PTSD treatment can help patients with childhood trauma
Adults who were abused or mistreated as a child and consequently suffer from post-traumatic stress disorder (PTSD) can benefit greatly from cognitive behavioral therapy. This is the conclusion of a study of 149 patients. Researcher and Ph.D. candidate Chris Hoeboer is hopeful about the results and the perspective they offer to people with severe symptoms. Ph.D. defense on 18 January.
Recount as vividly as possible
Prolonged exposure (PE) is a behavioral therapy technique that has proven effective for PTSD. Under the supervision of a therapist, the patient recounts the traumatic memory as vividly as possible. The patient talks about the memory in the first person and the present tense and is asked by the therapist about smells, sights and sounds connected to the experience.
"By repeatedly returning to these worst moments, people learn: "I'm safe now. I can think back to those memories and I can cope. Those images don't drive me crazy and my heart can handle the stress." These kinds of expectations are the reason why people avoid and block the memories," says Hoeboer. The patient is also given assignments to do at home to overcome avoidant behavior. This takes the edge off the trauma, often faster than people believed was possible.
Fear of increasing the trauma
However, PE is not often used to treat PTSD in people who were abused or mistreated as a child. In such cases, treatment is often chosen that mainly deals with the additional symptoms, says Hoeboer. "It's often thought that these people are so vulnerable that they can't cope with reliving these worst experiences, that PE will only increase the trauma or trigger a crisis. But that isn't the case."
To determine which form of PE is most effective for this specific group of patients, Hoeboer researched three variants. The standard variant for PTSD (weekly consultations) was compared with an intensive variant (three consultations per week). In the third variant the patient was first taught skills such as regulating emotions with the aim of making them better able to cope with the PE treatment. Hoeboer: "Although the three forms of therapy appear to work equally well, patients are symptom-free sooner with the intensive therapy."
Reliving childhood trauma every day
A total of 149 patients participated in the research, which Hoeboer conducted together with clinical psychologist Danielle Oprel and a team of 15 therapists. Many of the patients had been suffering from symptoms for years. The fact that they were offered a treatment method that has been proven effective for PTSD explains the level of interest in the study, says Hoeboer. "Imagine that every day you are affected by the images of what you experienced. Lots of people said: "It can't get any worse. If I have to relive it for an hour during the therapy and am then rid of it versus seeing those images every day for the rest of my life, the decision is easy."'
After treatment somewhat more than half of the patients had no PTSD symptoms at all and a quarter noticed a clear improvement. Hoeboer: "I spoke to someone who said: "It's thanks to this therapy that I'm still here. This was my last hope." And other people have gradually started working, studying or even daring to leave their house at all." A quarter of the participants saw no improvement in their symptoms. "That was a quarter too many. You want to help everyone," says Hoeboer. Based on other studies, attempts are now being made to further improve the treatment so that this last group of people can also be helped.
Help patients sooner
According to Hoeboer it is important that therapists use the PE treatment as soon as possible. The researchers are therefore going to present the results to psychologists. The therapists who were trained for the research will train other therapists in turn. And that is sorely needed because the 149 participating patients are just the tip of the iceberg. "These are people who have had the worst possible start in life and who are therefore still unable to live the life they want to live. This group must get proper treatment and soon."