Complex trauma disorders - Understanding and treatment : A clinical trial of stabilizing group treatment for patients with PTSD and Dissociative Disorders

Abstract

Victims of childhood trauma and abuse predominantly experience many forms of trauma and multiple traumatic incidents throughout the life-span often termed complex trauma. Victims of complex trauma are at risk of developing a range of mental health difficulties, including posttraumatic stress symptoms, interpersonal difficulties, problems with emotional regulation, and dissociative reactions. However, our understanding of these aforementioned mental health difficulties and how best to treat them is unclear and debated. Thus, this thesis has three main aims; 1) Broaden our understanding of trauma-related difficulties by testing a new theoretical model of dissociation, 2) Investigate the efficacy of stabilizing group treatment for patients with PTSD related to childhood abuse, and 3) Investigate the efficacy of stabilizing group treatment for patients with dissociative disorders. A clinical research project was conducted at Modum Bad’s Trauma Clinic. In paper I, the predictions of the 4-D model of dissociation were tested in a sample of 142 patients with PTSD, either with (n=46) or without (n=96) comorbid dissociative disorders. In paper II the efficacy of stabilizing group treatment for patients with PTSD related to childhood abuse (N= 89) was investigated in a delayed-treatment design. In paper III, the efficacy of group treatment for patients with complex dissociative disorders (N = 59) was investigated in a similar design, the first randomized trial ever conducted with this patient group. Paper I showed general support for the 4-D model as a promising theoretical framework for understanding trauma-related reactions. Paper II and paper III both showed significant treatment gains However, we did not find significantly better outcomes related to group participation in either sample, although some indications of positive long-term effects were found in paper III. Based on these results, stabilizing-group treatment should not be the first choice for treatment of PTSD related to childhood abuse. Further clinical research is needed to establish evidence-based treatment for dissociative disorders.