Stabilizing Group Treatment for Complex Posttraumatic Stress Disorder Related to Child Abuse Based on Psychoeducation and Cognitive Behavioural Therapy: A Multisite Randomized Controlled TrialDorrepaal E.a–d · Thomaes K.a, b · Smit J.H.a–c · van Balkom A.J.L.M.a–c · Veltman D.J.a, b · Hoogendoorn A.W.a, b · Draijer N.a–c
aGGZ inGeest, bDepartment of Psychiatry and cEMGO Institute, VU University Medical Center, Amsterdam, and dPsyQ, ParnassiaBavogroep, Den Haag, The Netherlands
Keywords: Randomized controlled trialPsychotherapy outcome researchChildhood abusePosttraumatic stress disorderGroup treatmentGroup interventionGroup psychotherapyPsychoeducationCognitive behaviour group therapyCognitive behavioural treatment
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Background: Evidence-based treatments for complex posttraumatic stress disorder (PTSD) related to childhood abuse are scarce. This is the first randomized controlled trial to test the efficacy of psycho-educational and cognitive behavioural stabilizing group treatment in terms of both PTSD and complex PTSD symptom severity. Methods: Seventy-one patients with complex PTSD and severe comorbidity (e.g. 74% axis II comorbidity) were randomly assigned to either a 20-week group treatment in addition to treatment as usual or to treatment as usual only. Primary outcome measures were the Davidson Trauma Scale (DTS) for PTSD and the Structured Interview for Disorders of Extreme Stress (SIDES) for complex PTSD symptoms. Statistical analysis was conducted in the intention-to-treat (ITT) and in the completer sample. Subjects were considered responders when scoring at 20 weeks at least 1 standard deviation below pretest findings. Results: The 16% attrition was relatively low. After 20 weeks, the experimental condition (large effect sizes) and control condition (medium effect sizes) both showed significant decreases on the DTS and SIDES, but differences between the conditions were not significant. The secondary responder analysis (ITT) revealed significantly more responders on the DTS (45 vs. 21%), but not on the SIDES (61 vs. 42%). Conclusions: Adding psycho-educational and cognitive behavioural stabilizing group treatment for complex PTSD related to child abuse to treatment as usual showed an equivocal outcome. Patients in both conditions improved substantially during stabilizing treatment, and while significant superiority on change scores was absent, responder analysis suggested clinical meaningfulness of adding group treatment.
© 2012 S. Karger AG, Basel
- Taylor GJ: Affects, trauma, and mechanisms of symptom formation: a tribute to John C. Nemiah, MD (1918–2009). Psychother Psychosom 2010;79:339–349.
- Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB: Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995;52:1048–1060.
- Herman JL: Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. J Trauma Stress 1992;5:377–391.
- Pelcovitz D, van der Kolk B, Roth S, Mandel F, Kaplan S, Resick P: Development of a criteria set and a structured interview for disorders of extreme stress (SIDES). J Trauma Stress 1997;10:3–16.
- Zlotnick C, Zakriski AL, Shea MT, Costello E, Begin A, Pearlstein T, Simpson E: The long-term sequelae of sexual abuse: support for a complex posttraumatic stress disorder. J Trauma Stress 1996;9:195–205.
- Van Der Kolk BA, Roth S, Pelcovitz D, Sunday S, Spinazzola J: Disorders of extreme stress: the empirical foundation of a complex adaptation to trauma. J Trauma Stress 2005;18:389–399.
- Ford JD: Disorders of extreme stress following war-zone military trauma: associated features of posttraumatic stress disorder or co-morbid but distinct syndromes? J Consult Clin Psychol 1999;67:3–12.
- Lanius RA, Vermetten E, Loewenstein RJ, Brand B, Schmahl C, Bremner JD, Spiegel D: Emotion modulation in PTSD: clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry 2010;167:640–647.
- Thomaes K, Dorrepaal E, Draijer N, de Ruiter MB, Balkom AJ, Smit JH, Veltman DJ: Reduced anterior cingulate and orbitofrontal volumes in child abuse related complex PTSD. J Clin Psychiatry 2010;71:1636–1644.
- Ford J, Stockton P, Kaltman S, Green BL: Disorders of extreme stress (DESNOS) symptoms are associated with type and severity of interpersonal trauma exposure in a sample of healthy young women. J Interpers Violence 2006;21:1399–1416.
- Bradley RB, Greene JMA, Russ EBA, Dutra L, Westen D: A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry 2005;162:214–227.
Foa EB, Keane TM, Friedman MJ (eds): Effective Treatments for PTSD. New York, Guilford Press, 2000.
Cloitre M: Effective psychotherapies for posttraumatic stress disorder: a review and critique. CNS Spectr 2009;14(suppl 1):32–43.
- Belaise C, Fava GA, Marks IM: Alternatives to debriefing and modifications to cognitive behavior therapy for posttraumatic stress disorder. Psychother Psychosom 2005;74:212–217.
- Resick PA, Galovski TE, O’Brien Uhlmansiek M, Scher CD, Clum GA, Young-Xu Y: A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. J Consult Clin Psychol 2008;76:243–258.
- McDonnagh A, Friedman M, McHugo G, Ford J, Sengupta A, Mueser K, Demment CC, Fournier D, Schnurr PP, Descamps M: Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. J Consult Clin Psychol 2005;73:515–524.
- Ford JD, Kidd P: Early childhood trauma and disorders of extreme stress as predictors of treatment outcome with chronic posttraumatic stress disorder. J Trauma Stress 1998;11:743–761.
- Van der Kolk BA, Spinazzola J, Blaustein ME, Hopper JW, Hopper EK, Korn DL, Simpson WB: A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long term maintenance. J Clin Psychiatry 2007;68:37–46.
- Cloitre M, Koenen KC, Cohen LR, Han H: Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to child abuse. J Consult Clin Psychol 2002;70:1067–1074.
- Schnyder U: Why new psychotherapies for posttraumatic stress disorder? Psychother Psychosom 2005;74:199–201.
- Peleikis DE, Dahl AA: A systematic review of empirical studies of psychotherapy with women who were sexually abused as children. Psychother Res 2005;15:304–315.
- Lubin H, Loris M, Burt J, Johnson DR: Efficacy of psychoeducational group therapy in reducing symptoms of PTSD among multiple traumatized women. Am J Psychiatry 1998;155:1172–1177.
- Resick PA, Nishith P, Griffin MG: How well does cognitive-behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial. CNS Spectrums 2003;8:340–355.
- Nishith P, Nixon RD, Resick PA: Resolution of trauma-related guilt following treatment of PTSD in female rape victims: a result of cognitive processing therapy targeting comorbid depression? J Affect Disord 2005;86:259–265.
- Chard KM: An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. J Consult Clin Psychol 2005;73:965–971.
- Zlotnick C, Shea TM, Rosen K, Simpson E, Mulrenin K, Begin A, Pearlstein T: An affect management group for woman with posttraumatic stress disorder and histories of childhood sexual abuse. J Trauma Stress 1997;10:425–436.
- Wolfsdorf CA, Zlotnick C: Affect management in group therapy for women with posttraumatic stress disorder and histories of childhood sexual abuse. J Clin Psychol 2001;57:169–181.
Dorrepaal E, Thomaes K, Draijer PJ: Stabilisation therapy as an answer to complex posttraumatic stress disorder. Diagnosis, treatment and research in women abused in childhood with a complex posttraumatic stress disorder. Tijdschr Psychiatr 2006;48:217–222.
- Dorrepaal E, Thomaes K, Smit JH, van Balkom AJLM, Dyck R, Veltman DJ, Draijer N: Stabilizing group treatment for complex posttraumatic stress disorder related to childhood abuse based on psychoeducation and cognitive behavioral therapy: a pilot study. Child Abuse Negl 2010;34:284–288.
Draijer N: Structured Trauma Interview. Amsterdam, Free University, Department of Psychiatry, 1989.
First MB, Spitzer RL, Gibbon M, Williams J: Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Washington, American Psychiatric Press, 1986.
Pfohl N, Blum N, Zimmerman M: Structured Interview for DSM-IV Personality (SIDP-IV). Washington, American Psychiatric Press, 1997.
- Steinberg M, Rounsaville B, Cicchetti DV: The Structured Clinical Interview for DSM-III-R dissociative disorders: preliminary report on a new diagnostic instrument. Am J Psychiatry 1990;147:76–82.
Zlotnick C, Simpson E, Begin A, Costello E: Affect-management group treatment for survivors of sexual abuse with posttraumatic stress disorder. Unpublished treatment manual. Providence, Brown University School of Medicine and Butler Hospital, 1995.
Dorrepaal E, Thomaes K, Draijer N: Vroeger en verder, stabilisatiecursus na misbruik of mishandeling. Handleiding. (Past and beyond, stabilization course after sexual and physical abuse. Treatment manual.) Amsterdam, Pearson, 2008.
Matsakis A: Posttraumatic Stress Disorder. A Complete Treatment Guide. Oakland, New Harbinger Publications, 1994.
Linehan MM: Cognitive-Behavioural Therapy for Borderline Personality Disorder: The Dialectics of Effective Treatment. New York, Guilford Press, 1993.
McKay M, Rogers PD, McKay J: When Anger Hurts. Oakland, New Harbinger Publications, 2003.
Meichenbaum D: A Clinical Handbook/Practical Therapist Manual for Assessing and Treating Adults with Posttraumatic Stress Disorder. Waterloo, Institute Press, 1994.
- Davidson JRT, Tharwani HM, Connor KM: Davidson Trauma Scale (DTS): normative scores in the general population and effect sizes in placebo-controlled SSRI trials. Depr Anxiety 2002;15:75–78.
- Arntz A, van den Hoorn M, Cornelis J, Verheul R, van den Bosch WM, de Bie AJ: Reliability and validity of the Borderline Personality Disorder Severity Index. J Pers Disord 2003;17:45–59.
- Bernstein EM, Putnam FW: Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986;174:727–735.
- Cohen J: A power primer. Psychol Bull 1992;112:155–159.
- Greeven A, van Balkom AJML, Visser S, Merkelbach JW, van Rood YR, van Dyck R, Van der Does AJW, Zitman FG, Spinhoven P: Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. Am J Psychiatry 2007;164:91–99.
- Jacobson NS, Truax P: Clinical significance: a statistical approach to defining meaningful change in psychotherapy. J Consult Clin Psychol 1991;59:12–19.
- Bisson JI, Ehlers A, Matthews R, Pilling S, Richards D, Turner S: Psychological treatments for chronic posttraumatic stress disorder. Systematic review and meta-analysis. Br J Psychiatry 2007;190:97–104.
- Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, Gøtzsche PC, Lang T, CONSORT Group (Consolidated Standards of Reporting Trials): The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001;134:663–696.
- Burns T, Catty J, Wright C: Deconstructing home-based care for mental illness: can one identify the effective ingredients? Acta Psychiatr Scand 2006;113(suppl 429):33–35.
- Mohr DC, Spring B, Freedland KE, Beckner V, Arean P, Hollon SD, Ockene J, Kaplan R: The selection and design of control conditions for randomized controlled trials of psychological interventions. Psychother Psychosom 2009;78:275–284.
- Rutherford BR, Sneed JR, Roose SP: Does study design influence outcome? The effects of placebo control and treatment duration in antidepressant trials. Psychother Psychosom 2009;78:172–181.
- Cloitre M, Stovall-McClough KC, Nooner K, Zorbas P, Cherry S, Jackson CL, Gan W, Petkova E: Treatment for PTSD related to childhood abuse: a randomized controlled trial. Am J Psychiatry 2010;167:915–924.
Korsten P: Draaiboek Sociaalvaardigheidstraining (manual for social skills training). Treatment manual, unpubl. Amsterdam, GGZ Buitenamstel, 2004.
Bouma E: Cursus voor vrouwen met incestervaring: een handleiding (course for women with incest experience: a manual). Utrecht, Riagg Westelyk Utrecht, 1999.
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