Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

Abstract

Background: There is ongoing debate as to whether emotion regulation problems should be improved first in order to profit from trauma-focused treatment, or will diminish after successful trauma processing. Objective: To enhance our understanding about the importance of emotion regulation difficulties in relation to treatment outcomes of trauma-focused therapy of adult patients with severe PTSD, whereby we made a distinction between people who reported sexual abuse before the age of 12, those who were 12 years or older at the onset of the abuse, individuals who met the criteria for the dissociative subtype of PTSD, and those who did not. Methods: Sixty-two patients with severe PTSD were treated using an intensive eight-day treatment programme, combining two first-line trauma-focused treatments for PTSD (i.e. prolonged exposure and EMDR therapy) without preceding interventions that targeted emotion regulation difficulties. PTSD symptom scores (CAPS-5) and emotion regulation difficulties (DERS) were assessed at pre-treatment, post-treatment, and six month follow-up. Results: PTSD severity and emotion regulation difficulties significantly decreased following trauma-focused treatment. While PTSD severity scores significantly increased from posttreatment until six month follow-up, emotion regulation difficulties did not. Treatment response and relapse was not predicted by emotion-regulation difficulties. Survivors of childhood sexual abuse before the age of 12 and those who were sexually abused later in life improved equally well with regard to emotion regulation difficulties. Individuals who fulfilled criteria of the dissociative subtype of PTSD showed a similar decrease on emotion regulation difficulties during treatment than those who did not. Conclusion: The results support the notion that the severity of emotion regulation difficulties is not associated with worse trauma-focused treatment outcomes for PTSD nor with relapse after completing treatment. Further, emotion regulation difficulties improved after trauma-focused treatment, even for individuals who had been exposed to early childhood sexual trauma and individuals with dissociative subtype.

A 1‐year follow‐up study of the longitudinal interplay between emotion dysregulation and childhood trauma in the treatment of anorexia nervosa

“…Overall, these data reaffirm the importance of assessing emotion regulation skills over the course of psychotherapy-based multidisciplinary treatment of AN, and support the possible use of supplementary modules with a specific focus on this dimension, such as dialectical behavior therapy ( Linehan, 1987 ), as already carried out in some ED treatment centers ( Ben-Porath, Federici, Wisniewski, & Warren, 2014 ; Rowsell et al, 2016 ). Finally, specific treatments for trauma-related psychopathology such as Eye Movement Desensitization and Reprocessing ( Shapiro, 1989 ), cognitive processing therapy ( Resick & Schnicke, 1992 ), or prolonged exposure therapy ( Foa, 2011 ) could also be useful in selected cases of AN with early trauma, given the evidence pointing to their effectiveness in reducing emotion dysregulation ( Galovski, Nixon, & Kaysen, 2020 ; Puhalla, Flynn, & Vaught, 2021 ; Shapiro, 1989 ; van Toorenburg et al, 2020 ).…”

Trauma-focused treatment outcome for complex PTSD patients: results of an intensive treatment programme

“…The intensive trauma-focused treatment format consisted of two consecutive weeks, with 4 days of treatment each week, in which patients went home for the weekend in between (De Jongh et al, 2020 ; Van Toorenburg et al, 2020 ; Van Woudenberg et al, 2018 ; Voorendonk, Sanches, De Jongh, & Van Minnen, 2019 ; Wagenmans, Van Minnen, Sleijpen, & De Jongh, 2018 ; Zoet, Wagenmans, Van Minnen, & De Jongh, 2018 ). The intensive treatment programme is developed to treat patients suffering from severe PTSD and is specifically designed to reduce the drop-out rates for PTSD patients.…”

Qualitative Research in EMDR Therapy: Exploring the Individual Experience of the How and Why

“…Reisetter et al (2004), Carey and Stiles (2015), and Whitehouse (in press) contend that qualitative research allows clinicians to feel a stronger connection between research and clinical practice because qualitative research is more likely (than quantitative research) to place value on the individual experience of a person. Some researchers assert that quantitative methods do not optimally reflect clients' experiences in usual care settings (Tucker, Donovan, & Marlatt, 1999), and that in the case of randomized controlled research especially, controlling for so many variables is not optimally reflective of real-world experiences ( Carey & Stiles, 2015;Clay, 2010). These contentions are not meant to disparage any form of quantitative inquiry, as many empirical studies within the EMDR literature have been conducted in usual care settings.…”

“…These findings may shed some important light on an often contested topic: How much preparation is adequate? This is an area of ongoing debate in the field of trauma-focused therapy (Van Toorenburg et al, 2020). While Shapiro (2018) has long contended that preparation is not processing, her third edition robustly welcomes ancillary and proactive measures, especially with more complicated cases.…”