Stationäre Therapie der komplexen PTBS in Folge körperlicher oder sexualisierter Gewalt in der Kindheit: Wirksamkeit und Prädiktoren des Behandlungsverlaufs

Kratzer, Leonhard; Heinz, Peter; Schennach, Rebecca; Schiepek, Günter; Padberg, Frank; Jobst, Andrea

doi:10.1055/a-0591-3962

Cited by 14 publications

(6 citation statements)

References 50 publications

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“…The 21 included studies contained a total of 1714 patients from 9 RCTs and 12 uncontrolled clinical trials or treatment cohort studies. 8 , 9 , 13 , 25 – 42 Table 1 shows the study characteristics and potential moderator variables (see supplementary Table 2 for more study details).…”

Section: Resultsmentioning

confidence: 99%

“…4 Several studies have shown that PTSD is associated with high levels of dissociation, both compared with non-clinical samples and patients with other psychiatric disorders. 5 – 8 Additionally, several studies have shown that dissociation is strongly related to the other PTSD symptoms and that these clusters wax and wane together, also in response to treatments. 9 – 13…”

Section: Introductionmentioning

confidence: 99%

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Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis

et al. 2020

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Background Many patients with post-traumatic stress disorder (PTSD) experience dissociative symptoms. The question of whether these dissociative symptoms negatively influence the effectiveness of psychotherapy for PTSD is unresolved. Aims To determine the influence of dissociative symptoms on psychotherapy outcome in PTSD. Method We conducted a systematic search in Cochrane, Embase, PILOTS, PsycINFO, PubMed and Web of Science for relevant clinical trials. A random-effects meta-analysis examined the impact of dissociation on psychotherapy outcome in PTSD (pre-registered at Prospero CRD42018086575). Results Twenty-one trials (of which nine were randomised controlled trials) with 1714 patients were included. Pre-treatment dissociation was not related to treatment effectiveness in patients with PTSD (Pearson's correlation coefficient 0.04, 95% CI −0.04 to 0.13). Between-study heterogeneity was high but was not explained by moderators such as trauma focus of the psychotherapy or risk of bias score. There was no indication for publication bias. Conclusions We found no evidence that dissociation moderates the effectiveness of psychotherapy for PTSD. The quality of some of the included studies was relatively low, emphasising the need for high-quality clinical trials in patients with PTSD. The results suggest that pre-treatment dissociation does not determine psychotherapy outcome in PTSD.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis

et al. 2020

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“…A typical presentation following child abuse includes co-occurrence of PTSD, somatization, and dissociation [ 10 ]. Co-occurrence of these conditions can sometimes lead to more treatment-resistant symptomatology [ 11 , 12 ]. In the present study, we aimed to identify direct connections between PTSD, somatic symptoms, and dissociation to gain deeper insight into the pathological processes underlying their comorbidity.…”

Section: Introductionmentioning

confidence: 99%

Co-occurrence of severe PTSD, somatic symptoms and dissociation in a large sample of childhood trauma inpatients: a network analysis

Kratzer

Knefel

Haselgruber

et al. 2021

Eur Arch Psychiatry Clin Neurosci

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Co-occurrence of mental disorders including severe PTSD, somatic symptoms, and dissociation in the aftermath of trauma is common and sometimes associated with poor treatment outcomes. However, the interrelationships between these conditions at symptom level are not well understood. In the present study, we aimed to explore direct connections between PTSD, somatic symptoms, and dissociation to gain a deeper insight into the pathological processes underlying their comorbidity that can inform future treatment plans. In a sample of 655 adult inpatients with a diagnosis of severe PTSD following childhood abuse (85.6% female; mean age = 47.57), we assessed symptoms of PTSD, somatization, and dissociation. We analyzed the comorbidity structure using a partial correlation network with regularization. Mostly positive associations between symptoms characterized the network structure. Muscle or joint pain was among the most central symptoms. Physiological reactivation was central in the full network and together with concentrations problems acted as bridge between symptoms of PTSD and somatic symptoms. Headaches connected somatic symptoms with others and derealization connected dissociative symptoms with others in the network. Exposure to traumatic events has a severe and detrimental effect on mental and physical health and these consequences worsen each other trans-diagnostically on a symptom level. Strong connections between physiological reactivation and pain with other symptoms could inform treatment target prioritization. We recommend a dynamic, modular approach to treatment that should combine evidence-based interventions for PTSD and comorbid conditions which is informed by symptom prominence, readiness to address these symptoms and preference.

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“…Selbst bei leitliniengerechter stationärer Psychotherapie bei Patienten mit komplexer PTBS finden sich Nonresponse-Raten von ca. 50 % [5]. Diese Ergebnisse können nicht zufriedenstellen.…”

Section: Introductionunclassified

Digitale Medien in der Psychotherapie – Neue Ansätze und Perspektiven in der Behandlung von Traumafolgestörungen

Kessler

Dangellia

Herpertz

et al. 2020

Psychother Psychosom Med Psychol

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ZusammenfassungDieser Artikel gibt einen Einblick in neue Ansätze und Perspektiven bei der Behandlung von Traumafolgestörungen unter Einsatz digitaler Medien. Ausgangslage ist die unzureichende flächendeckende Versorgung bei Traumafolgestörungen und die Suche nach neuen, spezifischen Behandlungsstrategien. Zunächst werden exemplarisch digitale Ansätze vorgestellt, die bekannte analoge Therapien zur Grundlage haben und zu deren Verbreitung und Ökonomisierung beitragen. Der Fokus liegt jedoch auf digitalen Therapien, die neue – z. B. aus der Kognitionswissenschaft entwickelte – Ansätze zur gezielten Arbeit an Symptomen erstmals nach deren Entwicklung in Grundlagenstudien auch an klinischen Populationen anwenden. Beispiele hierfür sind visuospatiale Interventionen zur Reduktion von Intrusionen und Trainings zur Verbesserung der Interferenzkontrolle (um traumabezogene Stimuli zu kontrollieren) oder zur Veränderung automatischer dysfunktionaler Kognitionen. Diese werden mit dem theoretischen Hintergrund und ersten (z.T. klinischen) Studien näher dargestellt, welche bereits vielversprechende Ergebnisse bezüglich Akzeptanz, Anwendbarkeit und Effektivität zeigen.

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Stationäre Therapie der komplexen PTBS in Folge körperlicher oder sexualisierter Gewalt in der Kindheit: Wirksamkeit und Prädiktoren des Behandlungsverlaufs

Cited by 14 publications

References 50 publications

Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis

Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis

Co-occurrence of severe PTSD, somatic symptoms and dissociation in a large sample of childhood trauma inpatients: a network analysis

Digitale Medien in der Psychotherapie – Neue Ansätze und Perspektiven in der Behandlung von Traumafolgestörungen

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