Is adherence to dialectic behaviour therapy for post-traumatic stress disorder (PTSD) and cognitive processing therapy related to treatment outcome in PTSD after childhood abuse?

ABSTRACT

Background: Literature on the association between therapist adherence and treatment success in the treatment of post-traumatic stress disorder (PTSD) is scarce, and the results are mixed.

Objective: To examine the relationship between therapist adherence to dialectical behaviour therapy for PTSD (DBT-PTSD) and cognitive processing therapy (CPT) on treatment outcome in women with PTSD and emotion regulation difficulties after interpersonal childhood abuse.

Method: Videotaped therapy sessions from 160 female participants of a large randomized controlled trial [Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., Fydrich, T., Kuehner, C., Resick, P. A., Stiglmayr, C., Schmahl, C., & Priebe, K. (2020). Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse. JAMA Psychiatry, 77(12), 1235. jamapsychiatry.2020.2148] were rated. Adherence to CPT and DBT-PTSD was assessed using two specifically developed rating scales.

Results: Higher therapist adherence was associated with a greater reduction of clinician-rated PTSD symptom severity. This effect was more pronounced in the CPT group than in the DBT-PTSD group. Adherence was also related to a greater reduction of self-rated PTSD symptoms, borderline symptoms, and dissociation intensity.

Conclusion: Our results indicate that higher therapist adherence can lead to better treatment outcomes in PTSD treatments, especially in CPT.

HIGHLIGHTS

• Higher therapist adherence to cognitive processing therapy was associated with higher treatment gains in women with post-traumatic stress disorder (PTSD) after childhood abuse.

• Adherence was related to higher reductions in symptom severity of PTSD, borderline symptoms, and dissociation intensity.

• Adherence to dialectical behaviour therapy for PTSD did not show a strong association with treatment outcome.

Antecedentes: La literatura acerca de la asociación entre la adherencia del terapeuta y el éxito terapéutico en el tratamiento del trastorno de estrés postraumático (TEPT) es escasa y los resultados son mixtos.

Objetivo: Examinar la relación entre la adherencia del terapeuta a la terapia dialéctica conductual para TEPT (DBT-PTSD por sus siglas en ingles) y la Terapia de procesamiento Cognitivo (CPT) en los resultados del tratamiento en mujeres con TEPT y dificultades en la regulación emocional después de abuso interpersonal en la infancia.

Método: Se calificaron las sesiones de terapia grabadas en video de 160 mujeres participantes de un gran estudio controlado aleatorizado (Bohus et al., 2020). La adherencia a CPT y a DBT-PTSD se evaluó utilizando dos escalas de calificación desarrolladas específicamente.

Resultados: Una mayor adherencia del terapeuta se asoció con mayor reducción de la gravedad de los síntomas de TEPT calificada por el clínico. Este efecto fue más pronunciado en el grupo de CPT que en el grupo DBT-PTSD. La adherencia tambien estuvo relacionada con una mayor reducción en los síntomas de TEPT autoevaluados, síntomas limítrofes e intensidad de la disociación.

Conclusión: Nuestros resultados indican que una mayor adherencia del terapeuta puede conducir a mejores resultados en los tratamientos de TEPT, especialmente en CPT.

背景：关于治疗师依从性与治疗创伤后应激障碍（PTSD）治疗成功之间关联的文献很少，结果混杂。

目的/目标：在人际儿童虐待后患有PTSD女性考查PTSD辩证行为疗法（DBT-PTSD）和认知加工疗法（CPT）的治疗师依从性对治疗结果和情绪调节困难的关系。

方法：对一项大型随机对照试验（Bohus 等人，2020 年）的 160 名女性参与者的录像治疗课程进行评分。使用两个专门开发的评分量表评估对CPT和DBT-PTSD的依从性。

结果：较高的治疗师依从性与临床医生评分PTSD症状严重程度的更大降低有关。这种效应在CPT组中比在DBT-PTSD组中更明显。依从性还与自我评分PTSD症状、边缘性症状和解离强度的更大减少有关。

结论：我们的结果表明，更高的治疗师依从性可以在PTSD治疗中带来更好的治疗结果，尤其是在CPT中。

KEYWORDS:

• Post-traumatic stress disorder; treatment integrity
• treatment fidelity
• therapeutic adherence
• dialectical behaviour therapy for PTSD
• cognitive processing therapy

PALABRAS CLAVE:

• Trastorno de estrés postraumático
• integridad del tratamiento
• fidelidad al tratamiento
• adherencia al tratamiento
• terapia dialéctica conductual para TEPT
• terapia de procesamiento cognitivo

关键词:

• 创伤后应激障碍
• PTSD治疗完整性
• 治疗保真度
• 治疗依从性
• 辩证行为疗法
• 认知加工疗法

Acknowledgement

This study was funded by the German Federal Ministry of Education and Research (01KR1303B).

Disclosure statement

Clara Dittmann, Kathlen Priebe, Meike Müller-Engelmann, and Regina Steil receive honoraries for workshops and talks on DBT-PTSD and CPT. No potential conflict of interest was reported by the remaining authors.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Regina Steil, upon reasonable request.

Ethics declaration

This study was approved by the independent Ethics Committee of the Medical Faculty Mannheim at Heidelberg University (reference number: 2013-635 N-MA). The study was also approved by the ethics committee of Goethe-University and Humboldt University. All subjects gave written informed consent in accordance with the Declaration of Helsinki.

Additional information

Funding

The study was funded by the German Federal Ministry of Education and Research [01KR1303B].