Lecture 11: Post-traumatic stress Flashcards
How is PTSD diagnosed?
Divided into PTSD and complex PTSD, ICD recognizes a more basic form of PTSD with its core features and complex form of PTSD which has disturbances in self-organization and core features. DSO: emotion regulation issues, interpersonal problems and negative self-concept (but unclear whether CPTSD is related to different patients or reflects more severe PTSD)
What does the PTSD criteria aim to define?
Patients who have been victims of severe, repeated and/or early traumatization. All of which interferes with emotional and cognitive development which can affect self-organization skills.
Why should PTSD and CPTSD be separated?
Can be less effective in patients with CPTSD as DSO symptoms can interfere with tolerating the distress of trauma-focussed treatment-> multi-modular treatment needed to target all symptoms. Such as skills training in affective and interpersonal regulation followed by prolonged exposure. Mixed results about whether they benefit from trauma-focussed treatment
What is the aim of this study?
Aim is to investigate whether CPTSD predicts and/or moderates treatment outcomes in patients with PTSD related to childhood abuse. They looked at CPTSD diagnosis and DSO symptom severity
What is the method of this study?
Sample :moderately severe PTSD relating to multiple traumas like childhood sexual/physical abuse
Assessment: PTSD symptoms assessed at baseline, after 4 weeks, after 8 weeks, post-treatment at 16 weeks, 6 month follow-up and 12 month follow-up
Treatment: PE (psychoeducation about PTSD, imaginal exposure, exposure in vivo) iPE, STAIR (psychoeducation and emotion regulation and interpersonal skills training) + PE
Measures: clinician-rated PTSD symptom severity (CAPS-5), International Trauma Questionnaire
What did results find?
- patients with CPTSD reported more childhood physical abuse, met criteria for depression, psychotic disorder, personality disorder
- those with CPTSD had a higher dropout rate than those without CPTSD, more severe DSO symptoms were not related to higher drop-out rates
- CPTSD related to more severe PTSD symptoms at baseline
- CPTSD not a significant predictor of outcome during treatment and did not moderate the outcome, but DSO severity was a significant moderator of outcome during treatment
- CPTSD did not benefit significantly less than those without CPTSD
What did the conclusion argue?
CPTSD is a more severe form of PTSD, or PTSD with more comorbidities. Symptoms were still alleviated, but those with CPTSD need more treatment sessions to experience same functioning at the end. So those with CPTSD benefit from exposure therapies as patients with non-complex PTSD
How does DSO affect PE effectiveness?
Other studies suggest that DSO could negatively influence the effectiveness of PE but these results indicate that DSO could positively influence the effectiveness of PE
Limitations (don’t need to know)
- patients included based on DSM-5 PTSD criteria
- all had a current diagnosis based on childhood abuse and half on CPTSD, higher than normal samples
- self-report version of ITQ used
What is prolonged exposure (PE)?
Form of cognitive behavioural therapy during which patients process the traumatic memories and learn that memories and trauma-related cues are safe and that they can cope with them. PE involves psychoeducation about PTSD, imaginal exposure and exposure in vivo. Many clinicians worry about whether it can be used for comorbid PTSD patients, but research suggests otherwise/
Prevalence of comorbid disorders in patients with PTSD
Depressive disorders: around 49% lifetime prevalence
Anxiety disorders: about 59% for all anxiety disorders
OCD: range from 30-41%
Substance use disorders: up to 49%
Psychotic disorders: lots of variability 15%-64%, but 2.8% for full-blown psychotic disorder
Eating disorders: AN = 10.4%, BM = 22.4%
Personality disorders: 35% had at least one, paranoid (26%), avoidant (23%), BPD (22%)
What has research found about treatment of comorbid disorders?
- Trauma-focussed behavioural therapy effective for PTSD and comorbid depression, reduction in PTSD led to reduced depressive symptoms.
- PE and TF-CBT were effective for PTSD and comorbid anxiety.
- TFT and OCD not been investigated
- TFT most effective for PTSD but SUD interventions more effective for SUD
- TFT reduced positive symptoms after treatment but not maintained
- CBT effective for PTSD but less so for eating disorders
-those with PD and PTSD might benefit less from TFT, PE and EMDR found to be effective for BPD and PTSD (focus on self-report measures due to less power for clinician-assessed diagnoses)
What is the aim of the study?
To investigate the effects of PE on clinician-assessed comorbid disorders for those with childhood-abuse related PTSD, comparing the effects of PE, intensified PE and PE preceded by STAIR
What is the method of the study?
Sample: at least moderate severity of PTSD symptoms and one specific memory of the traumatic event, childhood sexual/physical abuse. No SSI and severe suicidal behaviour, or severe addictions
Procedure: Received either PE, iPE or STAIR + PE (first half focussed on emotion regulation and interpersonal skills, then PE)
Measures: mini-international neuropsychiatric interview to assess comorbid disorders, SCID used to assess personality disorders
What did results find?
- less participants met the criteria for depressive, anxiety, substance and personality disorders btw baseline and post-treatment
- MDD, agoraphobia, panic disorder, alcohol use disorder, avoidant personality disorder decreased from baseline to post-treatment. No changes found during follow-up
- no changes for OCD, psychotic disorders, eating disorders
