CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS

According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a “stabilization phase.” This phase, focusing on teaching self‐regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma‐focused treatment. The purpose of this paper is to critically evaluate the research underlying these treatment guidelines for cPTSD, and to specifically address the question as to whether a phase‐based approach is needed. As reviewed in this paper, the research supporting the need for phase‐based treatment for individuals with cPTSD is methodologically limited. Further, there is no rigorous research to support the views that: (1) a phase‐based approach is necessary for positive treatment outcomes for adults with cPTSD, (2) front‐line trauma‐focused treatments have unacceptable risks or that adults with cPTSD do not respond to them, and (3) adults with cPTSD profit significantly more from trauma‐focused treatments when preceded by a stabilization phase. The current treatment guidelines for cPTSD may therefore be too conservative, risking that patients are denied or delayed in receiving conventional evidence‐based treatments from which they might profit.

[1]  B. Rothbaum,et al.  Primum Non Nocere (First Do No Harm): Symptom Worsening and Improvement in Female Assault Victims After Prolonged Exposure for PTSD. , 2017, Focus.

[2]  P. Schnurr,et al.  The influence of the dissociative subtype of posttraumatic stress disorder on treatment efficacy in female veterans and active duty service members. , 2016, Journal of consulting and clinical psychology.

[3]  B. Shiner,et al.  A Meta-Analysis of Depressive Symptom Outcomes in Randomized, Controlled Trials for PTSD , 2015, The Journal of nervous and mental disease.

[4]  S. Silverstein,et al.  Evaluation of cognitive restructuring for post-traumatic stress disorder in people with severe mental illness. , 2015, The British journal of psychiatry : the journal of mental science.

[5]  A. Wagner,et al.  Examining the Evidence for Complex Posttraumatic Stress Disorder as a Clinical Diagnosis , 2015 .

[6]  Melanie S. Harned,et al.  Changes in Comorbid Conditions After Prolonged Exposure for PTSD: a Literature Review , 2015, Current Psychiatry Reports.

[7]  H. Resnick,et al.  ICD-11 Complex PTSD in US National and Veteran Samples: Prevalence and Structural Associations with PTSD. , 2015, Clinical psychological science : a journal of the Association for Psychological Science.

[8]  M. Gaag,et al.  Prolonged Exposure vs Eye Movement Desensitization and Reprocessing vs Waiting List for Posttraumatic Stress Disorder in Patients With a Psychotic Disorder: A Randomized Clinical Trial , 2015 .

[9]  J. Markowitz,et al.  Is Exposure Necessary? A Randomized Clinical Trial of Interpersonal Psychotherapy for PTSD. , 2015, The American journal of psychiatry.

[10]  Michael K Suvak,et al.  The impact of childhood abuse among women with assault-related PTSD receiving short-term cognitive-behavioral therapy. , 2014, Journal of traumatic stress.

[11]  L. Zoellner,et al.  Changes in emotion regulation in adults with and without a history of childhood abuse following posttraumatic stress disorder treatment. , 2014, Journal of consulting and clinical psychology.

[12]  Kristen H Walter,et al.  Residential PTSD Treatment for Female Veterans With Military Sexual Trauma , 2014, Journal of interpersonal violence.

[13]  J. Gradus,et al.  TREATMENT OF POSTTRAUMATIC STRESS DISORDER REDUCES SUICIDAL IDEATION , 2013, Depression and anxiety.

[14]  C. Brewin,et al.  Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis , 2013, European journal of psychotraumatology.

[15]  Fridtjof W. Nussbeck,et al.  Cognitive Change Predicts Symptom Reduction With Cognitive Therapy for Posttraumatic Stress Disorder , 2012, Journal of consulting and clinical psychology.

[16]  K. Mills,et al.  Examining potential contraindications for prolonged exposure therapy for PTSD , 2012, European journal of psychotraumatology.

[17]  Michael K Suvak,et al.  A critical evaluation of the complex PTSD literature: implications for DSM-5. , 2012, Journal of traumatic stress.

[18]  J. Herman.  CPTSD is a distinct entity: comment on Resick et al. (2012). , 2012, Journal of traumatic stress.

[19]  J. Ford,et al.  A randomized clinical trial comparing affect regulation and social problem-solving psychotherapies for mothers with victimization-related PTSD. , 2011, Behavior therapy.

[20]  B. Green,et al.  Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices. , 2011, Journal of traumatic stress.

[21]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[22]  H. Kraemer,et al.  A comparison of trauma-focused and present-focused group therapy for survivors of childhood sexual abuse: A randomized controlled trial. , 2011 .

[23]  M. Bohus,et al.  Dialectical behavior therapy for posttraumatic stress disorder related to childhood sexual abuse: a pilot study of an intensive residential treatment program. , 2011, Journal of traumatic stress.

[24]  E. Petkova,et al.  Treatment for PTSD related to childhood abuse: a randomized controlled trial. , 2010, The American journal of psychiatry.

[25]  B. Olatunji,et al.  A meta-analysis of the influence of comorbidity on treatment outcome in the anxiety disorders. , 2010, Clinical psychology review.

[26]  Mark B. Powers,et al.  A meta-analytic review of prolonged exposure for posttraumatic stress disorder. , 2010, Clinical psychology review.

[27]  L. Hendriks,et al.  When do trauma experts choose exposure therapy for PTSD patients? A controlled study of therapist and patient factors. , 2010, Behaviour research and therapy.

[28]  Stabilizing group treatment for Complex Posttraumatic Stress Disorder related to childhood abuse based on psycho-education and cognitive behavioral therapy: a pilot study. , 2010, Child abuse & neglect.

[29]  M. Hagenaars,et al.  The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD. , 2010, Behaviour research and therapy.

[30]  U. Schnyder,et al.  Best practices in psychotherapy for adults. , 2009 .

[31]  B. Kolk,et al.  Treating complex traumatic stress disorders: An evidence-based guide. , 2009 .

[32]  T. Galovski,et al.  A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. , 2008, Journal of consulting and clinical psychology.

[33]  Harriet J. Rosenberg,et al.  A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness. , 2008, Journal of consulting and clinical psychology.

[34]  D. L. Korn,et al.  A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance. , 2007, The Journal of clinical psychiatry.

[35]  E. Foa,et al.  Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. , 2005, Journal of consulting and clinical psychology.

[36]  K. Chard,et al.  An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. , 2005, Journal of consulting and clinical psychology.

[37]  P. Schnurr,et al.  Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. , 2005, Journal of consulting and clinical psychology.

[38]  N. Tarrier,et al.  Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? , 2004, Behaviour research and therapy.

[39]  C. Becker,et al.  A survey of psychologists' attitudes towards and utilization of exposure therapy for PTSD. , 2004, Behaviour research and therapy.

[40]  R. Bradley,et al.  Group Therapy for Incarcerated Women Who Experienced Interpersonal Violence: A Pilot Study , 2003, Journal of traumatic stress.

[41]  P. Nishith,et al.  How Well Does Cognitive-Behavioral Therapy Treat Symptoms of Complex PTSD? An Examination of Child Sexual Abuse Survivors Within A Clinical Trial , 2003, CNS Spectrums.

[42]  Marylene Cloitre,et al.  Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. , 2002, Journal of consulting and clinical psychology.

[43]  E. Foa,et al.  Does imaginal exposure exacerbate PTSD symptoms? , 2002, Journal of consulting and clinical psychology.

[44]  A. Arntz,et al.  Prolonged exposure in patients with chronic PTSD: predictors of treatment outcome and dropout. , 2002, Behaviour research and therapy.

[45]  C. Zlotnick,et al.  Affect management in group therapy for women with posttraumatic stress disorder and histories of childhood sexual abuse. , 2001, Journal of clinical psychology.

[46]  A. Rubin,et al.  The effectiveness of EMDR with adult female survivors of childhood sexual abuse , 1999 .

[47]  C. Zlotnick,et al.  An affect-management group for women with posttraumatic stress disorder and histories of childhood sexual abuse. , 1997, Journal of traumatic stress.