttraumatic stress disorder: a meta-analysis of randomized controlled trials

Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment

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