The impact of childhood sexual abuse on the outcome of intensive trauma-focused treatment for PTSD

Abstract

Background: It is assumed that PTSD patients with a history of childhood sexual abuse benefit less from trauma-focused treatment than those without such a history. Objective: To test whether the presence of a history of childhood sexual abuse has a negative effect on the outcome of intensive trauma-focused PTSD treatment. Method: PTSD patients, 83% of whom suffered from severe PTSD, took part in a therapy programme consisting of 2 × 4 consecutive days of Prolonged Exposure (PE) and EMDR therapy (eight of each). In between sessions, patients participated in sport activities and psycho-education sessions. No prior stabilization phase was implemented. PTSD symptom scores of clinician-administered and self-administered measures were analysed using the data of 165 consecutive patients. Pre-post differences were compared between four trauma groups; patients with a history of childhood sexual abuse before age 12 (CSA), adolescent sexual abuse (ASA; i.e. sexual abuse between 12 and 18 years of age), sexual abuse (SA) at age 18 and over, or no history of sexual abuse (NSA). Results: Large effect sizes were achieved for PTSD symptom reduction for all trauma groups (Cohen’s d = 1.52–2.09). For the Clinical Administered PTSD Scale (CAPS) and the Impact of Event Scale (IES), no differences in treatment outcome were found between the trauma (age) groups. For the PTSD Symptom Scale Self Report (PSS-SR), there were no differences except for one small effect between CSA and NSA. Conclusions: The results do not support the hypothesis that the presence of a history of childhood sexual abuse has a detrimental impact on the outcome of first-line (intensive) trauma-focused treatments for PTSD.

Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder

“…Future research could study possible mediators and moderators of the treatment effects. In previous studies using subsamples of our presented data, childhood sexual abuse (Wagenmans, Van Minnen, Sleijpen, & De Jongh, 2018) and dissociative subtype (Zoet, Wagenmans, Van Minnen, & De Jongh, 2018), we were not able to identify any moderators of treatment results, which implies that these patients can benefit from the treatment programme. Another limitation pertains to the quality of our follow-up data, as we could only analyse a subsample for the 6 month follow-up.…”

The Loss of Autonomy in Abused Persons: Psychological, Moral, and Legal Dimensions

“…Thus, the removal of the abusive triggers is part of the liberation of oppressed groups, along with social and legal reform. difference in treatment response between those with and without childhood trauma (Walter et al 2014;Wagenmans et al 2018). We cannot assume, then, that victim-survivors of childhood trauma do not have the capacity to develop basic autonomy.…”

Core Interpersonal Patterns in Complex Trauma and the Process of Change in Psychodynamic Therapy: A Case Comparison Study

“…Our results suggest that this is not an either/or decision and that we should consider taking into account the mechanisms of change (Kazdin, 2009) to make any sound recommendations. In the case of Amy, we have noted that Amy responded particularly well to expressive interventions, which lines up with treatment approaches that protest against the use of initial stabilization (e.g., Wagemans et al, 2018). In contrast, in Pam's case, we argued that a straightforward approach on traumatic contents was non-profitable and instead, her case warranted a supportive, stabilizing approach (e.g., Jepsen et al, 2013).…”