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      The “one size fits all” approach to trauma treatment: should we be satisfied?

      research-article
      Author(s): 1 , 2 , *
      Publication date (Electronic):
      Journal: European Journal of Psychotraumatology
      Publisher: Co-Action Publishing
      Keywords: PTSD, complex PTSD, patient preferences

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          Abstract

          There have been significant advances in the treatment of posttraumatic stress disorder in the last two decades. Further improvements in outcomes will be supported by recognition of the heterogeneity of symptoms in trauma populations and the development of treatments that promote the tailoring of interventions according to patient needs. Collaboration with patients regarding preferences about treatment structure, process, and outcomes is critical and will benefit the effectiveness and quality of treatments as well as the speed of their dissemination. New research methodologies are required that can incorporate important variables such as patient preferences and symptom heterogeneity without necessarily extending already lengthy study times or further complicating study designs. An example of alternative methodology is proposed.

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          636,120 Ways to Have Posttraumatic Stress Disorder.

          Isaac R Galatzer-Levy, Richard A Bryant (2013)
          In an attempt to capture the variety of symptoms that emerge following traumatic stress, the revision of posttraumatic stress disorder (PTSD) criteria in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has expanded to include additional symptom presentations. One consequence of this expansion is that it increases the amorphous nature of the classification. Using a binomial equation to elucidate possible symptom combinations, we demonstrate that the DSM-IV criteria listed for PTSD have a high level of symptom profile heterogeneity (79,794 combinations); the changes result in an eightfold expansion in the DSM-5, to 636,120 combinations. In this article, we use the example of PTSD to discuss the limitations of DSM-based diagnostic entities for classification in research by elucidating inherent flaws that are either specific artifacts from the history of the DSM or intrinsic to the underlying logic of the DSM's method of classification. We discuss new directions in research that can provide better information regarding both clinical and nonclinical behavioral heterogeneity in response to potentially traumatic and common stressful life events. These empirical alternatives to an a priori classification system hold promise for answering questions about why diversity occurs in response to stressors.
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            Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse.

            Marylene Cloitre, Karestan C. Koenen, Lisa Cohen … (2002)
            Fifty-eight women with posttraumatic stress disorder (PTSD) related to childhood abuse were randomly assigned to a 2-phase cognitive-behavioral treatment or a minimal attention wait list. Phase 1 of treatment included 8 weekly sessions of skills training in affect and interpersonal regulation; Phase 2 included 8 sessions of modified prolonged exposure. Compared with those on wait list, participants in active treatment showed significant improvement in affect regulation problems, interpersonal skills deficits, and PTSD symptoms. Gains were maintained at 3- and 9-month follow-up. Phase 1 therapeutic alliance and negative mood regulation skills predicted Phase 2 exposure success in reducing PTSD, suggesting the value of establishing a strong therapeutic relationship and emotion regulation skills before exposure work among chronic PTSD populations.
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              Treatment for PTSD related to childhood abuse: a randomized controlled trial.

              Patricia Jackson, K Chase Stovall-McClough, Eva Petkova … (2010)
              Posttraumatic stress disorder (PTSD) related to childhood abuse is associated with features of affect regulation and interpersonal disturbances that substantially contribute to impairment. Existing treatments do not address these problems or the difficulties they may pose in the exploration of trauma memories, an efficacious and frequently recommended approach to resolving PTSD. The authors evaluated the benefits and risks of a treatment combining an initial preparatory phase of skills training in affect and interpersonal regulation (STAIR) followed by exposure by comparing it against two control conditions: Supportive Counseling followed by Exposure (Support/Exposure) and skills training followed by Supportive Counseling (STAIR/Support). Participants were women with PTSD related to childhood abuse (N=104) who were randomly assigned to the STAIR/Exposure condition, Support/Exposure condition (exposure comparator), or STAIR/Support condition (skills comparator) and assessed at posttreatment, 3 months, and 6 months. The STAIR/Exposure group was more likely to achieve sustained and full PTSD remission relative to the exposure comparator, while the skills comparator condition fell in the middle (27% versus 13% versus 0%). STAIR/Exposure produced greater improvements in emotion regulation than the exposure comparator and greater improvements in interpersonal problems than both conditions. The STAIR/Exposure dropout rate was lower than the rate for the exposure comparator and similar to the rate for the skills comparator. There were significantly lower session-to-session PTSD symptoms during the exposure phase in the STAIR/Exposure condition than in the Support/Exposure condition. STAIR/Exposure was associated with fewer cases of PTSD worsening relative to both of the other two conditions. For a PTSD population with chronic and early-life trauma, a phase-based skills-to-exposure treatment was associated with greater benefits and fewer adverse effects than treatments that excluded either skills training or exposure.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur J Psychotraumatol
                Journal ID (iso-abbrev): Eur J Psychotraumatol
                Journal ID (publisher-id): EJPT
                Title: European Journal of Psychotraumatology
                Publisher: Co-Action Publishing
                ISSN (Print): 2000-8198
                ISSN (Electronic): 2000-8066
                Publication date (Electronic): 19 May 2015
                Publication date Collection: 2015
                Volume: 6
                Electronic Location Identifier: 10.3402/ejpt.v6.27344
                Affiliations
                [1 ]National Center for PTSD Division of Dissemination and Training, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
                [2 ]Department of Psychiatry and of Child and Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
                Author notes
                [* ]Correspondence to: Marylene Cloitre, National Center for PTSD Division of Dissemination and Training, Palo Alto VA Health Care, 795 Menlo Park, California 94025, USA, Email: marylene.cloitre@ 123456nyumc.org
                Article
                Publisher ID: 27344
                DOI: 10.3402/ejpt.v6.27344
                PMC ID: 4439409
                PubMed ID: 25994021
                SO-VID: 028c0602-aee2-4fca-a2bf-083c24dd9803
                Copyright © © 2015 Marylene Cloitre
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, 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.

                History
                Date received : 20 January 2015
                Date revision received : 15 April 2015
                Date accepted : 15 April 2015
                Categories
                Subject: Trauma and PTSD: Setting the Research Agenda

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: ptsd,complex ptsd,patient preferences
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: ptsd, complex ptsd, patient preferences

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