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