Treatment of posttraumatic embitterment disorder with cognitive behaviour therapy based on wisdom psychology and hedonia strategies.

BACKGROUND: Posttraumatic embitterment disorder (PTED) is a reaction to unjust or humiliating life events, including embitterment and impairment of mood, somatoform complaints, reduction in drive, withdrawal from social contacts, and even suicide and murder suicide. Patients have been shown to be nonresponders to many treatments. This paper gives an outline of cognitive behaviour therapy based on wisdom psychology and reports first data on treatment effects. METHOD: In a first pilot study on psychotherapy for PTED, a cohort of 25 PTED inpatients was treated with routine multidimensional cognitive behaviour therapy. A second consecutive cohort of 28 patients was treated with PTED-specific cognitive behaviour therapy, which is based on wisdom psychology (wisdom psychotherapy) and another 29 patients with cognitive behaviour therapy based on wisdom psychology together with additional hedonia strategies (wisdom and hedonia psychotherapy). Treatment integrity was measured with special modules of the Behaviour Therapy Competency Checklist. The outcomes were measured in all 3 groups with the SCL-90 and a global clinical rating of patients and therapists on treatment outcome. RESULTS: There were significant and clinically meaningful reductions in the SCL score after wisdom therapy, as compared to routine treatment. In clinical ratings by therapists and patients, both specific treatments were judged as more effective than treatment as usual. Additional hedonia strategies did not lead to better treatment effects. CONCLUSIONS: The results of this pilot study suggest that wisdom psychology offers an approach to treat PTED and justify further randomized controlled outcome studies.

The Post-Traumatic Embitterment Disorder Self-Rating Scale (PTED Scale).

The present study introduces the Post-Traumatic Embitterment Disorder Self-Rating Scale (PTED Scale), which asks for prolonged and disabling embitterment reactions in the aftermath of negative life events. The PTED Scale was administered to four independent samples of patients and normals. Internal consistency and test-retest reliability were high. Factor analysis indicated a two-factor solution, accounting for 55.25% of the total variance. The PTED Scale discriminated significantly between patients who had been classified according to clinical judgement as suffering from pathological embitterment. Correlations with related instruments demonstrated good convergent validity. Data obtained from a non-clinical sample indicated a prevalence of clinically relevant embitterment in the general population of about 2.5%. The PTED Scale is a reliable and valid measure for embitterment as an emotional reaction to a negative life event. Furthermore, results demonstrate that reactive embitterment in connection to a negative life event is a prevalent phenomenon among clinical and non-clinical populations.

Posttraumatic embitterment disorder in comparison to other mental disorders.

BACKGROUND: The term 'posttraumatic embitterment disorder' (PTED) was recently introduced to describe a subtype of adjustment disorders, characterized by prolonged embitterment, severe additional psychopathological symptoms and great impairment in most areas of life in reaction to a severe negative but not life threatening life event. The aim of this study is an empirical description and validation of the clinical concept of PTED, by comparing clinically defined PTED patients with patients suffering from other mental disorders on measures of posttraumatic stress and psychopathological distress. METHODS: Fifty inpatients, suffering from PTED according to previously defined clinical diagnostic criteria, were compared with another 50 patients, matched by age and gender, who did not meet clinical criteria for PTED but for other mental disorders. Psychiatric diagnoses were assessed by the Mini International Neuropsychiatric Interview. Self-report measures included the Bern Embitterment Scale, the Impact of Event Scale, the PTED Self-Rating Scale and the SCL-90. RESULTS: According to the Mini International Neuropsychiatric Interview both groups fulfilled the criteria for many disorders with a significantly higher occurrence of major depression and chronic adjustment disorder but less generalized anxiety disorder lifetime in PTED patients. Patients with PTED scored significantly higher on the global scores and on most subdimensions of the SCL-90, the Impact of Event Scale, the Bern Embitterment Scale and the PTED Self-Rating Scale. CONCLUSIONS: Clear differences were found between PTED patients and patients with other mental disorders in regard to the quality and intensity of psychopathological as well as posttraumatic stress symptoms. PTED can help further subclassify and specify adjustment and reactive disorders.

Diagnostic criteria and the standardized diagnostic interview for posttraumatic embitterment disorder (PTED).

Objective. The posttraumatic embitterment disorder (PTED) is a specific form of adjustment disorder. The purpose of this study was to specify diagnostic criteria of PTED, and to develop a standardized instrument which allows a standardized diagnosis. Method. Data were obtained from 50 clinically defined PTED patients and 50 patients with other mental disorders (N=100) using a semi-standardized interview for PTED. Based on the answers of the participants, the description of PTED was refined and a standardized diagnostic interview for PTED was derived. Results. The diagnostic algorithm reached satisfying levels of sensitivity (94%) and specificity (92%). Conclusion. The diagnostic interview for PTED allows a standardized diagnosis of PTED.

The psychopathology of posttraumatic embitterment disorders.

BACKGROUND: The posttraumatic embitterment disorder (PTED) was introduced as a new subgroup of adjustment disorders. The trigger event in PTED is an exceptional, though normal negative life event that is experienced as a violation of basic beliefs and values. The predominant emotion in PTED is embitterment. This study presents first data on the psychopathological profile of PTED. METHOD: 48 inpatients were diagnosed by clinical judgment as suffering from PTED. Patients were then interviewed with the standardized Mini International Neuropsychiatric Interview (MINI) and an additional interview section on the diagnostic criteria for PTED. Patients also filled in the Symptom Checklist-90-Revision (SCL-90-R), and the Impact of Event Scale (IES-R). RESULTS: According to the MINI68.8% of the patients fulfilled the criteria for adjustment disorders, 52.1% for major depression, 41.7% for dysthymia, and 35.4% for generalized anxiety disorders. 100% of patients reported that they were suffering from intrusive thoughts about the event. 97.9% of the patients complained about persistent negative mood, 91.7% about restlessness, 83.3% inhibition of drive and loss of interest, 77.1% phobic avoidance of places related to the event, and 75% resignation, but 91.7% reported normal mood when distracted. The SCL-90-R indicated a high load of general psychopathological complaints with an average positive symptom total score of 52.26. Characteristic were feelings of injustice (100%), embitterment (97.7%), and rage (91.7%). The IES-R scale indicated a high prevalence of posttraumatic stress, with an average total score of 3.23. The average duration of illness was 31.7 months. CONCLUSIONS: The PTED patients are suffering from severe, multiform, and disabling symptoms. Their clinical features pose difficult diagnostic problems. The predominant complaints about feelings of injustice, embitterment, and rage and the results of the IES speak for the importance of the critical event for the development and understanding of such disorders.