A research programme to evaluate DBTPTSD, a modular treatment approach for Complex PTSD after childhood abuse
Date
2019
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Borderline personality disorder and emotion dysregulation
Abstract
Background: Posttraumatic stress disorder (PTSD) after childhood abuse (CA) is often related to severe co-occurring
psychopathology, such as symptoms of borderline personality disorder (BPD). The ICD-11 has included Complex PTSD
as a new diagnosis, which is defined by PTSD symptoms plus disturbances in emotion regulation, self-concept, and
interpersonal relationships. Unfortunately, the empirical database on psychosocial treatments for survivors of CA is
quite limited. Furthermore, the few existing studies often have either excluded subjects with self-harm behaviour and
suicidal ideation — which is common behaviour in subjects suffering from Complex PTSD. Thus, researchers are still
trying to identify efficacious treatment programmes for this group of patients.
We have designed DBT-PTSD to meet the specific needs of patients with Complex PTSD. The treatment programme is
based on the rules and principles of dialectical behavioural therapy (DBT), and adds interventions derived from cognitive
behavioural therapy, acceptance and commitment therapy and compassion-focused therapy. DBT-PTSD can be provided
as a comprehensive residential programme or as an outpatient programme. The effects of the residential programme
were evaluated in a randomised controlled trial. Data revealed significant reduction of posttraumatic symptoms, with
large between-group effect sizes when compared to a treatment-as-usual wait list condition (Cohen’s d = 1.5).
The first aim of this project on hand is to evaluate the efficacy of the outpatient DBT-PTSD programme. The second aim is
to identify the major therapeutic variables mediating treatment efficacy. The third aim is to study neural mechanisms and
treatment sensitivity of two frequent sequelae of PTSD after CA: intrusions and dissociation.
Methods: To address these questions, we include female patients who experienced CA and who fulfil DSM-5 criteria for
PTSD plus borderline features, including criteria for severe emotion dysregulation. The study is funded by the German
Federal Ministry of Education and Research, and started in 2014. Participants are randomised to outpatient psychotherapy
with either DBT-PTSD or Cognitive Processing Therapy. Formal power analysis revealed a minimum of 180 patients to be
recruited. The primary outcome is the change on the Clinician-Administered PTSD Scale for DSM-5.
Discussion: The expected results will be a major step forward in establishing empirically supported psychological
treatments for survivors of CA suffering from Complex PTSD
Description
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Keywords
International Resources, Germany, PTSD, Posttraumatic stress disorder, child abuse, psychopathology, research
Citation
Bohus, M., Schmahl, C., Fydrich, T., Steil, R., Müller-Engelmann, M., Herzog, J., ... & Priebe, K. (2019). A research programme to evaluate DBT-PTSD, a modular treatment approach for Complex PTSD after childhood abuse. Borderline personality disorder and emotion dysregulation, 6(1), 7.