Therapeutic Alliance, Negative Mood Regulation, and Treatment Outcome in Child Abuse-Related Posttraumatic Stress Disorder.

Abstract

This study examined the related contributions of the therapeutic alliance and negative mood regulation to the outcome of a 2-phase treatment for childhood abuse-related posttraumatic stress disorder (PTSD). Phase 1 focused on stabilization and preparatory skills building, whereas Phase 2 was comprised primarily of imaginal exposure to traumatic memories. Hierarchical regression analyses indicated the strength of the therapeutic alliance established early in treatment reliably predicted improvement in PTSD symptoms at posttreatment. Furthermore, this relationship was mediated by participants' improved capacity to regulate negative mood states in the context of Phase 2 exposure therapy. In the treatment of childhood abuse-related PTSD, the therapeutic alliance and the mediating influence of emotion regulation capacity appear to have significant roles in successful outcome.

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

“…What is more, even patients with attachment problems were able to establish a good working alliance with more than one therapist, indicating that attachment problems do not stand in the way of working with multiple therapists during therapy. Some argue that in the case of childhood abuse the patient needs to repair this interpersonal disturbance, and that a positive therapeutic relationship can play an important role in that process (Cloitre et al, 2004). Building positive relationships with more than one therapist may be even more powerful in this regard, and can potentially be regarded as an increase in dose of the therapeutic relationship (Krampe et al, 2004).…”

“…Lastly, we explored whether this therapist rotation model is acceptable to PTSD patients. Granted that a good working alliance is important for successful TFT (Capaldi, Asnaani, Zandberg, Carpenter, & Foa, 2016; Cloitre, Chase Stovall-McClough, Miranda, & Chemtob, 2004; Keller, Zoellner, & Feeny, 2010), we were interested in whether patients were able to develop an adequate working alliance with the therapists in this treatment rotation model. Especially because attachment problems may be present along with PTSD symptoms (Karatzias et al, 2018), a clinical relevant question is whether people with attachment problems are able to build adequate therapeutic alliances with the different therapists in the therapist rotation model.…”

Intervenções em terapia cognitivo-comportamental para trauma complexo: uma revisão sistemática

“…Através de sua categorização, os quadros pós-traumáticos não mais seriam avaliados sob a perspectiva de uma forma única de manifestação pós-traumáti-ca, passando a serem considerados a partir da natureza do evento traumático, ou seja seria necessário uma distinção entre TEPT simples (evento único) e TEPT complexo (múltiplos eventos durante períodos sensíveis do desenvolvimento). A caracterização conceitual de DESNOS fez com que alguns estudos começassem a ser publicados considerando tal diagnóstico (Cloitre, Stovall--McClough, Miranda, & Chemtob, 2004;Roth et al, 1997;van der Kolk et al, 1996;van der Kolk et al, 2005), incluindo uma proposta de entrevista estruturada para a avaliação dos sintomas de DESNOS, a Structured Interview for Disorders of Extreme Stress (SIDES; Pelcovitz et al, 1997).…”

“…Estes resultados mostram-se em consonância com os achados prévios que revelaram uma melhora signifi cativa nos sintomas pós-traumáticos de pacientes com TEPT crônico e histórico de abuso na infância a partir de intervenções focadas na regulação emocional (Cloitre et al, 2004;Cloitre et al, 2010;Mauritz, van de Sande, Goossens, van Achterberg, & Draijer, 2014). Curiosamente, todos estes protocolos adaptados fundamentaram suas intervenções na modalidade de psicoterapia em grupos, não tendo sido verifi cados por esta revisão protocolos de TCC adaptados para o tratamento de TC na modalidade de psicoterapia individual.…”

“…Foram utilizadas abordagens com enfoque predominantemente comportamentais (Exposição Prolongada, Inoculação de Estresse) (Resick et al, 2003) e/ou cognitivas (Terapia Cognitiva Processual e Terapia Cognitiva Clássica) (Cohen & Hien, 2006;Resick et al, 2003). Embora não se possa afi rmar qual modalidade de intervenção psicoterapêutica conduz a desfechos mais favoráveis no tratamento de TC, têm-se sugerido que abordar aspectos afetivos e interpessoais são essenciais para o tratamento destes indivíduos (Bryant, 2012;Cloitre et al, 2011;Cloitre et al, 2004;Herman, 2012;Mauritz et al, 2014). …”