Does complex PTSD predict or moderate treatment outcomes of three variants of exposure therapy?

Hoeboer, Chris M.; Kleine, Rianne A. de; Oprel, Danielle; Schoorl, Maartje; Does, Willem van der; Minnen, Agnes van

doi:10.1016/j.janxdis.2021.102388

Cited by 19 publications

(23 citation statements)

References 61 publications

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“…In addition, multiple experiences of ACEs (>4 ACEs) were associated with a severely increased risk to develop PTSD (7.0-times) and cPTSD (14.8-times) in adulthood. We add to previous research demonstrating an association of ACEs and PTSD as well as cPTSD, emphasizing the importance of a persons’ history of child maltreatment and adverse experiences for developing these psychopathologies ( 13 , 15 , 17 , 59 ).…”

Section: Discussionmentioning

confidence: 86%

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Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood

et al. 2022

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BackgroundAdverse childhood experiences (ACEs) are associated with posttraumatic and complex posttraumatic stress disorder symptoms in adulthood (PTSD/cPTSD), as well as reduced epistemic trust (trust in the authenticity and personal relevance of interpersonally transmitted information) and impaired personality functioning. The present work aims to investigate the predictive value of epistemic trust—the capacity for social learning—on the mediating effect of personality functioning in the association of ACEs and PTSD/cPTSD.MethodsWe conducted structural equation modeling (SEM) based on representative data of the German population (N = 2,004). Personality functioning (OPD-SQS) was applied as a mediator between ACEs and PTSD/cPTSD (ITQ), while epistemic trust (ETMCQ) was added as predictor for OPD-SQS. TLI, CFI, and RMSEA (95%-CI) determined the models’ fit.ResultsN = 477 (23.8%) participants reported at least one ACE and n = 218 (10.9%) reported ≥4 ACEs. Fit indices were good for both PTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.041–0.078) and cPTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.043–0.081). ACEs were significantly associated with cPTSD (β = 0.44, p < 0.001) and PTSD (β = 0.29, p < 0.001), explaining 20 and 8% of its variance. Adding personality functioning as a mediator increased the explained variance of cPTSD and PTSD to 47 and 19% while the direct association between ACEs and cPTSD/PTSD decreased (β = 0.21/β = 0.17), thus, indicating a partial mediation. Including epistemic trust substantially increased the explained variance for personality functioning (41%) compared to ACEs as a single predictor (16%).ConclusionWe add to previous research emphasizing the association between ACEs and PTSD/cPTSD symptoms. Offering insights on underlying mechanisms, we show that epistemic trust and personality functioning are relevant mediators. Since both are modifiable by psychotherapy, knowledge about the role of these constructs can inform research on psychotherapeutic interventions and prevention.

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Section: Discussionmentioning

confidence: 86%

“…With regard to mental disorders, posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) are most often associated with ACEs ( 13 – 17 ). However, specific symptoms often found in persons with PTSD and a history of ACEs led to significant conceptual changes.…”

Section: Introductionmentioning

confidence: 99%

Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood

et al. 2022

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“…However, the treatment was equally as effective in patients with probable CPTSD as in patients with PTSD in terms of the overall reduction in symptoms. Previous studies have similarly found that patients with CPTSD and PTSD had equal treatment-effect in intensive treatment (Voorendonk et al, 2020 ) and a clinical trial (Hoeboer et al, 2021 ), but to our knowledge, this is the first study to observe the same in ordinary clinical health care services.…”

Section: Discussionmentioning

confidence: 54%

Implementation of evidence-based treatment for PTSD in Norway: clinical outcomes and impact of probable complex PTSD

Bækkelund

Endsjø

Peters

et al. 2022

European Journal of Psychotraumatology

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Background: Posttraumatic stress disorder (PTSD) is a long-lasting and debilitating psychological disorder that affects a large portion of the population. Treatments such as Cognitive therapy for PTSD (CT-PTSD) and Eye movement desensitization and reprocessing (EMDR) have been shown to be effective and cost-efficient in clinical trials, but uptake and evidence of positive outcomes in real-world clinical services are limited. Implementation efforts have been hampered by providers’ concerns about the feasibility of trauma-focused treatments in more complex presentations (i.e. Complex PTSD). Objective: To evaluate the effectiveness of CT-PTSD and EMDR in a real-world setting, as implemented in Norwegian outpatient mental health clinics for adults, and investigate the impact of probable Complex PTSD status on treatment outcomes. Methods: Clinicians from 15 different outpatient clinics received training and supervision in EMDR or CT-PTSD as part of a national implementation project. 104 clinicians recruited and treated 196 participants with PTSD. Symptoms of PTSD, depression and anxiety were assessed session-by-session and used to estimate pre-post effect sizes. Mixed-models were employed to investigate the impact of complex PTSD. Results: Both EMDR and CT-PTSD were associated with significant reductions in PTSD symptoms, with large effect sizes. Probable Complex PTSD was associated with higher levels of symptoms before and after treatment but did not significantly impact the effectiveness of treatment. Conclusion: The use of evidence-based treatments for PTSD in routine clinical service is associated with good treatment outcomes, also for patients with Complex PTSD.

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“…The impact of confounding in our analyses will be examined by comparing unadjusted models to models adjusted for age, gender, personality dysfunction, other psychiatric conditions, attachment style, verbal IQ, severity of trauma history and type of PTSD (ICD-11 PTSD versus CPTSD). As an exploratory analysis, we will also examine results separately in those with ICD-11 PTSD and CPTSD, although statistical power comparing these subgroups will be limited, and evidence suggests outcomes might be similar in these groups (Hoeboer et al, 2021 ). Regression models will be used to estimate effect sizes and 95% confidence intervals for our outcomes per unit-difference in social cognition measures.…”

Section: Discussionmentioning

confidence: 99%

Study development and protocol for a cohort study examining the impact of baseline social cognition on response to treatment for people living with post-traumatic stress disorder

Wiseman

Lawrence

Bisson

et al. 2022

European Journal of Psychotraumatology

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Background: Social cognitive impairments, specifically in facial emotion processing and mental state attribution, are common in post-traumatic stress disorder. However few studies so far have examined whether social cognitive ability impacts on PTSD recovery. Objective: To examine whether baseline social cognitive abilities are associated with treatment outcomes following trauma-focused therapy for PTSD. Method: This is a cohort study that will relate treatment outcomes post-discharge to baseline measures of social cognition (five tasks: Emotion Odd-One-Out Task (Oddity), Reading the Mind in the Eyes Task (RMET), Social Shapes Test (SST), Spontaneous Theory of Mind Protocol (STOMP), and Reflective Functioning Questionnaire (RFQ-8)) in people starting a course of psychological therapy for PTSD (target N = 60). The primary outcome will be pre- to post-treatment change in PTSD symptom severity (assessed using the PTSD Checklist for DSM-5). Secondary outcomes include functional impairment (assessed using the Work and Social Adjustment Scale), drop-out rate, and analyses differentiating participants with DSM-5 PTSD and ICD-11 PTSD and CPTSD. Regression models will be used to examine associations between baseline social cognitive performance and outcome measures while adjusting for potential confounders. Two pilot studies informed the development of our study protocol. The first involved qualitative analysis of interviews with nine participants with lived experience of mental health problems to inform our research questions and study protocol. The second involved trialling social cognitive tasks on 20 non-clinical participants to refine our test battery. Discussion: This study will address a gap in the literature about whether abilities in social cognition in people living with PTSD are associated with treatment-related recovery. HIGHLIGHTS Impairments in social cognition are recognised in people with PTSD. Few studies have examined whether social cognitive ability is associated with recovery from PTSD. We present a study protocol, developed after pilot testing, to address this question.

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Does complex PTSD predict or moderate treatment outcomes of three variants of exposure therapy?

Cited by 19 publications

References 61 publications

Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood

Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood

Implementation of evidence-based treatment for PTSD in Norway: clinical outcomes and impact of probable complex PTSD

Study development and protocol for a cohort study examining the impact of baseline social cognition on response to treatment for people living with post-traumatic stress disorder

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