Authors: Eirini Melegkovits; Jocelyn Blumberg; Emily Dixon; Kimberley Ehntholt; Julia Gillard; Hamodi Kayal; Tim Kember; Livia Ottisova; Eileen Walsh; Maximillian Wood; Rafael Gafoor; Chris Brewin; Jo Billings; Mary Robertson; Michael Bloomfield · Research

How Effective Are Trauma-Focused Therapies for Complex PTSD?

Study examines effectiveness of trauma therapy approaches for complex PTSD in real-world clinical settings

Source: Melegkovits, E., Blumberg, J., Dixon, E., Ehntholt, K., Gillard, J., Kayal, H., ... & Bloomfield, M. (2023). The effectiveness of trauma-focused psychotherapy for complex post-traumatic stress disorder: A retrospective study. European Psychiatry, 66(1), e4, 1-9. https://doi.org/10.1192/j.eurpsy.2022.2346

What you need to know

  • Complex PTSD (CPTSD) is a more severe form of PTSD that typically develops after prolonged exposure to trauma, especially interpersonal trauma
  • Trauma-focused therapies like CBT and EMDR can significantly improve PTSD symptoms, depression, and overall functioning in people with CPTSD
  • Treatment often requires more sessions than standard PTSD therapy - an average of 28 sessions compared to the typical 8-12 sessions

Understanding Complex PTSD

Complex PTSD (CPTSD) is a relatively new diagnosis that differs from regular PTSD. While both conditions involve symptoms like flashbacks, nightmares, and avoiding trauma reminders, CPTSD includes additional challenges:

  • Difficulty managing emotions
  • Very negative beliefs about oneself
  • Problems maintaining relationships
  • More severe impairment in daily functioning

CPTSD typically develops after experiencing prolonged trauma, especially interpersonal trauma like:

  • Childhood abuse (physical, sexual, or emotional)
  • Domestic violence
  • Torture
  • Human trafficking
  • Genocide

The Treatment Approach

The study examined a phase-based treatment approach:

Phase 1: Stabilization (up to 5 sessions)

  • Education about PTSD
  • Learning grounding techniques for flashbacks
  • Developing safety and anxiety management skills
  • Getting help with practical problems (housing, finances)

Phase 2: Trauma Processing

Patients received one of three treatments:

  • Trauma-focused CBT
  • EMDR (Eye Movement Desensitization and Reprocessing)
  • A combination of both

These therapies help patients process traumatic memories and change negative beliefs about themselves, others, and the world.

What the Research Found

Improvements in Symptoms

After completing trauma-focused therapy:

  • Over half of patients showed significant improvement in PTSD symptoms
  • About half showed meaningful reduction in depression
  • Overall functioning improved, though many still had some difficulties
  • Both CBT and EMDR were equally effective

Important Considerations

  • Depression at the start of treatment predicted more severe PTSD symptoms and worse functioning
  • Treatment was safe - no patients had serious adverse effects
  • Most patients needed longer treatment than standard PTSD therapy
  • Many patients continued to have some functional difficulties even after treatment

Conclusions

  • Trauma-focused therapies can effectively treat Complex PTSD
  • Longer treatment duration is often needed compared to standard PTSD treatment
  • Depression should be carefully considered when planning treatment
  • While symptoms improve significantly, some patients may continue to need support with daily functioning
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