Background:
Complex post-traumatic stress disorder (CPTSD) describes chronic disturbances in self-organization (i.e. affect dysregulation; negative self-concept; severe difficulties in relationships) which are frequently observed in survivors of prolonged, repeated or multiple traumatic stressors. So far, evidence of psychodynamic treatment approaches for CPTSD is scarce.
Methods:
In this single-centre observational pilot study, symptom change during a 6-week psychodynamic inpatient treatment in a multimodal psychosomatic rehabilitation centre was evaluated using repeated measures analyses of variance (ANOVAs). Patients completed questionnaires on PTSD and CPTSD symptoms (ITQ), anxiety, depression and somatization (BSI-18), functional impairment (WHODAS) and epistemic trust, mistrust and credulity (ETMCQ) before (
T1
) and at the end of treatment (
T2
). A hierarchical linear regression analysis was calculated to identify factors associated with improved CPTSD symptoms.
Results:
A total of
n
= 50 patients with CPTSD were included in the study, of whom
n
= 40 (80%) completed treatment. Patients reported a significant reduction of CPTSD symptoms during treatment with a large effect size (−3.9 points;
p
< .001;
η
2
= .36), as well as a significant reduction of psychological distress (
p
< .001;
η
2
= .55) and functional impairment (
p
< .001;
η
2
= .59). At the end of treatment, 41.0% of patients no longer fulfilled the diagnostic criteria for CPTSD. Changes in epistemic stance included improved epistemic trust (
β
= –.34,
p
= .026) and decreased epistemic credulity (
β
= .37,
p
= .017), which together with lower age (
β
= .43,
p
= .012) and lower depression levels at baseline (
β
= .35,
p
= .054) were significantly associated with baseline adjusted mean change of CPTSD symptoms during therapy and explained 48% of its variance.
Discussion:
In our study, patients reported a significant reduction of CPTSD symptoms and comorbid symptoms during a multimodal psychodynamic inpatient rehabilitation treatment. Improved epistemic trust may facilitate the establishment of a trusting therapeutic relationship, thus fostering an environment of openness for knowledge transfer (i.e. social learning) and the exploration of diverse viewpoints and perspectives in the therapeutic process.