Abstract
BackgroundPosttraumatic Stress Disorder (PTSD) related to childhood sexual abuse (CSA) is often associated with a wide range of trauma-related aversive emotions such as fear, disgust, sadness, shame, guilt, and anger. Intense experience of aversive emotions in particular has been linked to higher psychopathology in trauma survivors. Most established psychosocial treatments aim to reduce avoidance of trauma-related memories and associated emotions. Interventions based on Dialectical Behavior Therapy (DBT) also foster radical acceptance of the traumatic event.MethodsThis study compares individual ratings of trauma-related emotions and radical acceptance between the start and the end of DBT for PTSD (DBT-PTSD) related to CSA. We expected a decrease in trauma-related emotions and an increase in acceptance. In addition, we tested whether therapy response according to the Clinician Administered PTSD-Scale (CAPS) for the DSM-IV was associated with changes in trauma-related emotions and acceptance. The data was collected within a randomized controlled trial testing the efficacy of DBT-PTSD, and a subsample of 23 women was included in this secondary data analysis.ResultsIn a multilevel model, shame, guilt, disgust, distress, and fear decreased significantly from the start to the end of the therapy whereas radical acceptance increased. Therapy response measured with the CAPS was associated with change in trauma-related emotions.ConclusionsTrauma-related emotions and radical acceptance showed significant changes from the start to the end of DBT-PTSD. Future studies with larger sample sizes and control group designs are needed to test whether these changes are due to the treatment.Trial registrationClinicalTrials.gov, number NCT00481000
Highlights
Posttraumatic Stress Disorder (PTSD) related to childhood sexual abuse (CSA) is often associated with a wide range of trauma-related aversive emotions such as fear, disgust, sadness, shame, guilt, and anger
This study investigates the change in trauma-related emotions and radical acceptance from the start to the end of Dialectical Behavior Therapy (DBT)-PTSD
While PTSD in trauma-exposed samples with a history of CSA is frequently accompanied by comorbidities such as substance abuse, alcohol abuse, or borderline personality disorder (BPD) [53], patients with such comorbidities as well as eating disorders or increased suicide risk are often excluded from studies [54,55,56,57]
Summary
Posttraumatic Stress Disorder (PTSD) related to childhood sexual abuse (CSA) is often associated with a wide range of trauma-related aversive emotions such as fear, disgust, sadness, shame, guilt, and anger. To emphasize the emotional consequences of traumatic experiences, the DSM-5 introduced two new criteria for PTSD as part of the new symptom cluster D “negative alterations in cognitions and mood” [15]: “Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others” as well as “persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame)”. Research on affective changes in trauma-focused therapy has focused primarily on fear and non-specific distress-partly as a consequence of Foa and Kozak’s influential Emotional Processing Theory [18]. Within this framework, a pathological “fear structure” is defined as the central component of anxiety disorders and PTSD [19]. The between-session changes in self-reported fear and distress were hypothesized to be important process variables
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