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1
Psychotrauma Expertise Centre (PSYTREC), Bilthoven, Netherlands.
2
Sinai Centrum, Amersfoort, Netherlands.
3
Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands.
4
Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands.
5
School of Health Sciences, Salford University, Manchester, UK.
6
Institute of Health and Society, University of Worcester, Worcester, UK.
7
School of Psychology, Queen's University, Belfast, UK.
1
Psychotrauma Expertise Centre (PSYTREC), Bilthoven, Netherlands.
2
Sinai Centrum, Amersfoort, Netherlands.
3
Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands.
4
Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands.
5
School of Health Sciences, Salford University, Manchester, UK.
6
Institute of Health and Society, University of Worcester, Worcester, UK.
7
School of Psychology, Queen's University, Belfast, UK.
Background:
Research indicates that intensive trauma-focused therapy can be effective in alleviating symptoms of post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). However, these studies have relied on self-report of BPD symptoms and follow-up data are scarce.
Objective:
The purpose of this feasibility study was to determine the effects of an intensive trauma-focused treatment programme on the severity of PTSD and BPD symptoms and the diagnostic status up to a 12-month follow-up.
Methods:
A total of 45 (60% female) individuals meeting the diagnostic criteria of both PTSD and BPD participated in an intensive eight-day trauma-focused treatment programme which combined prolonged exposure and EMDR therapy in an inpatient treatment setting. Severity of PTSD and BPD symptoms were assessed at pre-treatment, post-treatment, 6 months, and 12 months after treatment (CAPS-5, BPDSI-IV). Diagnostic status was determined using clinical interviews (CAPS-5 and SCID-5-P) at pre-treatment and 12-month follow-up.
Results:
Of all participants, 93.3% had been exposed to physical abuse, and 71.1% to sexual abuse prior to the age of 12 years. PTSD and BPD symptom severity significantly decreased from pre- to post-treatment (Cohen's
ds
: 1.58 and 0.98, respectively), and these results were maintained at 6- (
ds
: 1.20 and 1.01) and 12-month follow-up (
ds
: 1.53 and 1.36). Based upon CAPS-5, 69.2% no longer met the diagnostic criteria of PTSD at 12-month follow-up, while according to the SCID-5-P 73.1% no longer fulfilled the diagnostic criteria of BPD at that time. No significant worsening of symptoms occurred.
Conclusion:
The findings of this study, which is the first to examine the effects of psychotherapeutic treatment of PTSD on the presence of a borderline personality disorder one year after treatment, add support to the notion that a brief intensive trauma-focused treatment can be a valuable option for individuals suffering from both PTSD and BPD.
Antecedentes:
Las investigaciones indican que la terapia intensiva centrada en el trauma puede ser eficaz para aliviar los síntomas del trastorno de estrés postraumático (TEPT) y el trastorno límite de la personalidad (TLP). Sin embargo, estos estudios se han basado en el autoinforme de los síntomas del TLP y los datos de seguimiento son escasos.
Método:
Un total de 45 personas (60% mujeres) que cumplían con los criterios diagnósticos de TEPT y TLP participaron en un programa de tratamiento intensivo de ocho días centrado en el trauma que combinaba exposición prolongada y terapia EMDR en un entorno de tratamiento para pacientes hospitalizados. La gravedad de los síntomas de TEPT y TLP se evaluó antes del tratamiento, después del tratamiento, 6 meses y 12 meses después del tratamiento (CAPS-5, BPDSI-IV). El estado de diagnóstico se determinó mediante entrevistas clínicas (CAPS-5 y SCID-5-P) antes del tratamiento y a los 12 meses de seguimiento.
Resultados:
Del total de participantes, el 93,3% había estado expuesto a maltrato físico y el 71,1% a abuso sexual antes de los 12 años. La gravedad de los síntomas de TEPT y TLP disminuyó significativamente desde el pretratamiento hasta el postratamiento (
ds
de Cohen: 1,58 y 0,98, respectivamente), y estos resultados se mantuvieron a los 6 meses (
ds
: 1,20 y 1,01) y 12 meses de seguimiento (
ds
: 1.53 y 1.36). Según el CAPS-5, el 69,2% ya no cumplía los criterios diagnósticos de TEPT a los 12 meses de seguimiento, mientras que según el SCID-5-P, el 73,1% ya no cumplía los criterios diagnósticos de TLP en ese momento. No se produjo un empeoramiento significativo de los síntomas.
Conclusión:
Los hallazgos de este estudio, que es el primero en examinar los efectos del tratamiento psicoterapéutico del TEPT en la presencia de un trastorno límite de la personalidad un año después del tratamiento, respaldan la noción de que un tratamiento intensivo breve centrado en el trauma puede ser un opción valiosa para las personas que sufren de TEPT y TLP.
Post-traumatic stress disorder; Trastorno de estrés postraumático; borderline personality disorder; diagnostic status; estado de diagnóstico; intensive trauma-focused treatment; resultado del tratamiento; trastorno límite de la personalidad; tratamiento intensivo centrado en el trauma; treatment outcome; 创伤后应激障碍; 治疗结果; 聚焦创伤的强化治疗; 诊断状态; 边缘性人格障碍.
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