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DOI: 10.1055/a-0591-3962
Stationäre Therapie der komplexen PTBS in Folge körperlicher oder sexualisierter Gewalt in der Kindheit: Wirksamkeit und Prädiktoren des Behandlungsverlaufs
Inpatient Treatment of Complex PTSD Following Childhood Abuse: Effectiveness and Predictors of Treatment OutcomePublication History
eingereicht 04 December 2017
akzeptiert 19 February 2018
Publication Date:
30 May 2018 (online)
![](https://www.thieme-connect.de/media/ppmp/20190304/lookinside/thumbnails/0966_10-1055-a-0591-3962-1.jpg)
Zusammenfassung
Hintergrund Die Wirksamkeit stationärer traumafokussierter Psychotherapie ist bei PatientInnen mit komplexer posttraumatischer Belastungsstörung (PTBS) insbesondere unter klinischen Routinebedingungen unzureichend belegt. Ziel dieser Untersuchung war neben der Verlaufsanalyse die Identifikation von Prädiktoren des Behandlungserfolges.
Methode 150 PatientInnen der Abteilung für Psychotraumatologie der Klinik St. Irmingard mit komplexer PTBS in Folge körperlicher oder sexualisierter Gewalt in der Kindheit beantworteten Fragebögen zu PTBS, Kindheitstraumata, Achtsamkeit, Dissoziation und allgemeiner Psychopathologie. Die Unterschiede zwischen Prä- und Postmessung wurden regressionsanalytisch untersucht. Mittels konditionalem Klassifikationsbaum wurde untersucht, welche Parameter eine Response prädizieren.
Ergebnisse Die signifikante Verbesserung der PTBS-Symptomatik entsprach einem großen Effekt (d=1,8) und einer Responserate von 52% gemäß Reliable Change Index (p<0,05). Hinsichtlich anderer Symptombereiche waren Verbesserungen in der Größenordnung mittlerer bis großer Effekte (0,5<d<1,1) zu beobachten. Sowohl Abbrüche (7%) als auch Verschlechterungen (4%) waren selten. Somatoforme Beschwerden, das Vorliegen einer komplexen dissoziativen Störung sowie Achtsamkeitsdefizite erwiesen sich als negative Prädiktoren einer reliablen Besserung der PTBS-Belastung.
Diskussion und Schlussfolgerung Traumafokussierte Psychotherapie ist unter naturalistischen Bedingungen bei PatientInnen mit komplexer PTBS sicher und wirksam durchführbar. Zugleich zeigen sich hohe Nonresponseraten. Zukünftige Untersuchungen sollten die Bedeutung der identifizierten Prädiktoren für Nonresponse näher untersuchen. Mögliche Maßnahmen zur Reduktion von Nonresponse werden diskutiert.
Abstract
Background There is a lack of studies investigating the effectiveness of inpatient trauma-focused psychotherapy of complex post-traumatic stress disorder. The first aim of this retrospective investigation was to analyze the course of PTSD. Second, possible predictors of treatment response were investigated.
Methods 150 inpatients of Clinic St. Irmingard with complex PTSD following childhood physical and childhood sexual abuse were assessed regarding childhood abuse, PTSD symptomatology, mindfulness, dissociation and general psychopathology. Differences in pre and post scores were analyzed using regression analyses. A classification tree was used to identify predictors of response.
Results The significant reduction of PTSD symptoms corresponded to a large effect (d=1.8) and a reponse rate of 52% according to the reliable change index (p<0.05). Effect sizes for other symptoms were medium to large (0.5<d<1.1) and both drop-outs (7%) and worsenings (4%) were scarce. Somatoform symptoms, complex dissociative disorders and mindfulness deficits were identified as negative predictors of reliable change.
Conclusions Trauma-focused inpatient treatment is safe and effective for patients with complex PTSD under naturalistic conditions. Yet, despite significant improvements there is a high rate of nonresponse. Future studies should further investigate the negative predictors of treatment outcome we identified. Possible ways to reduce nonresponse are discussed.
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