Impact of therapist change after initial contact and traumatic burden on dropout in a naturalistic sample of inpatients with borderline pathology receiving dialectical behavior therapy

Steuwe C, Berg M, Driessen M, Beblo T. Impact of therapist change after initial contact and traumatic burden on dropout in a naturalistic sample of inpatients with borderline pathology receiving dialectical behavior therapy. Borderline Personality Disorder and Emotion Dysregulation. 2017;4(14): 14.Background This study focused on the predictors of therapy dropout in a naturalistic sample of patients with borderline pathology receiving dialectical behavior therapy (DBT) in an inpatient setting. We assumed that the change of the therapist between DBT-briefing and start of DBT-treatment as well as comorbid posttraumatic stress disorder (PTSD) and childhood trauma history were associated with elevated dropout. Methods Eighty-nine participants with borderline pathology (≥ 3 borderline personality disorder criteria) receiving an inpatient DBT program completed a quality assurance questionnaire set assessing demographic information and pretreatment psychopathology during the days of their inpatient stay. Beyond that, changes of therapists were documented. The predictor analyses were investigated with generalized estimating equations. Results The dropout rate was 24.7%. A change of therapist between DBT-briefing and treatment as well as high childhood emotional abuse was associated with premature termination of treatment. Higher values of physical neglect during childhood were associated with a protective effect on treatment dropout. Surprisingly, this was also true for comorbid PTSD. Conclusions This study supports the importance of therapy process variables as predictors of therapy dropout in borderline pathology. A change of therapist between DBT-briefing and treatment was associated with an increased vulnerability for dropping out of treatment and should therefore be avoided if possible. Against our hypotheses, a comorbid PTSD was even protective with regard to DBT dropout. Therefore, this severely suffering patient group should not be rejected from treatment assuming them to be too unstable for psychotherapy. However, results need to be replicated. ClinicalTrials.gov Identifier: NCT03018639, retrospectively registered on January 9, 2017

Effectiveness and feasibility of Narrative Exposure Therapy (NET) in patients with borderline personality disorder and posttraumatic stress disorder – a pilot study

Steuwe C, Rullkötter N, Ertl V, et al. Effectiveness and feasibility of Narrative Exposure Therapy (NET) in patients with borderline personality disorder and posttraumatic stress disorder – a pilot study. BMC Psychiatry. 2016;16(1): 254.Background This pilot study focused on the feasibility and potential effectiveness of a protocol based on Narrative Exposure Therapy (NET) that was integrated into a standard inpatient program to treat patients with comorbid Borderline Personality Disorder (BPD) and Posttraumatic Stress Disorder (PTSD). Methods Eleven patients (1 male, 10 female) without previous stabilization periods or the absence of intentional self-injury received NET during a ten-week inpatient program. Patients were assessed again at post-treatment and a 12-month follow-up. Results Drop-out rates during treatment were low, with 90.9 % completing NET. Furthermore, acceptance of NET was high, with only one patient rejecting treatment. The program was safe because it did not lead to aggravations in symptom severity at either the post-treatment or 12-month follow-up. Additionally, the rate of self-harming behaviors throughout the treatment phase was low (18.2 %). In fact, treatment was associated with positive effects on PTSD and BPD symptom severity as well as secondary outcome measures, including depression, dissociation and quality of life. Conclusions The present study found that NET is feasible and safe in an inpatient setting for treating highly burdened patients with BPD and PTSD. There is also evidence for the potential effectiveness of NET in this highly burdened population

Therapeutic alliance and dropout in patients with borderline pathology receiving residential dialectical behavior therapy.

Steuwe C, Berg M, Driessen M, Beblo T. Therapeutic alliance and dropout in patients with borderline pathology receiving residential dialectical behavior therapy. BMC Psychiatry . 2023;23(1): 605.BACKGROUND: This study focused on the impact of therapeutic alliance on therapy dropout in a naturalistic sample of patients with borderline pathology receiving dialectical behavior therapy (DBT) in a residential setting. We assumed that low therapeutic alliance shortly after admission would be associated with elevated dropout.; METHODS: 44 participants with borderline pathology (≥3 DSM-5 borderline personality disorder criteria) in a residential DBT program completed a quality assurance questionnaire set assessing demographic information, pretreatment psychopathology and therapeutic alliance during the first seven days of their residential stay. Predictors of dropout were investigated using binary logistic regression analyses.; RESULTS: The dropout rate was 34.1% (n=15). In binary logistic regression analyses with variables covering demographic and clinical characteristics, comorbidities and childhood trauma history, only the therapeutic alliance significantly predicted dropout (z = -2.371, p=.018).; CONCLUSIONS: This study supports the importance of therapy process variables, here the therapeutic alliance at the beginning of treatment, as predictors of therapy dropout in borderline pathology. If this finding is replicated, it shows the potential importance of monitoring the therapeutic relationship throughout the therapeutic process.; CLINICALTRIALS: gov Identifier: NCT05289583, retrospectively registered on March 11, 2022. © 2023. BioMed Central Ltd., part of Springer Nature

Evidence for a Dissociative Subtype of PTSD by Latent Profile and Confirmatory Factor Analyses in a Civilian Sample

Steuwe C, Lanius RA, Frewen PA. Evidence for a Dissociative Subtype of PTSD by Latent Profile and Confirmatory Factor Analyses in a Civilian Sample. Depression and Anxiety. 2012;29(8):689-700

Narrative Exposure Therapy in Patients With Posttraumatic Stress Disorder and Borderline Personality Disorder in a Naturalistic Residential Setting: A Randomized Controlled Trial

Steuwe C, Berg M, Beblo T, Driessen M. Narrative Exposure Therapy in Patients With Posttraumatic Stress Disorder and Borderline Personality Disorder in a Naturalistic Residential Setting: A Randomized Controlled Trial. Frontiers in Psychiatry. 2021;12: 765348.Background: Comorbid Posttraumatic Stress Disorder (PTSD) increases the already high symptom burden of patients with Borderline Personality Disorder (BPD). As the gold standard for BPD treatment, Dialectical Behavior Therapy (DBT), does not focus on PTSD, other treatment approaches are needed. Narrative Exposure Therapy (NET) was designed to address multiple traumatic events and may be especially useful in this patient group. The aim of the present study was to determine the efficacy of NET compared to DBT based treatment (DBT-bt) in a randomized controlled trial. Methods: Female patients (n = 60) with BPD and comorbid PTSD were randomized to either a 10-week residential NET or DBT-bt. The primary outcome was change in PTSD severity as assessed by the Clinician Administered PTSD Scale (CAPS). Mixed linear models as well as reliable change, remission, and response rates were used to compare improvement across treatment groups. Results: Mixed linear model showed that patients in both treatments improved significantly over time across all outcome measures. This improvement was not more pronounced in NET (no significant time × type of treatment effect). However, NET resulted in a higher remission rate as compared to DBT-bt. PTSD remission was accompanied by BPD remission in all cases. Conclusions: This study shows the value of trauma-focused therapy in patients with BPD and PTSD for recovery in both disorders. To shorten the duration of both illnesses as much as possible, future studies should focus on the factors predicting treatment success and enabling patients to benefit from trauma-focused treatment as soon as possible

Therapeutic alliance and dropout in patients with borderline pathology receiving residential dialectical behavior therapy

Abstract Background This study focused on the impact of therapeutic alliance on therapy dropout in a naturalistic sample of patients with borderline pathology receiving dialectical behavior therapy (DBT) in a residential setting. We assumed that low therapeutic alliance shortly after admission would be associated with elevated dropout. Methods 44 participants with borderline pathology (≥ 3 DSM-5 borderline personality disorder criteria) in a residential DBT program completed a quality assurance questionnaire set assessing demographic information, pretreatment psychopathology and therapeutic alliance during the first seven days of their residential stay. Predictors of dropout were investigated using binary logistic regression analyses. Results The dropout rate was 34.1% (n = 15). In binary logistic regression analyses with variables covering demographic and clinical characteristics, comorbidities and childhood trauma history, only the therapeutic alliance significantly predicted dropout (z = -2.371, p = .018). Conclusions This study supports the importance of therapy process variables, here the therapeutic alliance at the beginning of treatment, as predictors of therapy dropout in borderline pathology. If this finding is replicated, it shows the potential importance of monitoring the therapeutic relationship throughout the therapeutic process. ClinicalTrials.gov Identifier: NCT05289583, retrospectively registered on March 11, 2022

Personalized psychotherapy of posttraumatic stress disorder : Overview on the selection of treatment methods and techniques using statistical procedures

Steuwe C, Blaß J, Herpertz SC, Driessen M. Personalisierte Psychotherapie der posttraumatischen Belastungsstörung. Übersicht zur Auswahl von Behandlungsmethoden und -techniken mittels statistischer Verfahren. Nervenarzt, Der . 2023.BACKGROUND: Arelevant heterogeneity of treatment effects in posttraumatic stress disorder (PTSD) is discussed with respect to the debate about the necessity of phase-based treatment and in light of the new diagnosis of complex PTSD and has recently been proven; however, there has been little personalization in the treatment of PTSD. This article presents the current state of research on the personalized selection of specific psychotherapeutic methods for the treatment of PTSD based on patient characteristics using statistical methods.; METHODS: Asystematic literature search was conducted in the PubMed (including Medline), Embase, Web of Science Core Collection, Google Scholar, PsycINFO and PSYNDEX databases to identify clinical trials and reviews examining personalized treatment for PTSD.; RESULTS: A total of 13relevant publications were identified, of which 5articles were predictor analyses in samples without control conditions and 7articles showed analyses of randomized controlled trials (RCT) with apost hoc comparison of treatment effects in optimally and nonoptimally assigned patients. In addition, one article was asystematic review on the treatment of patients with comorbid borderline personality order and PTSD.; DISCUSSION: The available manuscripts indicate the importance and benefits of personalized treatment in PTSD. The relevant predictor variables identified for personalization should be used as asuggestion to investigate them in future prospective studies. © 2023. The Author(s).Hintergrund Eine relevante Heterogenität von Behandlungseffekten bei der posttraumatischen Belastungsstörung (PTBS) wird vor dem Hintergrund der Debatte um die Notwendigkeit einer phasenbasierten Behandlung sowie in Anbetracht der neuen Diagnose der komplexen PTBS diskutiert und ist inzwischen nachgewiesen. Dennoch gibt es bisher wenig Personalisierung in der Therapie der PTBS. Ziel der vorliegenden Arbeit ist es, den aktuellen Forschungsstand zur personalisierten Auswahl bestimmter Psychotherapiemethoden zur Behandlung der PTBS anhand von Patient:innenmerkmalen durch statistische Verfahren darzustellen. Methodik Es wurde eine systematische Literaturrecherche in den Datenbanken PubMed (inkl. Medline), Embase, Web of Science Core Collection, Google Scholar, PsycINFO und PSYNDEX zu klinischen Studien und Übersichtsarbeiten zu personalisierter Therapie der PTBS durchgeführt. Ergebnisse 13 relevante Publikationen wurden identifiziert, hiervon waren 5 Artikel Prädiktoranalysen in Stichproben ohne Kontrollbedingung. 7 Artikel zeigten Analysen von randomisiert-kontrollierten Studien (RCT) mit einem Post-hoc-Vergleich der Behandlungseffekte optimal und nichtoptimal zugeordneter Patient:innen. Zudem liegt ein Review-Artikel zur Behandlungsauswahl bei PTBS und komorbider BPS vor. Diskussion Die vorliegenden Publikationen deuten auf Bedeutung und Nutzen personalisierter Behandlung bei der PTBS hin. Die für die Personalisierung ermittelten relevanten Prädiktorvariablen sollten als Anregung genutzt werden, diese in prospektiven Studien genauer zu untersuchen

Borderline personality disorder and childhood trauma: Exploring the buffering role of self‐compassion and self‐esteem

Pohl S, Steuwe C, Mainz V, Driessen M, Beblo T. Borderline personality disorder and childhood trauma: Exploring the buffering role of self‐compassion and self‐esteem. Journal of Clinical Psychology. 2021;77(3):837-845.**Objectives** The aim of the present study was to investigate whether patients with borderline personality disorder (BPD) show lower self‐compassion and self‐esteem than healthy controls and whether patients’ self‐compassion and self‐esteem moderate the association between childhood trauma and the severity of their BPD symptoms. **Method** Self‐reported self‐compassion, self‐esteem, and the current severity of BPD symptoms were assessed in 35 female patients with BPD and 35 age‐matched control participants. Further, traumatic childhood experiences were recorded in the patient group. **Results** Patients with BPD reported significantly lower self‐compassion and self‐esteem compared to healthy controls. In addition, self‐compassion but not self‐esteem moderated the positive correlation between childhood trauma and the severity of BPD symptoms. **Discussion** Self‐compassion appears to buffer the negative consequences of childhood traumatization. Therefore, cultivating self‐compassion may be an important therapeutic aim for patients with BPD

Latent profile analysis and principal axis factoring of the DSM-5 dissociative subtype

Frewen PA, Brown MFD, Steuwe C, Lanius RA. Latent profile analysis and principal axis factoring of the DSM-5 dissociative subtype. European Journal of Psychotraumatology. 2015;6(1): 26406.Objective: A dissociative subtype has been recognized based on the presence of experiences of depersonalization and derealization in relation to DSM-IV posttraumatic stress disorder (PTSD). However, the dissociative subtype has not been assessed in a community sample in relation to the revised DSM-5 PTSD criteria. Moreover, the 20-item PTSD Checklist for DSM-5 (PCL-5) currently does not assess depersonalization and derealization. Method: We therefore evaluated two items for assessing depersonalization and derealization in 557 participants recruited online who endorsed PTSD symptoms of at least moderate severity on the PCL-5. Results: A five-class solution identified two PTSD classes who endorsed dissociative experiences associated with either 1) severe or 2) moderate PTSD symptom severity (D-PTSD classes). Those in the severe dissociative class were particularly likely to endorse histories of childhood physical and sexual abuse. A principal axis factor analysis of the symptom list identified six latent variables: 1) Reexperiencing, 2) Emotional Numbing/Anhedonia, 3) Dissociation, 4) Negative Alterations in Cognition & Mood, 5) Avoidance, and 6) Hyperarousal. Conclusions: The present results further support the presence of a dissociative subtype within the DSM-5 criteria for PTSD