Trauma-related emotions and radical acceptance in dialectical behavior therapy for posttraumatic stress disorder after childhood sexual abuse

Background: Posttraumatic Stress Disorder (PTSD) related to childhood sexual abuse (CSA) is often associated with a wide range of trauma-related aversive emotions such as fear, disgust, sadness, shame, guilt, and anger. Intense experience of aversive emotions in particular has been linked to higher psychopathology in trauma survivors. Most established psychosocial treatments aim to reduce avoidance of trauma-related memories and associated emotions. Interventions based on Dialectical Behavior Therapy (DBT) also foster radical acceptance of the traumatic event. Methods: This study compares individual ratings of trauma-related emotions and radical acceptance between the start and the end of DBT for PTSD (DBT-PTSD) related to CSA. We expected a decrease in trauma-related emotions and an increase in acceptance. In addition, we tested whether therapy response according to the Clinician Administered PTSD-Scale (CAPS) for the DSM-IV was associated with changes in trauma-related emotions and acceptance. The data was collected within a randomized controlled trial testing the efficacy of DBT-PTSD, and a subsample of 23 women was included in this secondary data analysis. Results: In a multilevel model, shame, guilt, disgust, distress, and fear decreased significantly from the start to the end of the therapy whereas radical acceptance increased. Therapy response measured with the CAPS was associated with change in trauma-related emotions. Conclusions: Trauma-related emotions and radical acceptance showed significant changes from the start to the end of DBT-PTSD. Future studies with larger sample sizes and control group designs are needed to test whether these changes are due to the treatment. Trial registration: ClinicalTrials.gov, number NCT0048100

San Diego, CA 92152--5001

this report was performed for the Office of Naval Research (ONR) by the Biosciences Division of the Space and Naval Warfare Systems Center, San Diego (SSC San Diego) and by Science Applications International Corporation (SAIC) under contract N001498WX20086. ACKNOWLEDGMENTS The authors wish to thank Ms. Nancy Harned, Dr. John Tague, and Mr. David Armstrong (all ONR) for their support over the course of this effort. The authors also wish to thank Linda Green, Deborah Skaar, and Justine Zafran (all SAIC) for their important contributions as trainers on this project. EXECUTIVE SUMMARY It is a widely accepted hypothesis that echolocating dolphins (Tursiops truncatus) best receive returning acoustic signals over the panbones of the lower jaw. It is also widely assumed that those areas function as the dolphin's peripheral hearing system. Previous research, however, does not exclude the possibility of other sound reception sites and suggests that additional areas of the head may be acoustically sensitive and frequency-dependent. For this report, jawphones were used to behaviorally measure the relative hearing thresholds at four frequencies (10, 30, 60, and 90 kHz) on more than 40 sites of a dolphin's head, from the tip of the rostrum to the base of the pectoral fins. Measurements were converted into iso-sensitivity curves projected onto a two-dimensional, heuristic representation of the head area investigated. The results suggest high-frequency sensitivity along the lower jaw with greater sensitivity forward of the panbone area, sensitivity to low frequency in the area of the external auditory meatus, and an asymmetry in sensitivity favoring the left side of the head. These results may have correlates in the underlying anatomy and suggest that the dolphin's peripheral hearing..