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. 2022 Sep 21;13(2):2114630.
doi: 10.1080/20008066.2022.2114630. eCollection 2022.

Complex PTSD and treatment outcomes in TF-CBT for youth: a naturalistic study

Tine K Jensen  1   2 , Nora Braathu  2 , Marianne Skogbrott Birkeland  2 , Silje Mørup Ormhaug  2 , Ane-Marthe Solheim Skar  2
Affiliations

Complex PTSD and treatment outcomes in TF-CBT for youth: a naturalistic study

Tine K Jensen et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: Complex posttraumatic stress disorder (CPTSD) has recently been added to the ICD-11 diagnostic system for classification of diseases. The new disorder adds three symptom clusters to posttraumatic stress disorder (PTSD) related to disturbances in self-organization (affect dysregulation, negative self-concept, and disturbances in relationships). Little is known whether recommended evidence-based treatments for PTSD in youth are helpful for youth with CPTSD. Objectives: This study examined whether Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is useful in reducing PTSD and CPTSD in traumatized youth. Methods: Youth (n = 73, 89.0% girls, M age = 15.4 SD = 1.8) referred to one of 23 Norwegian child and adolescent mental health clinics that fulfilled the criteria for PTSD or CPTSD according to ICD-11 and received TF-CBT were included in the study. Assessments were conducted pre-treatment, and every fifth session. Linear mixed effects models were run to investigate whether youth with CPTSD and PTSD responded differently to TF-CBT. Results: Among the 73 youth, 61.6% (n = 45) fulfilled criteria for CPTSD and 38.4% (n = 28) fulfilled criteria for PTSD. There were no differences in sex, age, birth country, trauma type, number of trauma types or treatment length across groups. Youth with CPTSD had a steeper decline in PTSD and CPTSD compared to youth with PTSD. The groups reported similar levels of PTSD and CPTSD post-treatment. The percentage of youth who dropped out of treatment was not different across groups. Further, the groups did not differ significantly in number of received treatment sessions. Conclusions: This is the first study to examine whether TF-CBT is helpful for youth who have CPTSD using a validated instrument for measuring CPTSD. The results suggest that TF-CBT may be useful for treating CPTSD in youth. These are promising findings that should be replicated in studies with larger sample sizes.

Antecedentes: El trastorno de estrés postraumático complejo (TEPT-C) ha sido agregado recientemente al sistema de diagnóstico para la clasificación de enfermedades CIE-11. El nuevo trastorno agrega tres grupos de síntomas al trastorno de estrés postraumático (TEPT), relacionados con alteraciones en la autoorganización (desregulación afectiva, autoconcepto negativo y alteraciones en las relaciones). Poco se sabe acerca de si los tratamientos basados en evidencia recomendados para el TEPT en jóvenes son útiles para los jóvenes con TEPT-C.Objetivos: Este estudio examinó si la Terapia Cognitiva Conductual Centrada en el Trauma (TF-CBT en sus siglas en inglés) es útil para reducir el TEPT y el TEPT-C en jóvenes traumatizados.Método: Se incluyó en el estudio a jóvenes derivados a una de las 23 clínicas noruegas de salud mental para niños y adolescentes, que cumplían con los criterios para TEPT o TEPT-C según el CIE-11 y recibieron TF-CBT (n = 73, 89% niñas, M edad = 15,4, DE = 1,8). Se realizaron evaluaciones antes del tratamiento y cada cinco sesiones. Se ejecutaron modelos de efectos mixtos lineales para investigar si los jóvenes con TEPT-C y TEPT respondían de manera diferente a la TF-CBT.Resultados: Entre los 73 jóvenes, el 61,6% (n = 45) cumplió con los criterios de TEPT-C y el 38,4% (n = 28) cumplió con los criterios de TEPT. No hubo diferencias en sexo, edad, país de nacimiento, tipo de trauma, número de tipos de trauma o duración del tratamiento entre los grupos. Los jóvenes con TEPT-C tuvieron una disminución más pronunciada en TEPT y TEPT-C en comparación con los jóvenes con TEPT. Los grupos reportaron niveles similares de TEPT y TEPT-C después del tratamiento. El porcentaje de jóvenes que abandonaron el tratamiento no difirió entre los grupos. Además, los grupos no difirieron significativamente en el número de sesiones de tratamiento recibidas.Conclusiones: Éste es el primer estudio que examina si la TF-CBT es útil para los jóvenes que tienen TEPT-C mediante un instrumento validado para medir el TEPT. Los resultados sugieren que la TF-CBT puede ser útil para tratar el TEPT-C en jóvenes. Estos son hallazgos prometedores que deberían replicarse en estudios con tamaños muestrales más grandes.

背景：复杂性创伤后应激障碍 (CPTSD) 最近已被添加到用于疾病分类的 ICD-11 诊断系统中。这种新疾病在创伤后应激障碍 (PTSD)中增加了三个自我组织障碍相关的症状簇（情感失调、消极自我概念和人际关系障碍）。对于青少年 PTSD 的推荐循证治疗对于患有 CPTSD 的青少年是否有帮助尚不清楚。目的：本研究考查了聚焦创伤的认知行为疗法 (TF-CBT) 是否有助于减少受创伤青少年的 PTSD 和 CPTSD。方法：研究纳入了被转诊至 23 家挪威儿童和青少年心理健康诊所之一的符合 ICD-11 PTSD 或 CPTSD 标准并接受了 TF-CBT的青少年（n = 73，89.0 % 女孩，平均年龄 = 15.4，标准差 = 1.8）。评估在治疗前进行，每五个疗程进行一次。采用线性混合效应模型以考查患有 CPTSD 和 PTSD 的青少年对 TF-CBT 的反应是否不同。结果：在 73 名青少年中，61.6%（n = 45）符合 CPTSD 标准，38.4%（n = 28）符合 PTSD 标准。性别、年龄、出生国家、创伤类型、创伤类型数量或治疗时间方面没有组间差异。与患有 PTSD 的青少年相比，患有 CPTSD 的青少年的 PTSD 和 CPTSD 下降幅度更大。这些组别报告了治疗后相似水平的 PTSD 和 CPTSD。退出治疗青少年的百分比无组间差异。此外，各组在接受治疗的次数上没有显著差异。结论：这是第一项使用经过验证的 CPTSD 测量工具考查 TF-CBT 对于患有 CPTSD 的青少年是否有帮助的研究。结果表明，TF-CBT 可能对治疗青少年 CPTSD 有用。这些有希望的发现应该在更大样本量的研究中重复。.

Keywords: Complex PTSD; TF-CBT; children; trauma; treatment; youth.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Levels of posttraumatic stress symptoms (PTSS) in youth with CPTSD compared to youth with PTSD over the course of TF-CBT, measured pre-treatment, session 5, session 10, session 15 and post-treatment.
Figure 2.
Figure 2.
Levels of complex posttraumatic stress symptoms (CPTSS) in youth with CPTSD compared to youth with PTSD over the course of TF-CBT, measured pre-treatment, session 5, session 10, session 15 and post-treatment.
Figure 3.
Figure 3.
Levels of disturbances in self-organization (DSO) in youth with CPTSD compared to youth with PTSD over the course of TF-CBT, measured pre-treatment, session 5, session 10, session 15 and post-treatment.
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