Suicidal ideation, self-injury, aggressive behavior and substance use during intensive trauma-focused treatment with exposure-based components in adolescent and young adult PTSD patients

Anne Fischer,Regina Steil,Rita Rosner,Babette Renneberg

doi:10.1186/s40479-021-00172-8

Abstract

BackgroundMultiple traumata such as child sexual and/or physical abuse often result in complex psychopathologies and a range of associated dysfunctional behaviors. Although evidence-based interventions exist, some therapists are concerned that trauma-focused psychotherapy with exposure-based elements may lead to the deterioration of associated dysfunctional behaviors in adolescents and young adults. Therefore, we examined the course of suicidal ideation, self-injury, aggressive behavior and substance use in a group of abuse-related posttraumatic stress disorder (PTSD) patients during phase-based, trauma-focused PTSD treatment.MethodsDaily assessments from a randomized controlled trial (RCT) of Developmentally adapted Cognitive Processing Therapy (D-CPT) were analyzed to test for differences in the stated dysfunctional behaviors between the four treatment phases. We conducted multilevel modeling and repeated measure ANOVAs.ResultsWe did not find any significant differences between the treatment phases concerning the stated dysfunctional behaviors, either at the level of urge or at the level of actual actions. On the contrary, in some primary outcomes (self-injury, aggressive behavior), as well as secondary outcomes (distress caused by trauma, joy), we observed significant improvements.DiscussionOverall, during D-CPT, adolescents and young adults showed no deterioration in dysfunctional behaviors, while even showing improvements in some, suggesting that trauma-focused treatment preceded by skills building was not deleterious to this population. Hence, the dissemination of effective interventions such as D-CPT should be fostered, whilst the concerns of the therapists regarding exposure-based components need to be addressed during appropriate training. Nevertheless, further studies with momentary assessment, extended measurement methods, a control group and larger sample sizes are needed to confirm our preliminary findings.Trial registrationThe trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787, 18 March 2013, https://www.drks.de/DRKS00004787.

Highlights

Multiple traumata such as child sexual and/or physical abuse often result in complex psychopathologies and a range of associated dysfunctional behaviors
On an explanatory level, we examined the differences between the treatment phases in terms of self-reported distress caused by trauma and joy as secondary outcomes
Missing diary cards can be assigned to the following reasons: there were 7 patients from whom no diary cards could be included in the analyses (2 participants never started therapy for organizational reasons, 2 patients had been erroneously randomized, and 1 patient did not respond to contact attempts shortly after intake)

Summary

Introduction

Multiple traumata such as child sexual and/or physical abuse often result in complex psychopathologies and a range of associated dysfunctional behaviors. We examined the course of suicidal ideation, self-injury, aggressive behavior and substance use in a group of abuse-related posttraumatic stress disorder (PTSD) patients during phase-based, trauma-focused PTSD treatment. The risk for a posttraumatic stress disorder (PTSD) is especially high after such an interpersonal traumatization [4]. Adolescent PTSD patients often show emotion regulation difficulties [5] and are likely to engage in high-risk problem behavior such as self-injury, substance use or suicidal ideation [3, 6, 7]. In addition to the core PTSD symptom clusters, CPTSD includes symptoms of disturbed selforganization such as interpersonal problems, emotion regulation difficulties and negative self-concept [10]

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