Uit mijn eigen gevangenis

Traumagerichte therapie bij complexe ptss
02/02/2024
Charesca Henriette, Dr. Jackie June ter Heide
1 reactie
W2-afbeelding
Issue 1

Samenvatting

ESCAPING MY PRISON: Trauma-focused therapy for COMPLEX ptsd

Charesca Henriette & Jackie June ter Heide

Despite the fact that treatment guidelines recommend trauma-

focused therapy as treatment of choice for adults who meet the criteria for posttraumatic stress disorder (ptsd), some clinicians still consider ‘complex’ patients the exception to the rule. Patient complexity may be related to traumatic experiences (multiple, prolonged, and childhood experiences) as well as to trauma symptomatology (including the dissociative subtype of ptsd, complex ptsd, and comorbid disorders). In the Netherlands, less than 40% of patients with ptsd are offered trauma-focused therapy, which leads to unnecessarily long and possibly ineffective treatment trajectories. This paper, written by a former patient and a therapist, describes the long road taken to achieve healing, and the scientific evidence that supports the effectiveness of trauma-focused treatment, even in so-called ‘complex’ patients.

 

350 Weergaven
10 Downloads
  • Samenvatting
  • Trauma en PTSS
  • Indicatiestelling en behandeling
  • Traumagerichte behandeling
  • Behandelresultaat
  • Conclusie
  • Literatuurlijst
  • Over de auteur
Log in
Een vroegkinderlijk getraumatiseerde patiënt met een diagnose van complexe posttraumatische stressstoornis (ptss), depressie en persoonlijkheidsproblematiek vraagt in februari 2016 een second opinion aan bij een instelling voor psychotrauma. Een traumagerichte behandeling is haar ontraden: te veel risico op decompensatie. Twee jaar later wordt dezelfde patiënt uitgeschreven bij de instelling. Aan een ptss-diagnose voldoet ze niet meer na een traject van intensieve exposure en emdr-therapie.

Het meemaken van seksueel of lichamelijk geweld in de kindertijd kan leiden tot ernstige vormen van posttraumatische stressstoornis (ptss; American Psychiatric Association, 2013). Traumagerichte therapieën, zoals emdr en traumagerichte cognitieve gedragstherapie, zijn effectief in het verminderen van ptss en zijn daarom in de behandelrichtlijnen opgenomen als behandelingen van eerste keus (GGZ Standaarden, 2020). Ondanks dat behandelaren geacht worden deze richtlijnen te volgen, krijgen de meeste Nederlandse patiënten met ptss deze behandelingen niet aangeboden (Zorginstituut Nederland, 2020), vaak vanuit de gedachte dat complex getraumatiseerde patiënten een traumagerichte behandeling niet aankunnen (zie bijvoorbeeld Bloemink, 2016). Door deze terughoudendheid wordt een groot deel van de Nederlandse patiënten met ptss een effectieve behandeling onthouden en duren de klachten onnodig lang voort.

De discussie over het al dan niet aanbieden van traumagerichte behandeling vindt op allerlei plekken plaats: in artikelen, tijdens congressen, in team-overleggen en op LinkedIn. Zelden is daarin

Literatuurlijst

  1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. Barawi, K. S., Lewis, C., Simon, N., & Bisson, J. I. (2016). A systematic review of factors associated with outcome of psychological treatments for post-traumatic stress disorder. European Journal of Psychotraumatology, 11, 1774240. https://doi.org/10.1080/20008198.2020.1774240
  3. Bloemink, S. (2016). De trauma-paradox: Waarom in de GGZ de mensen met de grootste problemen het minst worden geholpen. De Groene Amsterdammer, 9.
  4. Brady, K. T., Killeen, T. K., Brewerton, T., & Lucerini, S. (2000). Comorbidity of psychiatric disorders and posttraumatic stress disorder. Journal of Clinical Psychiatry, 62(7), 22-32.
  5. Burback, L., Brémault-Phillips, S., Nijdam, M. J., McFarlane, A., & Vermetten, E. (2023). Treatment of posttraumatic stress disorder: A state-of-the-art review. Current Neuropharmacology. https://doi.org./
  6. Burger, S. R., Hardy, A. H., Van der Linden, T., Van Zelst, C., De Bont, P. A. J., Van der Vleugel, B., Staring, A. B. P., De Roos, C., De Jongh, A., Marcelis, M., Van Minnen, A., Van der Gaag, M., &  Van den Berg, D. P. G. (2023). The bumpy road of trauma-focused treatment: Posttraumatic stress disorder symptom exacerbation in people with psychosis. Journal of Traumatic Stress, 36(2), 299-309. https://doi.org/10.1002/jts.22907
  7. Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Cook Middleton, J., Feltner, C., Brownley, K. A., Olmsted, K. R., Greenblatt, A., Weil, A., & Gaynes, B. N. (2016). Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clinical Psychology Review, 43, 128-141. http://dx.doi.org/10.1016/j.cpr.2015.10.003
  8. De Bont, P. A. J. M., Van der Vleugel, B M., Van den Berg, D. P. G., De Roos, C., Lokkerbol, J., Smit, F., De Jongh, A., Van der Gaag, M. & Van Minnen, A. (2019). Health–economic benefits of treating trauma in psychosis. European Journal of Psychotraumatology, 10:1, 1565032. https://doi.org/10.1080/20008198.2018.1565032
  9. Dell, L., Sbisa, A. M., Forbes, A., O’Donnell, M., Bryant, R., Hodson, S., Morton, D., Battersby, M., Tuerk, P. W., Wallace, D., & Forbes, D. (2022). Effect of massed v. standard prolonged exposure therapy on PTSD in military personnel and veterans: A non-inferiority randomised controlled trial. Psychological Medicine, 1–8. https://doi.org/10.1017/S0033291722000927
  10. De Vries, G. J., & Olff, M. (2009). The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands. Journal of Traumatic Stress, 22(4), 259–267. https://doi.org/10.1002/jts.20429
  11. Ehlers, A., Hackmann, A., Grey, N., Wild, J., Liness, S., Albert, I., Deale, A., Stott, R., & Clark, D. M. (2014). A randomized controlled trial of 7-day intensive and standard weekly cognitive therapy for PTSD and emotion-focused supportive therapy. American Journal of Psychiatry, 171(3), 294-304. https://doi.org/10.1176/appi.ajp.2013.13040552
  12. Eurelings-Bontekoe, E. H. M., & Snellen, W. M. (2021). Dynamische persoonlijkheidsdiagnostiek (5e editie). Pearson.
  13. Foa, E., B., McLean, C. P., Zang, Y., Rosenfield, D., Yadin, E., Yarvis, J. S., Mintz, J., Young-McCaughan, S., Borah, E. V., Dondanville, K. A., Fina, B. A., Hall-Clark, B. N., Lichner, T., Litz, B. T., Roache, J., Wright, E. C., & Peterson, A. L., for the STRONG STAR Consortium (2018). Effect of prolonged exposure therapy delivered over 2 weeks vs 8 weeks vs present-centered therapy on PTSD symptom severity in military personnel A randomized clinical trial. 2018. JAMA, 319(4), 354-364. https://doi.org/10.1001/jama.2017.21242
  14. GGZ Standaarden (2020). Zorgstandaard psychotrauma en stressorgerelateerde stoornissen.
  15. Hendriks, L., De Kleine, R. A., Broekman, T. G., Hendriks, G. J., & Van Minnen, A. (2018). Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts. European Journal of Psychotraumatology, 9:1, 1425574. https://doi.org/10.1080/20008198.2018.1425574
  16. Hoppen, T. H., Lindemann, A. S., & Morina, N. (2022). Safety of psychological interventions for adult post-traumatic stress disorder: Meta-analysis on the incidence and relative risk of deterioration, adverse events and serious adverse events. British Journal of Psychiatry, 221, 658-667.
  17. Kolthof, K. A., Voorendonk, E. M., Van Minnen, A., & De Jongh, A. (2022). Effects of intensive trauma-focused treatment of individuals with both post-traumatic stress disorder and borderline personality disorder. European Journal of Psychotraumatology, 13:2, 2143076. https://doi.org/10.1080/20008066.2022.2143076
  18. Kullberg, M. L. J., Schoorl, M., Oprel, D. A. C., Hoeboer, C.M., Smit, F., Van der Does, W., De Kleine, R. A., Van Minnen, A., & Van den Hout, W. (2023). Exposure-based treatments for childhood abuse-related post-traumatic stress disorder in adults: A health-economic evaluation. European Journal of Psychotraumatology, 14:1, 2171752. https://doi.org/10.1080/20008066.2023.2171752
  19. Lancel, M., Van Marle, H. J. F., Van Veen, M. M., & Van Schagen, A. M. (2021) Disturbed sleep in PTSD: Thinking beyond nightmares. Frontiers in Psychiatry, 12:767760. https://doi.org/10.3389/fpsyt.2021.767760
  20. Lewis, C., Roberts, N. P., Gibson, S., & Bisson, J. I. (2020). Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11, 1709702. https://doi.org/10.1080/20008198.2019.1709709
  21. Lloyd, A., & Borrill, J. (2020). Examining the effectiveness of restorative justice in reducing victims’ post-traumatic stress. Psychological Injury and Law, 13, 77-89. https://doi.org/10.1007/s12207-019-09363-9
  22. Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C., & Bohus, M. (20223). Complex post-traumatic stress disorder. Lancet, 400(10345), 60-72.
  23. Mavranezouli, I., Megnin-Viggars, O., Grey, N., Bhutani, G., Leach, J., Daly, C., Dias, S., Welton, N. J., Katona, C., El-Leithy, S., Greenberg, N., Stockton, S., & Pilling, S. (2020). Cost-effectiveness of psychological treatments for post-traumatic stress disorder in adults. PLoS ONE, 15(4): e0232245.
  24. Neuner, F. (2023). Physical and social trauma: Towards an integrative transdiagnostic perspective on psychological trauma that involves threats to status and belonging. Clinical Psychology Review, 99. https://doi.org/10.1016/j.cpr.2022.102219
  25. Oprel, D. A. C., Hoeboer, C. M., Schoorl, M., De Kleine, R. A., Cloitre, M., Wigard, I. G., Van Minnen, A., & Van der Does, W. (2021). Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: A randomized controlled trial. European Journal of Psychotraumatology, 12:1, 1851511. https://doi.org/10.1080/20008198.2020.1851511
  26. Peterson, A. L., Blount, T. H., Foa, E. B., Brown, L. A., McLean, C. P., Mintz, J., Schobitz, R. P., DeBeer, B. R., Mignogna, J., Fina, B. A., Evans, W. R., Synett, S., Hall-Clark, B. N., Rentz, T. O., Schrader, C., Yarvis, J. S., Dondanville, K A., Hansen, H., Jacoby, V. M., … & Keane, T. M., for the Consortium to Alleviate PTSD (2023). Massed vs intensive outpatient prolonged exposure for combat-related posttraumatic stress disorder: A randomized clinical trial. JAMA Network Open, 6(1):e2249422.
  27. Smid, G.E., Van der Meer, C.A.I., Olff, M., Nijdam, M.M. (2018). Predictors of outcome and residual symptoms following trauma-focused psychotherapy in police officers with posttraumatic stress disorder. Journal of Traumatic Stress, 31, 764–774. https://doi.org/10.1002/jts.22328
  28. Van den Berg, D. P. G., De Bont, P. A. J. M., Van der Vleugel, B. M., De Roos, C., De Jongh, A., Van Minnen, A., Van der Gaag, M. (2015). Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patient with a psychotic disorder: A randomized clinical trial. JAMA Psychiatry, 72(3), 259-267.
  29. Van der Meer, C.A.I., Bakker, A., Smit, A.S., Van Buschbach, S., Den Dekker, M., Westerveld, G.J., Hutter, R.C., Gersons, B.P.R., & Olff, M. (2017). Gender and age differences in trauma and PTSD among Dutch treatment-seeking police officers. Journal of Nervous and Mental Disease, 205, 87–92. https://doi.org/10.1097/NMD.0000000000000562
  30. Van Minnen, A., Hendriks, L., & Olff, M. (2010). When do trauma experts choose exposure therapy for PTSD patients? A controlled study of therapist and patient factors. Behaviour Research and Therapy, 48, 312-320.
  31. Van Minnen, A., Ter Heide, F. J. J., Koolstra, T., De Jongh, A., Karaoglu, S. & Gevers, T. (2022). Initial development of perpetrator confrontation using deepfake technology in victims with sexual violence-related PTSD and moral injury. Frontiers in Psychiatry, 13:882957. https://doi.org/10.3389/fpsyt.2022.882957
  32. Van Pelt, Y., Fokkema, P., De Roos, C., & De Jongh, A. (2021). Effectiveness of an intensive treatment programme combining prolonged exposure and EMDR therapy for adolescents suffering from severe post-traumatic stress disorder. European Journal of Psychotraumatology, 12:1. https://doi.org/
  33. Van Toorenburg, M. M., Sanches, S. A., Linders, B., Rozendaal, L., Voorendonk, E. M., Van Minnen, A., & De Jongh, A. (2020). Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD? European Journal of Psychotraumatology, 11:1, 1724417. https://doi.org/10.1080/20008198.2020.1724417
  34. Van Vliet, N. I., Huntjens, R. J. C., Van Dijk, M. K., Bachrach, N., Meewisse, M. L., & De Jongh, A. (2021). Phase-based treatment versus immediate trauma-focused treatment for post-traumatic stress disorder due to childhood abuse: Randomised clinical trial. BJPsych Open, 7, e211, 1-7.
  35. Van Woudenberg, E., Voorendonk, E. M., Bongaerts, H., Zoet, H. A., Verhagen, M., Lee, C. W., Van Minnen, A., & De Jongh, A. (2018). Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder. European Journal of Psychotraumatology, 9:1, 1487225. https://doi.org/10.1080/20008198.2018.1487225
  36. Voorendonk, E. M., De Jongh, A., Rozendaal, L., & Van Minnen, A. (2020). Trauma-focused treatment outcome for complex PTSD patients: Results of an intensive treatment programme. European Journal of Psychotraumatology, 11:1, 1783955.
  37. White, W. F., Burgess, A., Dalgleish, T., Halligan, S., Hiller, R., Oxley, A., Smith, P., & Meiser-Stedman, R. (2022). Prevalence of the dissociative subtype of post-traumatic stress disorder: A systematic review and meta-analysis. Psychological Medicine, 52, 1629–1644.
  38. World Health Organization (2019/2021). International Classification of Diseases, Eleventh Revision (ICD-11). .
  39. Zoet, H. A., Wagenmans, A., Van Minnen, A., & De Jongh, A. (2018). Presence of the dissociative subtype of PTSD does not moderate the outcome of intensive trauma-focused treatment for PTSD. European Journal of Psychotraumatology, 9:1, 1468707.
  40. Zepeda Méndez, M., Nijdam, M. J., Ter Heide, F. J. J., Van der Aa, N., & Olff, M. (2018). A 5-day inpatient EMDR treatment programme for PTSD: Pilot study. European Journal of Psychotraumatology, 9:1, 1425575. https://doi.org/10.1080/20008198.2018.1425575
  41. Zorginstituut Nederland (2020). Verbetersignalement Posttraumatische stress-stoornis.