What was helpful in today's session? Responses of clients in two different psychotherapies for posttraumatic stress disorder.

The aim of this study was to qualitatively analyze and compare the written responses clients in treatment for posttraumatic stress disorder (PTSD) gave when asked about helpful and negative aspects of the previous session. Data were collected during a randomized quantitative study comparing dialogical exposure therapy (DET, a gestalt-based integrative therapy, n = 58) and cognitive processing therapy (CPT, a cognitive-behavioral therapy, n = 52). We developed a coding manual using Mayring's (2015) qualitative content analysis approach and were able to code responses reliably. Five main categories emerged, unspecified and specific therapy elements, therapeutic relationship, client process, and general positive experience, with the first three containing subcategories. Each therapy had its own codes for specific therapy elements, while the other codes were identical for both treatments. The results for specific therapy elements were in accordance with the theories behind the two treatments, with CPT clients naming cognitive factors most frequently, whereas in DET, emotions were the most frequently mentioned. Results for therapeutic relationship were surprisingly similar given that DET therapists consider the therapeutic relationship to be an active ingredient, while CPT therapists consider it as the basis for the intervention rather than a working mechanism in itself. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Difficulties in Conducting Long Term Follow Ups in Psychotherapy Research-Issues in the Literature and Data From a Randomized Therapy Comparison Study for Posttraumatic Stress Disorder.

Studies of psychotherapy for posttraumatic stress disorder (PTSD) typically encompass short follow-up periods, leading to a dearth of information on the long-term course of symptoms after treatment. We summarize existing long-term follow-up studies and highlight the issues making such research difficult. In this context, we report on a 2-year follow-up on a randomized treatment study comparing dialogical exposure therapy and cognitive processing therapy for adults with PTSD after type I trauma. Many of the problems connected to long-term follow-up also pertained to this study. Attrition was high, and the recruited sample was not representative of the study completers. Gains made during therapy were mostly stable, with no significant differences between interventions. At least for an originally successful subset of patients, the gains made during both treatments in our study tended to stay stable 2 years after the end of treatment.

A Randomized Controlled Clinical Trial of Dialogical Exposure Therapy versus Cognitive Processing Therapy for Adult Outpatients Suffering from PTSD after Type I Trauma in Adulthood.

BACKGROUND: Although there are effective treatments for posttraumatic stress disorder (PTSD), there is little research on treatments with non-cognitive-behavioural backgrounds, such as gestalt therapy. We tested an integrative gestalt-derived intervention, dialogical exposure therapy (DET), against an established cognitive-behavioural treatment (cognitive processing therapy, CPT) for possible differential effects in terms of symptomatic outcome and drop-out rates. METHODS: We randomized 141 treatment-seeking individuals with a diagnosis of PTSD to receive either DET or CPT. Therapy length in both treatments was flexible with a maximum duration of 24 sessions. RESULTS: Dropout rates were 12.2% in DET and 14.9% in CPT. Patients in both conditions achieved significant and large reductions in PTSD symptoms (Impact of Event Scale - Revised; Hedges' g = 1.14 for DET and d = 1.57 for CPT) which were largely stable at the 6-month follow-up. At the posttreatment assessment, CPT performed statistically better than DET on symptom and cognition measures. For several outcome measures, younger patients profited better from CPT than older ones, while there was no age effect for DET. CONCLUSIONS: Our results indicate that DET merits further research and may be an alternative to established treatments for PTSD. It remains to be seen whether DET confers advantages in areas of functioning beyond PTSD symptoms.

Interpersonal Subtypes and Therapy Response in Patients Treated for Posttraumatic Stress Disorder.

UNLABELLED: Interpersonal traits may influence psychotherapy success. One way of conceptualizing such traits is the interpersonal circumplex model. In this study, we analyse interpersonal circumplex data, assessed with the Inventory of Interpersonal Problems (Horowitz, Strauß, & Kordy, 1994) from a randomized study with 138 patients suffering from posttraumatic stress disorder after trauma in adulthood. The study compared cognitive processing therapy and dialogical exposure therapy, a Gestalt-based intervention. We divided the interpersonally heterogeneous sample according to the quadrants of the interpersonal circumplex. The division into quadrants yielded subgroups that did not differ in their general psychological distress, but the cold-submissive quadrant tended to exhibit higher posttraumatic stress disorder symptom severity and interpersonal distress than the other three. There was also a trend for patients in different quadrants to be affected differently by the treatments. Correlation analyses supported these results: in cognitive processing therapy, more dominant patients had more successful therapies, while in dialogical exposure therapy, success was not correlated with interpersonal style. Results indicate that especially patients with cold interpersonal styles profited differentially from the two treatments offered. Dividing samples according to the interpersonal circumplex quadrants seems promising. KEY PRACTITIONER MESSAGE: Interpersonal traits may contribute to psychotherapy outcome. Dividing the sample according to the quadrants of the interpersonal circumplex, as opposed to cluster analysis, yielded promising results. Patients higher in dominance fared better with cognitive processing therapy, while interpersonal style had no correlations with therapy success in dialogical exposure therapy.

Dialogical Exposure with Traumatically Bereaved Bosnian Women: Findings from a Controlled Trial.

OBJECTIVE: In this trial, we compared the relative efficacy of dialogical exposure group treatment using Gestalt empty-chair method with a supportive group in the treatment of symptoms stemming from traumatic loss in a post-war society. METHODS: One-hundred and nineteen women whose husbands were either killed or registered as missing during the war in Bosnia and Herzegovina were quasi-randomized to seven sessions of group treatment with dialogical exposure or to an active control condition. RESULTS: Both interventions resulted in significant improvement from baseline to post-treatment for both kinds of loss, in terms of post-traumatic symptoms, general mental health and grief reactions, with the exception of depression and traumatic grief in the control condition. Regarding mean effect sizes (Cohen's d), pre-treatment to post-treatment improvements were moderate (d = 0.56) for the dialogical exposure group and small (d = 0.34) for the supportive group. Treatment gains were maintained at least until the 1-year follow-up. In controlled comparisons, dialogical exposure was superior concerning traumatic grief (Cohen's d = 0.37) and post-traumatic avoidance (d = 0.73) at post-treatment. CONCLUSIONS: Results show that short-term dialogical exposure group treatment was moderately effective in treating traumatically bereaved women. KEY PRACTITIONER MESSAGE: Research attests to high levels of symptoms among post-war civil populations, in particular, when a loved one was killed, which can lead not only to trauma reactions but also to severe separation distress. Grieving the loss of a loved one is hampered if the death remains unconfirmed. Unconfirmed loss could be conceptualized as unfinished business in terms of Gestalt therapy, which offers empty-chair dialogue for resolving unfinished business and grief. Dialogical exposure therapy (DET) supports the client in gaining awareness of and expressing his or her inner dialogues concerning the traumatic event, using Gestalt empty-chair method. Short-term DET was effective in treating traumatically bereaved women but showed little additional effects in comparison with a supportive group treatment, so further research is warranted.

Sudden gains in two psychotherapies for posttraumatic stress disorder.

We examined sudden, large, and stable shifts in symptoms from one therapy session to the next in two treatments for posttraumatic stress disorder (PTSD). Shifts in a positive direction (sudden gains) have so far been more frequently analyzed than those in a negative direction (sudden losses). We analyzed data from 102 outpatients suffering from PTSD who received either a cognitive-behavioral or a Gestalt-based intervention. Sudden gains, at 22.5%, were more frequent than sudden losses (3.9% of patients). Participants who had experienced sudden gains had lower PTSD scores at posttreatment, but not at the 6-month follow-up. As sudden losses were so rare, they were not analyzed statistically. Sudden gains accounted for 52% of overall treatment gains or 26% of overall change in a positive direction. Among very successful patients, those with sudden gains were overrepresented, but in absolute terms, there were as many patients without sudden gains in this group. There was no connection between sudden gains and type of intervention or depressive symptoms. Sudden gains and sudden losses occurred in our sample of PTSD patients, but in the light of current results, their clinical importance seems to be limited.

Feasibility and outcome of dialogical exposure therapy for posttraumatic stress disorder: a pilot study with 25 outpatients.

OBJECTIVE: The research on psychotherapy for posttraumatic stress disorder (PTSD) stems predominantly from a cognitive-behavioral orientation while other approaches are underrepresented. We evaluated dialogical exposure in trauma therapy (DET), a treatment for PTSD combining cognitive-behavioral elements with an interpersonal, gestalt-based framework. METHODS: In this uncontrolled pilot trial, 25 PTSD patients were treated with DET in an outpatient setting and 21 completed therapy. RESULTS: There was a significant reduction in self-rated PTSD symptoms from pre- to posttreatment. Effect sizes were large in the completer sample and moderate to large in the intent-to-treat sample. General psychopathology also decreased significantly. The dropout rate was rather low at 16%. CONCLUSION: These results show that further research on DET as a treatment for PTSD is warranted.

Crisis intervention after the Tsunami in Phuket and Khao Lak.

After the Tsunami disaster in Southeast Asia, India, Sri Lanka, and Africa, the German government set up a crisis task force that implemented crisis-intervention teams covering Thailand (Phuket and Khao Lak), Sri Lanka, and Sumatra. Two crisis teams were sent to Phuket; the first one on 28 December 2004, and the second one on 3 January 2005, each for an average of 1 week. This intervention was primarily for the benefit of German citizens and their expatriates and relatives caught up in a major catastrophe as well as the German helpers. This article describes the organizational structures of the German crisis intervention, protective factors for the helpers, psychiatric syndromes--often acute traumata, the problems of the identification process for relatives, and crisis intervention itself. Consequences for further crisis intervention after natural disasters are discussed.

Posttraumatic Stress Disorder three years after the siege of Sarajevo.

The goals of this study were to estimate the lifetime prevalence of traumatic events, the current prevalence of Posttraumatic Stress Disorder (PTSD), and the connection between the kinds of traumatic events experienced and the probability of developing PTSD in three study samples in Sarajevo, Bosnia-Herzegovina, three years after the end of the war. A total of 311 people surviving the siege of Sarajevo were assessed with the Checklist for War Related Experiences (CWE) and an adapted version of the Posttraumatic Diagnostic Scale (PDS). The study groups consisted of a randomly selected residents sample (n = 98), a group of individuals in psychological treatment (n = 114), and a group in medical treatment (n = 99). Each individual survived an average of 24 traumatic events. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV; American Psychiatric Association, 1994) criteria, 18.6% of individuals in the residents sample, 32.7% of those in medical treatment, and 38.6% of those in psychological treatment developed PTSD.

Posttraumatic growth after war: a study with former refugees and displaced people in Sarajevo.

Research carried out with survivors of a variety of different traumata indicates that a large proportion of them perceive positive changes in themselves after the trauma. This study investigated whether posttraumatic growth also could be found among people who had been exposed to particularly severe traumata over a period of several years (1991 to 1995) during the war in the area of the former Yugoslavia. Included in the study were two representative samples of adult former refugees and displaced people who lived anywhere in former Yugoslavia before the war and were currently living in Sarajevo, Bosnia and Herzegovina, three and a half years after the war. The main instrument was a new Bosnian translation of the Posttraumatic Growth Inventory. Results indicated some differences in the factor structure as compared with the original instrument. The overall means for the scale were considerably lower than reported in most studies on other kinds of trauma. Younger people reported considerably more growth than older people.