Trauma Treatment Program Research Articles

Response of patients with complex forms of PTSD to highly intensive trauma treatment: A clinical cohort study.

Although highly intensive trauma treatment programs show promising results in the treatment of patients with posttraumatic stress disorder (PTSD), it remains uncertain if patients with complex forms of PTSD can benefit equally from these intensive programs. To investigate whether patients with the dissociative subtype of PTSD (PTSD + DS) and patients with probable complex PTSD (CPTSD) draw equal benefits from a highly intensive trauma treatment program as patients with PTSD. In this clinical cohort study, patients were included who attended a 5-day intensive program consisting of eye movement desensitisation reprocessing, exposure in vivo and trauma-sensitive yoga components. PTSD with DS was assessed with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (CAPS-5), and a provisional diagnosis of CPTSD was assessed with the International Trauma Questionnaire. Primary outcome measure was self-reported PTSD-symptom severity measured by PTSD Checklist for DSM-5 at the start of the program (T1) and a week after the program (T2). Both groups, PTSD + DS (d = 0.85) and probable CPTSD (d = 0.85) benefitted significantly in terms of PTSD-symptom severity reduction and the size of the decrease was not significantly different from that of patients with PTSD. Patients with both forms of PTSD complexity can benefit even from a very brief intensive treatment program, which extends previous studies. The diagnoses of PTSD + DS and CPTSD seem helpful to assess the initial severity of the symptoms, but do not imply contra-indications to benefit from intensive treatment. Highly intensive treatment programs are promising interventions to effectively treat complex forms of PTSD and should be studied further in randomized clinical trials. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exhausting, but necessary: the lived experience of participants in an intensive inpatient trauma treatment program.

Intensive inpatient treatment programs have shown robust results in the treatment of post-traumatic stress disorder (PTSD). How patients experience this treatment program and what changes they experience as a result of the treatment have, however, only scarcely been explored through qualitative studies. This study aimed to explore the lived experience of participants in an intensive inpatient trauma treatment program. Our research questions were as follows: how do patients experience intensive trauma-focused treatment? How do they experience possible changes related to participating in the treatment program? Six patients diagnosed with PTSD with significant comorbidities, who recently participated in an intensive 2-week (4 + 4 days) inpatient trauma treatment program with prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and therapist rotation (TR), were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach. Our analysis resulted in five main themes: (1) the need to feel safe; (2) the benefits of many and different therapeutic encounters; (3) variable experience with elements of treatment; (4) intensity; and (5) experienced change. Our results suggest that feeling safe within the framework of the treatment program facilitated the treatment process. Many and different therapeutic encounters, both through TR and with ward staff, contributed to experienced change. All participants described the intensity as facilitative to trauma processing. However, most participants also describe often feeling too overwhelmed to benefit from all elements of the treatment program. Our findings suggest that participants experience the overall treatment program as beneficial and contributing to experienced change. Participants described the intensity of the program as exhausting, but necessary. Most did, however, report at times of being too overwhelmed to benefit from elements of the program. Consequently, our results prompt us to question the optimal level of intensity. ClinicalTrials.gov identifier: NCT05342480. Date of registration: 2022-04-22.

The Effectiveness and Tolerability of an Intensive Outpatient Trauma Treatment Program for Adolescents With PTSD

Following the promising effects of an intensive trauma treatment for adults, the question arises whether adolescents suffering from posttraumatic stress disorder (PTSD) can also benefit from a similar treatment program. The objective of this study was to assess the effectiveness and tolerability of an intensive trauma treatment program combining two evidence-based, trauma-focused therapies—prolonged exposure (PE) and eye movement desensitization and reprocessing (EMDR)—with psychoeducation and physical activity for adolescents suffering from PTSD in an outpatient clinic. We used a multiple-baseline study design. Fifteen adolescents aged 12–18 years old with aDiagnostic and Statistical Manual of Mental Disorders(5th ed.) diagnosis of PTSD were included. Participants were randomized to wait 2, 3, or 4 weeks between the start of baseline and the start of the intervention. In the 2-week intervention period, participants received daily PE, EMDR, and physical activity. The social network of adolescents was involved for support. PTSD symptoms and treatment tolerability were assessed daily. PTSD diagnosis was assessed at baseline and at 1 month and 3 months after completion of treatment. In addition, semistructured interviews were conducted after treatment to determine the tolerability. After treatment, we found a diagnostic PTSD remission of 58%–62% and a decrease in PTSD severity compared with baseline. The effects were maintained at 1-month and 3-month follow-ups. The dropout rate was 13%. Participants reported good treatment tolerability. This study provides initial evidence that an intensive outpatient trauma treatment including PE, EMDR therapy, psychoeducation, and physical activity is effective and tolerable for adolescents with PTSD and is associated with low dropout rates.

Outcomes of an Intensive Trauma Treatment Program for Military Service Members and Veterans

<h3>Research Objectives</h3> To investigate the effectiveness of an accelerated treatment program in reducing psychiatric and cognitive complaints in military veterans with history of TBI. <h3>Design</h3> Participants were surveyed prior to and after attending a 2-week daily treatment program. Each treatment cohort consists of between 8-12 participants. <h3>Setting</h3> Institutional practice; outpatient clinic. <h3>Participants</h3> 133 military service members and veterans admitted to 2-week intensive treatment program. <h3>Interventions</h3> 2-weeks of daily interventions including group therapy, individual cognitive rehabilitation or cognitive behavioral therapy, expressive art therapies, and additional medical follow-up. <h3>Main Outcome Measures</h3> Self- report on PTSD Symptom Checklist (PCL-5), Patient Health Questionnaire (PHQ-8), Neurobehavioral Symptom Inventory (NSI), Patient Reported Outcomes Measurement (PROMIS). <h3>Results</h3> There was a significant reduction in symptoms of PTSD (t(129)= 10.78, p< 0.001, d=0.97), depression (t(128)= 10.37, p< 0.001, d=0.91), and cognitive complaints t(124)= 10.99, p< 0.001, d=0.99). Additionally, following program completion, participants reported a significant increase in satisfaction with work (t(131)= -8.89, p< 0.001, d=- 0.78) and satisfaction with one's family role (t(132)= -5.74, p< 0.001, d=-0.50). <h3>Conclusions</h3> Results demonstrate the acceptability and effectiveness of the program in treatment of mTBI, in that there was a significant reduction in self-reported depression, PTSD symptoms, and cognitive complaints, and related improvements in quality of life. Further research into mechanisms contributing to this reduction are recommended, given the high levels of comorbidity between psychiatric diagnoses in this population. <h3>Author(s) Disclosures</h3> No disclosures to report.

Identifying posttraumatic stress disorder staging from clinical and sociodemographic features: a proof-of-concept study using a machine learning approach

This proof-of-concept study aimed to investigate the viability of a predictive model to support posttraumatic stress disorder (PTSD) staging. We performed a naturalistic, cross-sectional study at two Brazilian centers: the Psychological Trauma Research and Treatment (NET-Trauma) Program at Universidade Federal of Rio Grande do Sul, and the Program for Research and Care on Violence and PTSD (PROVE), at Universidade Federal of São Paulo. Five supervised machine-learning algorithms were tested: Elastic Net, Gradient Boosting Machine, Random Forest, Support Vector Machine, and C5.0, using clinical (Clinician-Administered PTSD Scale version 5) and sociodemographic features. A hundred and twelve patients were enrolled (61 from NET-Trauma and 51 from PROVE). We found a model with four classes suitable for the PTSD staging, with best performance metrics using the C5.0 algorithm to CAPS-5 15-items plus sociodemographic features, with an accuracy of 65.6% for the train dataset and 52.9% for the test dataset (both significant). The number of symptoms, CAPS-5 total score, global severity score, and presence of current/previous trauma events appear as main features to predict PTSD staging. This is the first study to evaluate staging in PTSD with machine learning algorithms using accessible clinical and sociodemographic features, which may be used in future research.

The course of (comorbid) trauma-related, dissociative and personality disorders: two year follow up of the Friesland study cohort

ABSTRACT Background: There is substantial comorbidity between trauma-related disorders (TRDs), dissociative disorders (DDs) and personality disorders (PDs), especially in patients who report childhood trauma and emotional neglect. However, little is known about the course of these comorbid disorders, despite the fact that this could be of great clinical importance in guiding treatment. Objective: This study describes the two-year course of a cohort of patients with (comorbid) TRDs, DDs and PDs and aims to identify possible predictors of course. Possible gender differences will be described, as well as features of non-respondents. Method: Patients (N = 150) referred to either a trauma treatment program or a PD treatment program were assessed using five structured clinical interviews for diagnosing TRDs, DDs, PDs and trauma histories. Three self-report questionnaires were used to assess general psychopathology, dissociative symptoms and personality pathology in a more dimensional way. Data on demographics and received treatment were obtained using psychiatric records. We described the cohort after a two-year follow-up and used t-tests or chi-square to test possible differences between respondents and non-respondents and between women and men. We used regression analysis to identify possible course predictors. Results: A total of 85 (56.7%) of the original 150 patients participated in the follow-up measurement. Female respondents reported more sexual abuse than female non-respondents. Six patients (4.0%; all women) died because of suicide. Levels of psychopathology significantly declined during the follow-up period, but only among women. Gender was the only significant predictor of change. Conclusions: Comorbidity between TRDs, DDs and PDs was more the rule than the exception, pleading for a more dimensional and integrative view on pathology following childhood trauma and emotional neglect. Courses significantly differed between men and women, advocating more attention to gender in treatment and future research.

Treating Sexual Abuse and Trauma with Children, Adolescents, and Young Adults with Developmental Disabilities: A Workbook for Clinicians

Vanessa Houdek, PsyD, and Jennifer Gibson, PsyD. Springfield, Illinois: Charles C. Thomas, Ltd. 2017. 174 pp. $28.98. This book was published as part of the Childhood Trauma Treatment Program's (CTTP) efforts to train professionals to assess and treat childhood trauma and abuse. CTTP is supported

A Descriptive Analysis of the Theory and Processes of an Innovative Day Program for Young Women with Trauma-Related Symptoms

ABSTRACTThis article describes the theoretical foundation and processes of a trauma treatment and skills training program for young adult women. The goal of the program is to decrease length of hospital stay and increase community stability. Experiences of trauma in childhood may lead to struggles in young adulthood. Hypervigilance, hyperarousal, and poor responses to sensory stimuli are often evident, as is self-injurious behavior and episodic behavioral dysregulation. Grace House is operationalized around three components implemented by occupational therapists and other professional staff: Attachment, self-regulation, and competency; sensory-based strategies, and a strength-based approach that builds upon internal and external resources.

The clinical course of trauma-related disorders and personality disorders: study protocol of two-year follow-up based on structured interviews

BackgroundTrauma-related disorders and personality disorders are prevalent in survivors of chronic childhood trauma and neglect. Both conditions have serious consequences for patients, their families, society and public health and a high risk of development of chronicity. However, information on the long term course trajectories is lacking and predictors of course outcome in survivors of chronic childhood traumatization are unknown. The first aim of the current study is to identify two-year course trajectories of pathology in patients with trauma-related disorders and personality disorders. The second aim is to examine predictors of the course, including demographics, clinical characteristics and comorbidities.Methods/designThe study is a naturalistic two-year follow-up of 150 patients consecutively admitted to the trauma treatment program and the personality disorder treatment program respectively at GGZ Friesland, a regular Dutch mental health care center. The only exclusion criterion is insufficient mastery of the Dutch language. Participants will be assessed after 2 years of treatment through measures that have been completed at baseline, including structured clinical interviews to measure childhood histories of trauma and neglect, (symptoms of) trauma-related disorders and personality disorders, and psychological questionnaire measures (e.g., general psychopathology, depressive symptoms and personality features). In addition, participants will complete an evaluation questionnaire to assess medication prescribed and treatment (s) received outside GGZ Friesland between baseline and follow-up. Information about (psychological and pharmacological) treatment received at GGZ Friesland during the follow-up period will be collected from patient files.DiscussionThis study provides insight in the two-year course of (comorbid) trauma-related disorders and personality disorders. Identifying predictors of the course of trauma-related and personality disorders will allow to differentiate clinical profiles and will offer indicators for treatment.

From Cumulative Strain to Available Resources: A Narrative Case Study of the Potential Effects of New Trauma Exposure on Recovery.

This article presents a narrative case study of a client with a history of multiple traumas and severe symptomatology, coupled with an ongoing recovery process. A hermeneutical–phenomenological approach was used to analyze two interviews with the participant over a period of 1 year, following a trauma treatment program. Her husband’s suicide in between the two interviews allowed for an exploration of the possible effects of new trauma exposure on the process of recovery. Analysis of the data revealed how the participant’s early trauma experiences had resulted in escalating symptomatology. Through her relationship with her husband, she gradually became ready to engage in therapy in a way that allowed her to benefit from it. Her husband’s suicide forced her to reconsider her own part in her recovery, resulting in a strengthened feeling of inner security and self-efficacy parallel to what is seen in posttraumatic growth. The results contribute our understanding of individual processes of change and recovery, including processes of growth following cumulative trauma. Plausible mechanisms for growth in the present case was the ability to recognize and tolerate feelings, making sense of one’s own reactions, as well as a sense of control and trust in available resources.

Improved Attachment Style for Female Veterans Who Graduated Warrior Renew Sexual Trauma Treatment

The Warrior Renew sexual trauma treatment program proposes to target perceived attachment style and the internal working models of interpersonal relationships. This study examined scores on the Relationships Scales Questionnaire and Brief Symptom Inventory pre- and posttreatment in a sample of 62 female veterans who graduated the program. Findings revealed that graduates of Warrior Renew reported significant decreases in fearful and dismissive insecure attachment and significant increases in secure attachment. Scores were significantly correlated with symptoms. Findings lend support to an upward spiral hypothesis associated with long-term positive outcomes found in previous research on Warrior Renew.

Establishing a new military sexual trauma treatment program: Issues and recommendations for design and implementation.

This article presents a review of issues and considerations when developing a comprehensive military sexual trauma (MST) treatment program. A review of the current literature was conducted, which we argue is the first step in informing programmatic design. Next, information on how to obtain local public data and then a description of how we used this information to design the new MST program at our facility are discussed. Our clinic design reflects best practice while simultaneously incorporating real-world information and will be more likely to positively influence overall care to patients. As such, we recommend that clinicians involved in clinic development will use this process as a model for successful clinic planning and program development.

Integrated Trauma Treatment in Drug Court: Combining EMDR Therapy and Seeking Safety

Trauma and co-occurring substance use disorders are disproportionately prevalent in individuals involved in the criminal justice system. The Thurston County Drug Court Program (TCDCP) in Washington State conducted a preliminary study with 220 participants arrested for nonviolent, felony drug-related crimes. All TCDCP participants were required to engage in a structured 12- to 18-month 3-phase program referred to as Program as Usual (PAU). Data was collected from 2004 to 2009 to investigate the efficacy of adding an “Integrated Trauma Treatment Program” (ITTP) component for those endorsing a Criterion A trauma history (68% of TCDCP). The ITTP combined 2 empirically supported trauma therapies in a phased, integrated approach: mandatory Seeking Safety groups followed by voluntary, individual eye movement desensitization and reprocessing (EMDR) therapy. The investigators hypothesized that trauma-specific treatment might improve existing program outcomes, including higher graduation rates and lower postprogram recidivism. One hundred twelve of the initial 150 participants endorsing trauma completed the Seeking Safety groups and were offered individual EMDR therapy. Of those 112, those who selected EMDR therapy (n = 65) graduated at a rate of 91%; those who declined (n = 47) graduated at 57%. Recidivism rates also differed among TCDCP graduates: PAU, 10%; graduates selecting EMDR therapy, 12%; and graduates declining EMDR, 33%. This article summarizes the literature, describes the ITTP program, reports on graduation rates and recidivism outcomes, and discusses possible differences between those who selected and those who declined EMDR therapy. The authors discuss the benefits of including EMDR therapy in drug court programs with recommendations for future research.

Longitudinal Outcomes of Women Veterans Enrolled in the Renew Sexual Trauma Treatment Program

Forty-three female veterans who were starting the 12 weeks Renew treatment program for survivors of sexual trauma at a Department of Veterans Affairs medical center were recruited for this study. Forty-one participants enrolled in a within subjects design longitudinal study. Participants completed structured interviews at pre-treatment (baseline) and post-treatment, and at 6, 9, and 12 months from baseline. Thirty-seven completed the treatment (10 % dropout) and 32 completed the entire study. Similar to previous findings on Renew, posttraumatic symptoms decreased immediately after graduation with large to medium effect sizes. In addition, up to 70 % had reliable clinical change at the 95 % confidence interval. However, the main hypothesis of this study was to test the stability of treatment outcomes at 12 months from baseline. Not only were these changes sustained 12 months from baseline, positive factors of self-esteem and quality of life continued to increase over time. Given participants’ level of trauma and their chronicity of symptoms prior to Renew, results suggest that Renew is an effective treatment for female veterans with multiple traumas across the life span including military sexual trauma, and a variety of life stressors including homelessness, substance abuse, and medical problems.

Trauma Severity, Poly-victimization, and Treatment Response: Adults in an Inpatient Trauma Program

The goal of the current study was to evaluate the extent to which abuse history predicted change in treatment in an inpatient setting. Poly-victimization and trauma severity were examined as predictors of treatment response measured by the Trauma Symptom Checklist-40 and the Symptom Checklist-90-R at admission, discharge, and 6-months follow-up. Data from 161 clients of an inpatient trauma treatment program were analyzed using structural equation modeling. Results indicate that level of poly-victimization predicted treatment response from admission to discharge on two of four outcome variables; however, this relationship was not found at follow-up. Further analyses suggest that the difference in treatment response at discharge among clients with higher rates of poly-victimization was an artifact of scores at admission. Trauma severity analyses reveal that differing types of abusive experiences generally did not predict treatment response. Overall, results demonstrate that this inpatient treatment program is similarly effective for a broad array of patients, including those with a greater number, and higher severity, of victimizations.

Attention to process and clinical outcomes of implementing a rural school‐based trauma treatment program

The Louisiana Rural Trauma Services Center was established to provide, improve, and enhance urgently needed assessment, treatment, crisis management, and consultation services for children and adolescents exposed to traumatic events in three rural southeastern Louisiana parishes. The purpose of this study is to describe the process of implementing the rural school-based trauma treatment program and to evaluate its effectiveness in 115 students. Through attention to process including the three-tiered approach of relationship building, trauma training, and trauma services, the school-based trauma treatment program proved effective in reducing trauma symptoms. This study is important to support the widespread implementation of school-based mental health services.

Family Environment and Adult Attachment as Predictors of Psychopathology and Personality Dysfunction Among Inpatient Abuse Survivors

The current study explored the role of early family environment and adult attachment style in explaining long-term outcomes among child abuse survivors. Adult patients (N = 80) in a trauma treatment program were assessed for clinical diagnosis and administered a multiscale questionnaire. Hierarchical regression analyses were significant for dissociative identity disorder (DID), substance abuse, anxiety disorder, posttraumatic stress, somatization, and six personality disorder dimensions. Adult attachment styles were significant predictors of most outcome variables. Of particular note was the strong contribution of attachment avoidance to DID. Five family environment scales (Independence, Organization, Control, Conflict, Expressiveness) also contributed to various psychopathological outcomes. Evidence emerged supporting a mediating role for attachment style in the link between family independence and five personality disorder dimensions.

Attachment, personality, and psychopathology among adult inpatients: Self-reported romantic attachment style versus Adult Attachment Interview states of mind

The present study examined self-reported romantic attachment style and Adult Attachment Interview (AAI) states of mind regarding early attachment relationships, personality dimensions, and psychopathology in a psychiatric sample of trauma survivors. Inpatients (N = 80) admitted to a hospital trauma treatment program were administered the Experiences in Close Relationships Scale, AAI, Millon Clinical Multiaxial Inventory-III, Dissociative Experiences Scale, and Dissociative Disorder Interview Schedule. Self-report and AAI attachment classifications were not related, and different results emerged for the two measures. Self-reported romantic attachment style was significantly associated with personality dimensions, with fearful adults showing the most maladaptive personality profiles. Findings suggested that self-report dimensions of self and other independently contribute to different forms of psychological dysfunction. AAI unresolved trauma was uniquely associated with dissociation and posttraumatic stress disorder, whereas unresolved trauma and unresolved loss jointly contributed to schizotypal and borderline personality disorder scores. The differences in findings between the two measures are discussed with a view toward the developmental and clinical implications.

Experiences of Adults Abused as Children after Discharge from Inpatient Treatment: Informal Social Support and Self-Care Practices Related to Trauma Recovery

This qualitative study explored adults' perceptions of experiences that were helpful and unhelpful to their recovery from the traumatic effects of childhood physical and sexual abuse. The authors conducted in-depth interviews with 30 participants approximately 6 months after discharge from an inpatient trauma treatment program. Participants reported that barriers to recovery postdischarge were lack of follow-up support immediately after discharge, social isolation, lack of friends, problems with partners, and lack of emotional support from family members. Facilitating factors were concrete support from family and friends; emotional support, particularly from friends; developing a social network unrelated to the abuse history; and continuing self-care strategies learned in the inpatient program. Implications for community-based mental health professionals are discussed.

A Child Trauma Treatment Pilot Study

We examined outcomes of a promising 21-session trauma treatment model for children aged 3 to 17 and their caregivers. All children in treatment had experienced at least one traumatic event. The treatment intervention was rooted in theories of trauma and attachment and combines parent training with cognitive behavioral therapy to form a comprehensive trauma treatment program. We report on 27 families who completed the program. Results reflect significant reductions in conduct disorder, problems in social relations, and caregiver depression at an average of a one-year post-treatment follow-up. Results from our preliminary study offer support for further evaluation of the model.