Stabilizing group treatment for childhood-abuse related PTSD: a randomized controlled trial

Abstract

Background : Patients with PTSD related to childhood-abuse often experience additional problems such as emotional dysregulation and interpersonal difficulties. Psychotherapy focused on stabilization of symptoms, emotion-regulation, and skills training has been suggested as a treatment for this patient population, either as preparation for further treatment or as a stand-alone intervention. Objective : The present study tests the efficacy of treatment using a group-protocol for stabilizing treatment delivered adjunct with conventional individual therapy. Methods : In a delayed-treatment design with switching replication, a clinically representative sample of 89 patients with PTSD and histories of childhood abuse were randomly assigned to either 20-week stabilizing group treatment or a corresponding waiting-period, both adjunct with conventional individual therapy. After the waiting-period, patients in the control condition were offered group treatment. The primary outcome was psychosocial functioning, measured with interview – assessed Global Assessment of Functioning (GAF), while secondary outcome was self-reported PTSD symptoms. These were measured before treatment, after treatment and at 6 months follow up. The trial was preregistered at Clinical Trials (NCT02450617). Results : We found large within-group effect sizes in both conditions on GAF and moderate effects on PTSD symptoms. Linear mixed-models did not indicate significant differences in treatment trajectories between conditions. Conclusion : Stabilizing group treatment focused on emotional-regulation and skills-training does not improve outcomes beyond individual-treatment alone, and should not be recommended as first-line treatment for this patient-group

The Effectiveness of Trauma-Focused Interventions in Prison Settings: A Systematic Review and Meta-Analysis

“…Such findings are in line with evidence from nonoffending populations, which has found individual trauma-focused therapies (such as TF-CBT) to be the most effective (Bisson et al, 2007). Similarly, some studies have found minimal or no significant treatment differences between stabilizing group treatment when compared to individual TAU (Baekkelund et al, 2021; Dorrepaal et al, 2012). In one recent RCT, the stabilization phase was not found to improve outcomes, or difficulties in emotion regulation, when compared to exposure therapy alone (Oprel et al, 2021).…”

Ten misconceptions about trauma-focused CBT for PTSD

“… Bohus et al, 2020 ; Cloitre et al, 2002 ). However, there is limited evidence that phase-based approaches are superior to interventions that primarily focus on trauma processing, with critics arguing that they are an unnecessary use of clinical time, neither improving outcomes nor reducing drop-out ( Baekkalund et al, 2021 ; de Jongh et al, 2016 ; Oprel et al, 2021 ). There is also great variability in what constitutes stabilisation, what interventions are offered and whether this is provided individually or in a group.…”

Implementation of evidence-based treatment for PTSD in Norway: clinical outcomes and impact of probable complex PTSD

“…Many clinicians remain concerned that the positive outcomes of EBTs for PTSD observed in clinical studies are not generalizable to ordinary clinical practice (Riggs et al, 2020 ), despite effectiveness research showing promising results (Eftekhari et al, 2013 ; Ehlers et al, 2013 ). This concern is especially related to patients with more complex presentations and CPTSD since the safety and effectiveness of trauma-focused treatments for CPTSD has been questioned (Bækkelund et al, 2021 ; Cloitre et al, 2010 ). It is argued that the problems with emotion regulation can interfere with the patients’ ability to tolerate trauma processing and that the heterogeneity of symptoms is not sufficiently addressed by standard EBTs (Karatzias & Cloitre, 2019 ).…”