Fischer Anne, Rosner Rita, Renneberg Babette, Steil Regina
Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany.
Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Germany.
Borderline Personal Disord Emot Dysregul. 2022 Jan 3;9(1):1. doi: 10.1186/s40479-021-00172-8.
Multiple traumata such as child sexual and/or physical abuse often result in complex psychopathologies and a range of associated dysfunctional behaviors. Although evidence-based interventions exist, some therapists are concerned that trauma-focused psychotherapy with exposure-based elements may lead to the deterioration of associated dysfunctional behaviors in adolescents and young adults. Therefore, we examined the course of suicidal ideation, self-injury, aggressive behavior and substance use in a group of abuse-related posttraumatic stress disorder (PTSD) patients during phase-based, trauma-focused PTSD treatment.
Daily assessments from a randomized controlled trial (RCT) of Developmentally adapted Cognitive Processing Therapy (D-CPT) were analyzed to test for differences in the stated dysfunctional behaviors between the four treatment phases. We conducted multilevel modeling and repeated measure ANOVAs.
We did not find any significant differences between the treatment phases concerning the stated dysfunctional behaviors, either at the level of urge or at the level of actual actions. On the contrary, in some primary outcomes (self-injury, aggressive behavior), as well as secondary outcomes (distress caused by trauma, joy), we observed significant improvements.
Overall, during D-CPT, adolescents and young adults showed no deterioration in dysfunctional behaviors, while even showing improvements in some, suggesting that trauma-focused treatment preceded by skills building was not deleterious to this population. Hence, the dissemination of effective interventions such as D-CPT should be fostered, whilst the concerns of the therapists regarding exposure-based components need to be addressed during appropriate training. Nevertheless, further studies with momentary assessment, extended measurement methods, a control group and larger sample sizes are needed to confirm our preliminary findings.
The trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787, 18 March 2013, https://www.drks.de/DRKS00004787 .
诸如儿童性虐待和/或身体虐待等多重创伤往往会导致复杂的精神病理学问题以及一系列相关的功能失调行为。尽管存在循证干预措施，但一些治疗师担心，包含暴露环节的创伤聚焦心理治疗可能会导致青少年和年轻人的相关功能失调行为恶化。因此，我们研究了一组与虐待相关的创伤后应激障碍（PTSD）患者在基于阶段的、创伤聚焦的PTSD治疗期间自杀意念、自我伤害、攻击行为和物质使用的变化过程。
对一项发育适应性认知加工疗法（D-CPT）随机对照试验（RCT）的每日评估进行分析，以测试四个治疗阶段之间所述功能失调行为的差异。我们进行了多层次建模和重复测量方差分析。
在冲动水平或实际行为水平上，我们未发现各治疗阶段之间在所述功能失调行为方面存在任何显著差异。相反，在一些主要结局（自我伤害、攻击行为）以及次要结局（创伤引起的痛苦、愉悦）方面，我们观察到了显著改善。
总体而言，在D-CPT治疗期间，青少年和年轻人的功能失调行为没有恶化，甚至在某些方面有所改善，这表明在技能培养之前进行的创伤聚焦治疗对该人群无害。因此，应促进D-CPT等有效干预措施的推广，同时在适当培训期间应解决治疗师对基于暴露环节的担忧。然而，需要进一步开展具有即时评估、扩展测量方法、对照组和更大样本量的研究来证实我们的初步发现。
该试验于2013年3月18日在德国临床试验注册中心（GCTR）注册，注册号为DRKS00004787，网址为https://www.drks.de/DRKS0000478
