Skills Training in Affective and Interpersonal Regulation Narrative Therapy for women with ICD-11 complex PTSD related to childhood abuse in Japan: a pilot study.

Background: Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative Therapy (SNT) has shown efficacy in alleviating symptoms of posttraumatic stress disorder (PTSD) and improving emotion regulation and interpersonal skills among individuals with complex trauma, such as childhood abuse. Although this therapy is expected to be effective for patients with complex PTSD (CPTSD), no study has directly assessed diagnostic and symptom outcomes. Moreover, the potential of therapy to achieve good outcomes in non-Western countries remains unclear. Objective: This pilot study examined the feasibility, safety, and outcomes of SNT for CPTSD among women with a history of childhood abuse in a Japanese clinical setting. Methods: Ten women aged 21-54 years (M = 29.1 years) with childhood-abuse-related ICD-11 CPTSD were enrolled in this study. The International Trauma Interview and International Trauma Questionnaire were administered to diagnose CPTSD and assess its severity. Symptoms of dissociation and depression, difficulties in emotion regulation and interpersonal relationships, quality of life, and negative cognitions were assessed pretreatment, midtreatment (after the STAIR phase), and immediately posttreatment (after the Narrative Therapy phase), in addition to 3 months after treatment. Results: Seven of the 10 participants completed the treatment. The therapists' adherence to the therapy protocol was 96.4%, ranging from 93.6% to 100% across therapists. Serious adverse events were not observed. Among the seven completers, six at posttreatment and all at follow-up no longer met CPTSD diagnosis. Exploratory analyses using the linear mixed-effects model showed significant improvements at posttreatment and follow-up for almost all the variables. Conclusions: The results provide preliminary evidence for the feasibility and safety of SNT for CPTSD in a Japanese clinical setting. This study is the first to report the use of SNT for individuals diagnosed with ICD-11 CPTSD using reliable clinician and self-report measures. HIGHLIGHTS: This study examined the feasibility and safety of STAIR Narrative Therapy for women with ICD-11 CPTSD related to childhood abuse in a Japanese clinical setting.High therapy adherence was observed.No serious adverse events occurred.

Antecedentes: La terapia narrativa (SNT en su sigla en inglés) de Entrenamiento de habilidades en regulación afectiva e interpersonal (STAIR en su sigla en inglés) ha demostrado eficacia en el alivio de los síntomas del trastorno de estrés postraumático (TEPT) y mejorar regulación emocional y las habilidades interpersonales entre individuos con trauma complejo, como el abuso en la infancia. Aunque esta terapia se espera que sea efectiva para pacientes con TEPT complejo (TEPT-C), ningún estudio ha evaluado directamente su estado diagnóstico y síntomas. Además, el potencial de la terapia para alcanzar resultados parecidos en países no Occidentales sigue sin estar claro.Objetivo: Este estudio piloto examinó la viabilidad, seguridad y resultados de la SNT para TEPTC en mujeres con historia de abuso en la infancia en un contexto clínico japonés.Métodos: Se inscribieron en este estudio diez mujeres de edad entre los 21­54 años (M = 29.1) con TEPT-C según la CIE-11 relacionado con abuso infantil. Se aplicó la Entrevista Internacional de Trauma y el Cuestionario Internacional de Trauma para diagnosticar TEPT-C y evaluar su gravedad. Los síntomas de disociación y depresión, dificultades en la regulación emocional y relaciones interpersonales, calidad de vida y cogniciones negativas se evaluaron durante el pretratamiento, a la mitad del tratamiento (después de la fase STAIR) e inmediatamente postratamiento (después de la fase de Terapia Narrativa), además de a los 3 meses después del tratamiento.Resultados: Siete de las 10 participantes completaron el tratamiento. La adherencia de los terapeutas al protocolo de la terapia fue del 96.4%, con una variación del 93.6% al 100% entre terapeutas. No se observaron eventos adversos serios. Entre las siete que completaron el tratamiento, seis en el postratamiento y todas al seguimiento ya no cumplían con el diagnóstico de TEPT-C. Los análisis exploratorios que utilizaron el modelo lineal de efectos mixtos mostraron una mejoría significativa en el postratamiento y seguimiento para casi todas las variables.Conclusiones: Los resultados entregan evidencia preliminar para la viabilidad y seguridad de la SNT para TEPT-C en un contexto clínico japonés. Este estudio es el primero en reportar el uso de la SNT para individuos diagnosticados con TEPT-C según la CIE-11 usando medidas clínicas y de auto-reporte confiables.

Prevalence of Autoantibodies and the Efficacy of Immunotherapy for Autoimmune Cerebellar Ataxia.

OBJECTIVE: Autoimmune cerebellar ataxias were recently reported to be treatable. However, the proportion of patients with cortical cerebellar atrophy of unknown etiology with autoimmune-associated cerebellar ataxia and the actual effectiveness of immunotherapy in these diseases remain unknown. METHODS: We measured the level of autoantibodies (including anti-gliadin antibody, anti-glutamic acid decarboxylase (GAD) antibody, and anti-thyroid antibody) in 58 Japanese patients with cerebellar ataxia, excluding those with multiple system atrophy, hereditary spinocerebellar ataxia, cancer, or those who were receiving phenytoin, and the efficacy of immunotherapy was assessed. RESULTS: Thirty-one of 58 (53%) patients were positive for anti-GAD antibody, anti-gliadin antibody, or anti-thyroid antibody. Seven of the 12 anti-gliadin antibody-positive patients, three of the four anti-GAD antibody-positive patients, and three of the six anti-thyroid antibody-positive patients responded well to immunotherapy, indicating that 59% of patients with ataxia-associated antibody-positive cerebellar ataxia undergoing immunotherapy responded well. CONCLUSION: Some patients with cerebellar ataxia have autoimmune conditions and diagnosing autoimmune cerebellar ataxia is therefore an important component in the care of patients with this disease entity.