Improvements of complex post-traumatic stress disorder symptoms during a multimodal psychodynamic inpatient rehabilitation treatment - results of an observational single-centre pilot study.
Level 4 - case-series / case-control
Uncontrolled prospective before-and-after observational pilot study
PubMed 38577992 · doi:10.1080/20008066.2024.2333221
What was done
This single-centre observational pilot study evaluated symptom changes in 50 patients with complex post-traumatic stress disorder (CPTSD) undergoing a 6-week multimodal psychodynamic inpatient rehabilitation program. Outcomes were assessed before (T1) and at the end of treatment (T2) using self-report questionnaires: the International Trauma Questionnaire (ITQ for PTSD/CPTSD), Brief Symptom Inventory-18 (BSI-18 for anxiety, depression, and somatization), WHO Disability Assessment Schedule (WHODAS for functional impairment), and the Epistemic Trust, Mistrust and Credulity Questionnaire (ETMCQ). Analysis utilized repeated-measures ANOVAs and hierarchical linear regression.
What was found
Of 50 enrolled patients, 40 (80%) completed treatment. Completers showed significant reductions in CPTSD symptoms (-3.9 points, p < .001, η² = .36), psychological distress (p < .001, η² = .55), and functional impairment (p < .001, η² = .59). At discharge, 41.0% of patients no longer met diagnostic criteria for CPTSD. Hierarchical linear regression showed that increased epistemic trust (β = -.34, p = .026), decreased epistemic credulity (β = .37, p = .017), younger age (β = .43, p = .012), and lower baseline depression (β = .35, p = .054) were significantly associated with CPTSD symptom reduction, together explaining 48% of the variance.
Why it matters
Evidence for psychodynamic treatment approaches in CPTSD is limited. This study provides preliminary evidence that a multimodal psychodynamic inpatient protocol is feasible and associated with symptom improvement, identifying changes in epistemic trust as a potential psychological mechanism.
Limits
The study lacked a control or comparison group, meaning improvements cannot be uniquely attributed to psychodynamic therapy over non-specific inpatient milieu effects, concurrent interventions, or regression to the mean. The sample size was small (n = 50, with 20% attrition), restricted to a single centre, and relied exclusively on self-report measures without post-discharge follow-up to assess whether gains persisted.
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