EFFECTIVE PSYCHOLOGICAL TREATMENTS SPECIFIC TO INDIVIDUALS SUFFERING FROM POST-TRAUMATIC STRESS DISORDER DUE TO CHILDHOOD ABUSE

Year 2023, Volume: 25 Issue: 3, 1278 - 1307, 15.09.2023

Melek Sever Fatima Zehra Allahverdi

https://doi.org/10.16953/deusosbil.1282604

Abstract

Abuse experienced during childhood, whether it is emotional, physical, sexual, or economic, has an impact on an individual’s mental well-being. Those who experience these abuses may develop multiple psychopathologies simultaneously, with the most common psychopathology observed being Post-Traumatic Stress Disorder (PTSD). Particularly, children who experience physical and sexual abuse are at a higher risk of developing this disorder. The aim of this study is to explore effective, evidence-based, and up-to-date psychological treatments for individuals who develop PTSD due to the abuse endured during childhood. Proven intervention techniques for individuals developing PTSD as a result of sexual abuse are Trauma-Focused Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Skills Training in Affect and Interpersonal Regulation (STAIR), Emotion-Focused Therapy for Trauma (EFT), Eye Movement Desensitization and Reprocessing (EMDR), and Imagery Rescripting (IR).

Keywords

Sexual Abuse, Community Mental Health, CBT, DBT, EMDR, Physical Abuse, STAIR, PTSD.

Çocukluk Döneminde Maruz Kalınan İstismar Nedeniyle Travma Sonrası Stres Bozukluğu Yaşayan Bireylere Özgü Etkili Psikolojik Tedaviler

Abstract

Çocukluk döneminde yaşanan duygusal, fiziksel, cinsel ve ekonomik istismar kişiyi ruhsal yönde olumsuz olarak etkilemektedir. Bu istismarları yaşayan kişiler birden fazla psikopatolojiyi aynı anda geliştirebilirken bu kişilerde en sık rastlanan psikopatoloji Travma Sonrası Stres Bozukluğu (TSSB)’dur. Özellikle fiziksel ve cinsel istismar yaşayan çocukların bu bozukluğu geliştirme riski daha yüksektir. Bu çalışmanın amacı çocukluk döneminde maruz kalınan istismardan dolayı TSSB geliştiren bireyler için etkili, kanıtlanmış, güncel psikolojik tedavileri araştırmaktır. Cinsel istismardan dolayı TSSB geliştiren bireyler için kanıtlanmış müdahale teknikleri: Travma Odaklı Bilişsel Davranışçı Terapi (BDT), Diyalektik Davranış Terapi (DDT), Duygu ve Kişilerarası İlişkiyi Düzenleme Becerisi Eğitimi (STAIR), Travma için Duygu Odaklı Terapi (DOT), Göz Hareketleriyle Duyarsızlaştırma ve Yeniden İşlemleme (EMDR), Yeniden Senaryolaştırma (Imagery Rescripting, IR)’dır.

Keywords

Cinsel İstismar, Toplum Ruh Sağlığı, BDT, DDT, EMDR, Fiziksel İstismar, STAIR, Travma Sonrası Stres Bozukluğu.

References

• Amerikan Psikoloji Birliği (2013). DSM-5 tanı ölçütleri başvuru el kitabı. (E., Köroğlu, Çev.). Ankara: Hekimler Yayın Birliği
• Arntz, A. (2012). Imagery rescripting as a therapeutic technique: Review of clinical trials, basic studies, and research agenda. Journal of Experimental Psychopathology, 3(2), 189-208.
• Arntz, A., & Weertman, A. (1999). Treatment of childhood memories: Theory and practice. Behaviour Research and Therapy, 37(8), 715-740.
• Bækkelund, H., Karlsrud, I., Hoffart, A., & Arnevik, E. A. (2021). Stabilizing group treatment for childhood-abuse related PTSD: A randomized controlled trial. European Journal of Psychotraumatology, 12(1), 1859079.
• Başbakanlık Sosyal Hizmetler ve Çocuk Esirgeme Kurumu & UNICEF-Türkiye (2010). Türkiye’de çocuk istismarı ve aile içi şiddet araştırması.https://www.unicef.org/turkey/raporlar/türkiyede-çocuk-istismari-ve-aile-içi-şiddet- araştirmasi-özet-raporu-2010
• Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561– 571.
• Bernstein, D., & Fink, L. (1998). Manual for the Childhood Trauma Questionnaire. San Antonio, TX: Psychological Corporation.
• Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis. The British Journal of Psychiatry, 190(2), 97-104.
• Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498.
• Bohus, M., Dyer, A. S., Priebe, K., Krüger, A., Kleindienst, N., Schmahl, C., Niedfeld, I., & Steil, R. (2013). Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: A randomised controlled trial. Psychotherapy and Psychosomatics, 82(4), 221-233.
• Borg, K., Snowdon, C., & Hodes, D. (2014). Child sexual abuse: Recognition and response when there is a suspicion or allegation. Pediatrics and Child Health, 24(12), 536-543.
• Briere, J., Madni, L. A., & Godbout, N. (2016). Recent suicidality in the general population: Multivariate association with childhood maltreatment and adult victimization. Journal of Interpersonal Violence, 31(18), 3063-3079.
• Brown, R. L., Wood, A., Carter, J. D., & Kannis‐Dymand, L. (2022). The metacognitive model of post‐traumatic stress disorder and metacognitive therapy for post‐traumatic stress disorder: A systematic review. Clinical Psychology & Psychotherapy, 29(1), 131-146.
• Cloitre, M., & Koenen, K. C. (2001). The impact of borderline personality disorder on process group outcome among women with posttraumatic stress disorder related to childhood abuse. International Journal of Group Psychotherapy, 51(3), 379-398.
• Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. European Journal of Psychotraumatology, 4(1), 20706.
• Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70(5), 1067-1074.
• Cloitre, M., Petkova, E., Wang, J., & Lu, F. (2012). An examination of the influence of a sequential treatment on the course and impact of dissociation among women with PTSD related to childhood abuse. Depression and Anxiety, 29(8), 709-717.
• Cloitre, M., Roberts, N. P., Bisson, J. I., & Brewin, C. R. (2015). The ICD-11 Trauma Questionnaire (ICD-TQ). [Unpublished Measure].
• Cloitre, M., Stovall-McClough, K. C., Nooner, K., Zorbas, P., Cherry, S., Jackson, C. L., Weijin Gan, E.P., & Petkova, E. (2010). Treatment for PTSD related to childhood abuse: A randomized controlled trial. American Journal of Psychiatry, 167(8), 915-924.
• Cutajar, M. C., Mullen, P. E., Ogloff, J. R., Thomas, S. D., Wells, D. L., & Spataro, J. (2010). Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse & Neglect, 34(11), 813-822.
• Davidson, J. R. T., Tharwani, H. M., & Connor, K. M. (2002). Davidson Trauma Scale (DTS): Normative scores in the general population and effect sizes in placebo-controlled SSRI trials. Depression and Anxiety, 15(2), 75–78.
• 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.
• Derogatis, L. R., Lipman, R. S., & Covi, L. (1973). SCL-90: An outpatient psychiatric rating scale-preliminary report. Psychopharmacology Bulletin, 9(1), 13–28.
• Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., Clifton, M.L., & Giles, W. H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 28(7), 771-784.
• Dorrepaal, E., Thomaes, K., Smit, J. H., Van Balkom, A. J., van Dyck, R., Veltman, D. J., & Draijer, N. (2010). Stabilizing group treatment for complex posttraumatic stress disorder related to childhood abuse based on psycho-education and cognitive behavioral therapy: A pilot study. Child Abuse & Neglect, 34(4), 284-288.
• Draijer, N. (1989). Structured Trauma Interview. Amsterdam: Free University, Department of Psychiatry.
• Draijer, N., & Langeland, W. (1999). Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients. American Journal of Psychiatry, 156(3), 379–385.
• Ehring, T., Welboren, R., Morina, N., Wicherts, J. M., Freitag, J., & Emmelkamp, P. M. (2014). Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clinical Psychology Review, 34(8), 645-657.
• Ertan, E. A., & Cankorur, V. Ş. (2017). Kişilik bozukluklarının tanısı: yeni bulgular ile tanıda kullanılan anket ve ölçekler. Kriz Dergisi, 25(1).
• Foa, E. B., & Tolin, D. F. (2000). Comparison of the PTSD symptom scale-interview version and the clinician-administered PTSD scale. Journal of Traumatic Stress, 13(2), 181–191.
• Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993). PTSD Symptom Scale-Interview Version (PSS-I) [Database record]. PsycTests. https://doi.org/10.1037/t05176-000
• Franke, G.H. (1995). SCL-90-R: Die Symptom-Check Liste Von Derogatis-Deutsche Version. Göttingen: Belz Test Gesellschaft.
• Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden and consequences of child maltreatment in high-income countries. The Lancet, 373(9657), 68-81.
• Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54.
• Griesel, D., Wessa, M., & Flor, H. (2006). Psychometric porperties of the German version of the posttraumatic diagnostic scale (PDS). Psychological Assessment, 18(3), 262-268.
• Hackmann, A. (2011). Imagery rescripting in posttraumatic stress disorder. Cognitive and Behavioral Practice, 18(4), 424-432.
• Harned, M. S., Rizvi, S. L., & Linehan, M. M. (2010). Impact of co-occurring posttraumatic stress disorder on suicidal women with borderline personality disorder. American Journal of Psychiatry, 167(10), 1210-1217.
• Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377-391.
• Hoeboer, C.M., Oprel, D.A., De Kleine, R.A., Schwartz, B., Deisenhofer, A.K., Schoorl, M., Lutz, W. (2021). Personalization of treatment for patients with childhood-abuse related posttraumatic stress disorder. Journal of Clinical Medicine, 10(9), 4522.
• Horowitz, L. M., Alden, L. E., Wiggins, J. S., & Pincus, A. L. (2000). Inventory of Interpersonal Problems. San Antonio, TX: The Psychological Corporation.
• Hovens, J. G., Wiersma, J. E., Giltay, E. J., Van Oppen, P., Spinhoven, P., Penninx, B. W., & Zitman, F. G. (2010). Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls. Acta Psychiatrica Scandinavica, 122(1), 66-74.
• Jakubczyk A, Klimkiewicz A, Krasowska A, Kopera M, Sławińska-Ceran A, Brower KC, & Wojnar M. (2014). History of sexual abuse and suicide attempts in alcohol-dependent patients. Child Abuse & Neglect, 38(9), 1560-1568.
• Jung, K., & Steil, R. (2012). The feeling of being contaminated in adult survivors of childhood sexual abuse and its treatment via a two-session program of cognitive restructuring and imagery modification: A case study. Behavior Modification, 36(1), 67-86.
• Karterud, S., Pedersen, G., Loevdahl, H., & Friis, S. (1998). Global Assessment of Functioning-Split Version (S-GAF): Background and Scoring Manual. Oslo, Norway: Ullevaal University Hospital, Department of Psychiatry.
• King, A. P., Erickson, T. M., Giardino, N. D., Favorite, T., Rauch, S. A., Robinson, E., Kulkarni, M., & Liberzon, I. (2013). A pilot study of group mindfulness‐based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and Anxiety, 30(7), 638-645.
• Kleindienst, N., Steil, R., Priebe, K., Müller-Engelmann, M., Biermann, M., Fydrich, T., Schmahl, C., & Bohus, M. (2021). Treating adults with a dual diagnosis of borderline personality disorder and posttraumatic stress disorder related to childhood abuse: Results from a randomized clinical trial. Journal of Consulting and Clinical Psychology, 89(11), 925-936.
• Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D. (2010). Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. American Journal of Psychiatry, 167(6), 640-647.
• Lau, M., & Kristensen, E. (2007). Outcome of systemic and analytic group psychotherapy for adult women with history of intrafamilial childhood sexual abuse: A randomized controlled study. Acta Psychiatrica Scandinavica, 116(2), 96-104.
• Lecrubier, Y, Sheehan, D.V., Weiller, E., Amorim. P., & Bonora, I., Sheehan, K.,H., Janavs., J., & Dunbar, G.C. (1997). The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: Reliability and validity according to the CIDI. European Psychiatry, 12(5), 224–231.
• MacIntosh, H. B., Cloitre, M., Kortis, K., Peck, A., & Weiss, B. J. (2018). Implementation and evaluation of the skills training in affective and interpersonal regulation (STAIR) in a community setting in the context of childhood sexual abuse. Research on Social Work Practice, 28(5), 595-602.
• Niwa, M., Kato, T., Narita-Ohtaki, R., Otomo, R., Suga, Y., Sugawara, M. & Kim, Y. (2022). Skills training in affective and interpersonal regulation narrative therapy for women with ICD-11 complex PTSD related to childhood abuse in Japan: A pilot study. European Journal of Psychotraumatology, 13(1), 2080933.
• Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Medicine, 9(11), e1001349.
• Oprel, D. A., Hoeboer, C. M., Schoorl, M., Kleine, R. A. D., Cloitre, M., Wigard, I. G., Minnen, A.V., & 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.
• Overbeek, T., Schruers, K., & Griez, E. (1999). Mini International Neuropsychiatric Interview. Maastricht: University of Maastricht.
• Öztürk, S. (2007). Çocuklarda duygusal istismar. (Yayınlanmamış Yüksek Lisans Tezi), Fırat Üniversitesi, Sosyal Bilimler Enstitüsü, Elazığ.
• Paivio, S. C., & Nieuwenhuis, J. A. (2001). Efficacy of emotion focused therapy for adult survivors of child abuse: A preliminary study. Journal of Traumatic Stress, 14(1), 115-133.
• Paivio, S. C., Jarry, J. L., Chagigiorgis, H., Hall, I., & Ralston, M. (2010). Efficacy of two versions of emotion-focused therapy for resolving child abuse trauma. Psychotherapy Research, 20(3), 353-366.
• Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30(6), 635-641.
• Raabe, S., Ehring, T., Marquenie, L., Arnoud, A., & Kindt, M. (2022). Imagery rescripting as stand-alone treatment for posttraumatic stress disorder related to childhood abuse: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 77, 101769.
• Raabe, S., Ehring, T., Marquenie, L., Olff, M., & Kindt, M. (2015). Imagery rescripting as stand-alone treatment for posttraumatic stress disorder related to childhood abuse. Journal of Behavior Therapy and Experimental Psychiatry, 48(1), 170-176.
• Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748–756.
• Rüsch, N., Corrigan, P. W., Bohus, M., Kühler, T., Jacob, G. A., & Lieb, K. (2007). The impact of posttraumatic stress disorder on dysfunctional implicit and explicit emotions among women with borderline personality disorder. The Journal of Nervous and Mental Disease, 195(6), 537-539.
• Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). STAI Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.
• Spitzer, R. L., Willliams, J. B., Gibbon, M., & First, M. B. (1994). Structured Clinical Interview for DSM–IV—Patient Edition. New York: New York State Psychiatric Institute Biometrics Research Department.
• Steil, R., Dyer, A., Priebe, K., Kleindienst, N., & Bohus, M. (2011a). Dialectical behavior therapy for posttraumatic stress disorder related to childhood sexual abuse: A pilot study of an intensive residential treatment program. Journal of Traumatic Stress, 24(1), 102-106.
• Steil, R., Jung, K., & Stangier, U. (2011b). Efficacy of a two-session program of cognitive restructuring and imagery modification to reduce the feeling of being contaminated in adult survivors of childhood sexual abuse: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 42(3), 325-329.
• Taner, Y., & Gökler, B. (2004). Çocuk istismarı ve ihmali: Psikiyatrik yönleri. Acta Medica, 35 (2), 82–86.
• Taylor, S., Thordarson, D. S., Fedoroff, I. C., Maxfield, L., Lovell, K., & Ogrodniczuk, J. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71 (2), 330−338.
• Van Vliet, N. I., Huntjens, R. J., 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, 19(1), 138-145.
• Varkovitzky, R. L., Sherrill, A. M., & Reger, G. M. (2018). Effectiveness of the unified protocol for transdiagnostic treatment of emotional disorders among veterans with posttraumatic stress disorder: A pilot study. Behavior Modification, 42(2), 210-230.
• Wagenmans, A., Van Minnen, A., Sleijpen, M., & De Jongh, A. (2018). The impact of childhood sexual abuse on the out- come of intensive trauma-focused treatment for PTSD. European Journal of Psychotraumatology, 9(1), 1430962.
• Weathers, F., Keane, T., & Davidson, J. (2001). Clinician-administered PTSD scale: A review of the first ten years of research. Depression and Anxiety, 13(3), 132-156.
• Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event Scale-Revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing Psychological Trauma and PTSD (pp. 399-411). New York: Guilford Press.
• Wittchen, H.U., Wunderlich, U., Gruschwitz, S., & Zaudig, M. (1996). Strukturiertes Klinisches Interview Für DSM-IV (SKID). Goettingen: Beltz Test.
• World Health Organization (2022). Child maltreatment. https://www.who.int/news-room/fact-sheets/detail/child-maltreatment
• Yalçın, N. (2011). Türkiye’de Çocuk İstismarı ve Çözüm Önerileri. (Yayınlanmamış Yüksek Lisans Tezi), Beykent Üniversitesi Sosyal Bilimler Enstitüsü, Istanbul.
• Zoroğlu, S. S., Tüzün, Ü., Şar, V., Öztürk, M., Kora, M. E., & Alyanak, B. (2001). Çocukluk dönemi istismar ve ihmalinin olası sonuçları. Anadolu Psikiyatri Dergisi, 2(2), 69-78.