Trauma-focused psychodynamic therapy and STAIR Narrative Therapy of post-traumatic stress disorder related to childhood maltreatment: trial protocol of a multicentre randomised controlled trial assessing psychological, neurobiological and health economic outcomes (ENHANCE).

INTRODUCTION: Success rates of psychotherapy in post-traumatic stress disorder related to childhood maltreatment (PTSD-CM) are limited. METHODS AND ANALYSIS: Observer-blind multicentre randomised clinical trial (A-1) of 4-year duration comparing enhanced methods of STAIR Narrative Therapy (SNT) and of trauma-focused psychodynamic therapy (TF-PDT) each of up to 24 sessions with each other and a minimal attention waiting list in PTSD-CM. Primary outcome is severity of PTSD (Clinician-Administered PTSD Scale for DSM-5 total) assessed by masked raters. For SNT and TF-PDT, both superiority and non-inferiority will be tested. Intention-to-treat analysis (primary) and per-protocol analysis (secondary). Assessments at baseline, after 10 sessions, post-therapy/waiting period and at 6 and 12 months of follow-up. Adult patients of all sexes between 18 and 65 years with PTSD-CM will be included. Continuing stable medication is permitted. To be excluded: psychotic disorders, risk of suicide, ongoing abuse, acute substance related disorder, borderline personality disorder, dissociative identity disorder, organic mental disorder, severe medical conditions and concurrent psychotherapy. To be assessed for eligibility: n=600 patients, to be e randomly allocated to the study conditions: n=328. Data management, randomisation and monitoring will be performed by an independent European Clinical Research Infrastructure Network (ECRIN)-certified data coordinating centre for clinical trials (KKS Marburg). Report of AEs to a data monitoring and safety board. Complementing study A-1, four inter-related add-on projects, including subsamples of the treatment study A-1, will examine (1) treatment integrity (adherence and competence) and moderators and mediators of outcome (B-1); (2) biological parameters (B-2, eg, DNA damage, reactive oxygen species and telomere shortening); (3) structural and functional neural changes by neuroimaging (B-3) and (4) cost-effectiveness of the treatments (B-4, costs and utilities). ETHICS AND DISSEMINATION: Approval by the institutional review board of the University of Giessen (AZ 168/19). Following the Consolidated Standards of Reporting Trials statement for non-pharmacological trials, results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media. TRIAL REGISTRATION NUMBER: DRKS 00021142.

[Trauma-Informed Peer Counselling in the Care of Refugees with Trauma-Related Disorders]. / Trauma-informierte Peer-Beratung in der Versorgung von Flüchtlingen mit Traumafolgestörungen.

Providing adequate culture-sensitive care for a large number of refugees with trauma-related disorders constitutes a major challenge. In this context, peer support and trauma-informed peer counselling can be regarded as a valuable means to complement the psychosocial care systems. In recent years, peer support and peer education have been successfully implemented e. g. in health care education, in psychiatric care, and in the treatment of traumatized individuals. Only little research data is available for traumatized refugees. However, results are encouraging. A program is presented which integrates trauma-informed peer educators (TIP) with migration background in the care of traumatized refugees. Peers' responsibility includes emotional support and understanding the refugees' needs, sensitizing for trauma-related disorders, providing psychoeducation, and teaching trauma-specific stabilization techniques under supervision of professional psychotherapists.

[Basic thoughts on psychopharmacological interventions through psychotherapy of severe forms of post-traumatic stress disorder: a case study]. / Pharmakotherapeutische Interventionen in der Psychotherapie von schweren Traumafolgestorungen: Grundsatzliche Uberlegungen anhand einer Fallstudie.

The present paper focuses on clinical issues concerning the psychopharmacological treatment of severe forms of post-traumatic stress disorder (PTSD).Using a case study, we discuss problems in this field against the background of psychodynamic and psychotraumatological theories. We also present strategies for the appropriate use of psychotropic drugs in the psychotherapy of PTSD.

Psychodynamic psychotherapy for posttraumatic stress disorder related to childhood abuse--Principles for a treatment manual.

In this article, the authors present a psychodynamically oriented psychotherapy approach for posttraumatic stress disorder (PTSD) related to childhood abuse. This neurobiologically informed, phase-oriented treatment approach, which has been developed in Germany during the past 20 years, takes into account the broad comorbidity and the large degree of ego-function impairment typically found in these patients. Based on a psychodynamic relationship orientation, this treatment integrates a variety of trauma-specific imaginative and resource-oriented techniques. The approach places major emphasis on the prevention of vicarious traumatization. The authors are presently planning to test the approach in a randomized controlled trial aimed at strengthening the evidence base for psychodynamic psychotherapy in PTSD.

Effects of trauma-focused psychotherapy upon war refugees.

The aim of this study is to evaluate the effects of a trauma-focused psychotherapy upon war refugees from Bosnia. Seventy refugees who met the criteria for posttraumatic stress disorder (PTSD) and somatoform disorders were included. The first 35 refugees were offered psychotherapy and the following 35 refugees received usual care. Outcome variables were changes in self-reported PTSD symptoms, psychological symptoms, and health status. At 12-month follow-up, participants in the intervention group reported significantly lower scores on the PTSD scale and the measure of psychological symptoms than the comparison group participants. Our results suggest that psychotherapy reduces symptoms of PTSD and somatoform disorders among war refugees even in the presence of insecure residence status.

[Influence of personality variables on perceived help and stress by group therapy and fellow patients in multimodal psychodynamic inpatient psychotherapy]. / Einfluss von Persönlichkeitsmerkmalen auf die erlebte Hilfe und Belastung durch Gruppentherapie und Mitpatienten in der stationären psychodynamischen Psychotherapie.

OBJECTIVE: The aim of the study was to investigate whether dimensional traits of personality disorder and other aspects of personality had an influence on perceived help and stress by the subsettings of a multimodal psychodynamic inpatient psychotherapy. METHODS: 89 patients of a psychodynamic psychotherapy clinic were investigated. Symptom severity was measured using SCL-R-90 symptom check list and BSS (Impairment Score). A questionnaire for patients' assessment of perceived help and stress by each subsetting of the therapy program was administered weekly. Personality assessment included (1) personality traits related to specific personality disorder as defined by SCID-II interview and questionnaire, (2) interpersonal problems as measured by the IIP, (3) self-related affiliation as measured by SASB-INTREX questionnaire (Introjekt), and (4) psychotrauma as determined by the Childhood Trauma Questionnaire (CTQ). Therapy outcome measures were: change of SCL-90-R, change of BSS, perceived change in VEV. RESULTS: Perceived help and stress by the total setting, by inpatient group therapy and by fellow patients were shown to be primarily influenced by personality traits related to DSM-IV clusters of personality disorders, particularly by Cluster-A-related traits. Interpersonal dominance and trauma history had an influence as well. CONCLUSION: Perceived help and stress by subsettings of inpatient psychotherapy can be predicted on the basis of several aspects of personality.

[Why does the general practitioner overlooks psychological disorders in his patient?]. / Warum übersieht der Hausarzt die psychischen Störungen seiner Patienten? - Determinanten der hausärztlichen Identifikation psychischer Störungen -

Physicians have a major screening function in the care of patients suffering from psychological disorders. Often, psychosocial disorders are overlooked in primary care. The study presented here investigates factors correlating with the identification of psychosocial disorders in primary care. Physician-patient consultations of 120 patients with psychological disorders of 16 primary care practices were analyzed with respect to doctor-patient interactions using Structured Analysis of Social Behavior (SASB). In addition, reported complaints, length of consultations and identification of psychological disorders by the physicians were analyzed. The physicians identified 60.8 % of the psychological disorders. There was a significant association between physician's identification of psychological disorders and (1) the severity of the disorder, (2) the number of complaints reported during consultation (3) the pattern of physician-patient interaction. A high frequency of interaction patterns referred to as complementary and controlling in terms of SASB categories, interferes with identification of psychological disorders. The study shows that the interactional process during primary care consultation is associated with physicians' identification of psychological disorders.

[Effects of a psychosocial education programme to improve doctor-patient interaction with cancer patients]. / Effekte eines psychosozialen Fortbildungsprogramms zur Verbesserung der Arzt-Patient-Interaktion mit Krebspatienten.

OBJECTIVES: The quality of medical care by somatically treating physicians has considerable influence on the coping process in cancer patients. In outpatient psychosocial care, information supply and doctor-patient interaction are often considered difficult by the patients. This study therefore investigates the effects of a teaching and training programme on interactional skills of experienced physicians in dealing with cancer patients. METHODS: In a pre-post comparison design, the effects of a 6-hour and a 24-hour interaction and teaching programme were compared. To measure the effects, interviews with standardised patients were carried out and analysed using the Medical Interaction Process System (Ford 1998). RESULTS: About one third of all physicians practicing in the area of Mönchengladbach, Germany, could be motivated to participate in the programme. The physicians who received the 24-hour training showed a substantial improvement in interaction skills whereas no marked changes were seen in those physicians who had participated in the 6-hour training. CONCLUSIONS: Interactional skills of experienced physicians can be improved by teaching and training programmes. Therefore, doctor-patient interaction training should be integrated into continuing medical education.

[On the effects of psychoanalytic oriented psychotherapy - an inpatient multicenter study] / Effekte stationärer psychoanalytisch orientierter Psychotherapie - eine Multizenterstudie.

Whereas the efficacy of inpatient treatment in socalled psychosomatic rehabilitation clinics in Germany has been well researched and documented, studies involving large samples on the efficacy of inpatient treatment in acute hospitals are lacking. A multicentered retrospective study involving clinics for psychotherapy at three separate universities was conducted on a sample of n=495. The patients were treated on an inpatient basis between April 1990 and July 1998 in one of the clinics. The predominant approach to treatment of these clinics was psychodynamic. Other approaches such as behavioral therapy are integrated. In addition to sociodemographic variables clinical data (SCL-90-R, IIP, BSS, ICD-Diagnosis) at admission and discharge were collected. A follow-up study was not conducted. With an average effect size of 0.84 in terms of clinical scales the results demonstrate good efficacy of inpatient treatment. Effect sizes were high on the depression, obsessive-compulsive and anxiety scale of the SCL-90-R, and were low on the phobia subscale. By self report 55% of all patients indicated they had markedly improved, 22% indicated no change and 6% stated they were worse. 17% of all patients were below the chosen cut-off point of the GSI. Patients with a low level of education took benefit as well from the offered therapy. There was no clear relationship between effect size and length of hospital stay. This may be due to the particular setting of a university clinic.