“Currently, treatment for [PTSD associated with childhood abuse] mostly relies on established treatments that were developed for survivors of adult-onset trauma,” wrote Martin Bohus, M.D., Ph.D., of Heidelberg University in Germany and colleagues. “Most treatment guidelines recommend prolonged exposure, cognitive processing therapy [CPT], or trauma-focused cognitive behavioral therapy, but there is debate on whether these treatments are sufficient for [these] patients.”
From January 2014 to October 2016, women who sought treatment were recruited from three sites in Germany and randomly assigned to receive DBT-PTSD or CPT. The participants were aged 18 to 65, were diagnosed with PTSD following sexual or physical abuse before age 18, and met three or more criteria for borderline personality disorder. Forty-eight percent of the participants also met the threshold for a diagnosis of borderline personality disorder.
DBT-PTSD is based on the principles of DBT, which was originally developed to treat borderline personality disorder by giving patients skills to manage painful emotions and regulate their emotions. DBT-PTSD includes supplemental trauma-focused cognitive-behavioral interventions. CPT is an established, trauma-focused therapy that challenges patients to face dysfunctional emotions related to trauma.
The 193 participants received up to 45 weekly individual sessions of DBT-PTSD or CPT within one year, plus three additional sessions in the three following months. Both treatments included individual therapy, plus homework and telephone consultations as needed. Participants were assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) before the start of therapy and again after three, six, nine, 12, and 15 months.
Although the women in both groups showed significant improvements in CAPS-5 scores over the course of the study, the improvements were more pronounced in the group receiving DBT-PTSD, the authors noted. “The same results were seen for other aspects of psychopathology closely associated with a history of [childhood abuse], such as dissociation, self-harm, and high-risk behaviors,” they wrote. “[P]articipants in the DBT-PTSD group were more likely to achieve symptomatic remission, reliable improvement, and reliable recovery and were less likely to drop out of treatment,” the authors wrote.
“The study shows that even severe forms of [childhood abuse]-associated PTSD that include multiple co-occurring mental disorders and emotion dysregulation can be treated efficaciously,” the authors concluded. “Future studies should strive for a better definition of patient groups that might profit from current therapies.”
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