The effectiveness of an intensive clinical trauma treatment for older adults with Complex PTSD.

In the 11th edition of the International Classification of Diseases (ICD-11) complex Post traumatic Stress Disorder (cPTSD) was added as a formal disorder. Similar to post traumatic stress disorder (PTSD), cPTSD includes re-experiencing the traumatic event, avoidance of trauma-related stimuli and hyperarousal. Additionally, three symptom clusters have been defined for cPTSD: affect dysregulation, negative self-concept and disturbances in interpersonal relationships. These symptom clusters are thought to represent disturbances in self-organization (DSO). Since the treatment methods developed for the treatment of PTSD do not include specific interventions targeting the DSO symptom cluster, there has been debate about the approach that should be taken regarding treatment for cPTSD. Some suggest that a phase-based approach is required (i.e., starting with a stabilization phase before focusing on trauma confrontation and processing). However, others suggest that there is insufficient evidence to warrant the inclusion of a stabilization phase, and this may even have a detrimental effect on the patient’s treatment process. Although more research is needed to clarify which approach is recommended, there is a growing consensus that treatment of cPTSD requires more than the standard interventions used for the treatment of PTSD. This view is also supported by a recent meta-analysis which showed an increased treatment effect when using a combined treatment program (comprising trauma focused techniques- and personality-focused treatment techniques such as CBT and dialectical behavior therapy (DBT)) in comparison to trauma-focused interventions alone. At present, there is little research available as to what specific psychological treatments should be combined for optimal treatment of cPTSD. Moreover, the research presented above has focused on (younger) adult patients (65 years and younger). To our knowledge, little is known about the treatment of PTSD in older adults, let alone older adults with cPTSD.

Drawing on previous findings, we hypothesize that elderly patients with cPTSD will benefit from an intensive, clinical, trauma-focused treatment. Furthermore, we hypothesize that adding a supplementary treatment intervention, integrally targeting the DSO symptom clusters, will increase the treatment effect. Therefore, the present study will focus on assessing the effectiveness of a combined treatment protocol, comprising an intensive multi-method (trauma-focused) inpatient treatment and a subsequent short (DSO-focused) outpatient treatment program for elderly patients with cPTSD. The inpatient part of the treatment program will comprise daily trauma treatment (EMDR or a combination of IM and EMDR), as well as psychoeducation, art therapy and a physical activity program. The following outpatient treatment program will comprise two conditions. Participants will either receive treatment as usual (TAU) or a short treatment program with interventions from schema-focused therapy (SFT) specifically aimed at DSO symptoms of cPTSD. In the present study, both the immediate effect of the intensive trauma-focused treatment and the effect of subsequent SFT-based treatment or TAU will be investigated.

We hypothesize that elderly patients with cPTSD will benefit from an intensive, clinical, trauma-focused treatment (i.e. reduction of trauma symptoms). Furthermore, we hypothesize that adding a supplementary treatment intervention, integrally targeting the DSO symptom clusters, will increase the treatment effect.

Primary outcomes: (1) VAS negative and positive cognitions are measured daily during baseline and clinical trauma treatment, twice per week during the outpatient treatment phase and once at follow-up; (2) PCL-5 measured once per week during baseline and treatment phases and once at follow-up.
Secondary outcomes: (1) YSQ and SMI and (2) BSI. Both 1 and 2 are measured at the start of the baseline phase, at the beginning and end of the outpatient treatment phase, and at follow-up.

Intensive clinical traumatreatment and schema-focused therapy.