Academic journal article European Journal of Psychotraumatology

Sudden Losses and Sudden Gains during a DBT-PTSD Treatment for Posttraumatic Stress Disorder Following Childhood Sexual Abuse

Academic journal article European Journal of Psychotraumatology

Sudden Losses and Sudden Gains during a DBT-PTSD Treatment for Posttraumatic Stress Disorder Following Childhood Sexual Abuse

Article excerpt

CLINICAL RESEARCH ARTICLE

Sudden losses and sudden gains during a DBT-PTSD treatment for posttraumatic stress disorder following childhood sexual abuse

Antje Krüger1,2*, Thomas Ehring1, Kathlen Priebe2, Anne S. Dyer3, Regina Steil4 and Martin Bohus2

1Institute of Psychology, University of Münster, Münster, Germany; 2Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; 3Department of Psychology and Psychotherapy, School of Social Science, University of Mannheim, Mannheim, Germany; 4Department of Psychology and Sports Sciences, Institute of Psychology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany

Abstract

Background : Exposure-based treatment approaches are first-line interventions for patients suffering from posttraumatic stress disorder (PTSD). However, the dissemination of exposure-based treatments for PTSD is challenging, as a large proportion of clinicians report being concerned about symptoms worsening as a result of this type of intervention and are therefore reluctant to offer it to patients with PTSD. However, there is only little empirical evidence to date on the pattern of symptom worsening during exposure-based treatment for PTSD.

Objective : The goal of the present study was to explore the frequency of sudden losses and sudden gains in the course of an exposure-based treatment programme for female patients suffering from PTSD related to childhood sexual abuse who also show severe comorbidity. In addition, the relationship between sudden changes and treatment outcome was examined.

Methods : Female participants (N =74) were randomised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list. The pattern of symptom change was assessed via weekly assessments using the Posttraumatic Diagnostic Scale (PDS). Sudden changes were computed as suggested by the literature on sudden gains.

Results : During treatment, only one participant (3%) experienced a sudden loss, whereas 25% of participants experienced sudden gains. In the waiting condition, 8% of the participants experienced sudden losses and 5% experienced sudden gains during the same time period. No symptom worsening was observed in response to exposure sessions. However, sudden gains occurred during exposure and non-exposure treatment weeks. Patients with sudden gains showed better treatment outcome in the post-treatment and follow-up assessments.

Conclusions : Exposure-based treatment did not lead to PTSD symptom worsening in the study sample. Results show that sudden gains occur frequently during PTSD treatment and have a prognostic value for treatment outcome.

Keywords: Posttraumatic stress disorder; symptom worsening; sudden changes; exposure-based treatment

*Correspondence to: Antje Krüger, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, J 5, 68159 Mannheim, Germany, Email: antje.krueger@uni-muenster.de

For the abstract or full text in other languages, please see Supplementary files under Article Tools online

Received: 27 March 2014; Revised: 22 July 2014; Accepted: 18 August 2014; Published: 17 September 2014

European Journal of Psychotraumatology 2014. © 2014 Antje Krüger et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 Unported (CC BY 4.0) License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. …

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