The project compares three therapy forms for complex PTSD following childhood trauma. The aim is to identify the most beneficial therapy, for whom, and how change occurs.

Peter Sele is a clinical psychologist and PhD candidate at Modum Bad and the University of Oslo.

About the Project

The Complex PTSD study at Modum Bad is a randomized controlled trial comparing three treatments for complex PTSD after childhood trauma: a) prolonged exposure therapy, b) interpersonal and affective regulation skills training (STAIR), and c) phase-oriented treatment (i.e., skills training followed by exposure, STAIR Narrative Therapy). The first patients were recruited in 2017, and the project’s treatment phase concluded in the fall of 2020. Nearly 250 individuals were assessed for potential participation, with just under a hundred included and completing one of the three treatments through random selection.

The project has three main objectives:

• Compare the effectiveness of the three treatment forms.
• Investigate how change occurs during treatment.
• Examine which type of treatment suits whom.

Results

Two articles using data from the project have been published, and more publications are in progress.

The first investigates the psychometric properties of the Norwegian version of a self-report instrument for complex PTSD symptoms, in accordance with ICD-11 criteria. The study found satisfactory overall psychometric properties of the Norwegian version but suggests separately measuring affective over- and underactivation to reduce measurement errors.

The second article compares the efficacy of the three treatment forms we examined. We did not find support for the hypothesis that phase-oriented therapy would be the most effective treatment for complex PTSD. Contrary to expectations, results showed that prolonged exposure therapy led to a greater reduction in intrusive trauma memories, avoidance, and overactivation (PTSD symptoms), and an equally significant reduction in affective dysregulation, negative self-image, and relational difficulties (additional symptoms of complex PTSD) compared to phase-oriented treatment and skills training used alone.

Prolonged exposure therapy is a shorter treatment directly addressing intrusive trauma memories without specific interventions targeting additional problems in complex PTSD. Although primarily developed for PTSD, findings suggest its effectiveness for the complex symptoms in patients with complex PTSD.

Background

The treatment of complex PTSD has been debated in the field, with few prior studies. Phase-oriented treatment and trauma-focused treatment are two proposed and discussed main approaches.

In phase-oriented treatment, an initial therapy phase addresses additional difficulties in complex PTSD (known as the “stabilization phase” or “phase 1”) before working with trauma memories (the “processing phase” or “phase 2”).

Trauma-focused therapy has one phase, working with trauma memories and breaking avoidance of situations that are actually safe but are associated with danger due to trauma.

The Complex PTSD Project at Modum Bad is the first randomized controlled study of patients with a complex PTSD diagnosis. The project was conducted in collaboration with the Anxiety Disorders Department and Trauma Disorders Department at Modum Bad. Before the project, all therapists received training, and the treatment was supported by regular guidance from method experts within each treatment form. All therapy sessions were filmed to assess therapist adherence, which was satisfactory in all three treatments.

Funding

The project is funded by Modum Bad.

Collaboration

In this project, we collaborated closely with the main developer of STAIR Narrative Therapy, Marylène Cloitre, at Stanford University, USA, and an expert and developer of Prolonged Exposure, Elizabeth Hembree, at Penn State University, USA.

Tools

The assessment tool for complex PTSD (ITQ) is available in Norwegian here: Link to ITQ

Contact Information

Project Contact: Peter Sele

You can also reach us through the Modum Bad telephone service: 32 74 97 00.

Project participants

Asle Hoffart, PhD, Project Leader

Peter Sele, PhD Candidate

Tuva Øktedalen, PhD, Main Supervisor

Marylène Cloitre

Elizabeth Hembree

Publications

1. Sele, P., Hoffart, A., Bækkelund, H., & Øktedalen, T. (2020) Psychometric properties of the International Trauma Questionnaire (ITQ) examined in a Norwegian trauma-exposed clinical sample, European Journal of Psychotraumatology, 11:1, DOI: 10.1080/20008198.2020.1796187 https://www.duo.uio.no/handle/10852/85028
2. Sele, P., Hoffart, A., Cloitre, M., Hembree, E., & Øktedalen, T. (2023). Comparing phase-based treatment, prolonged exposure, and skills-training for Complex Posttraumatic Stress Disorder: A randomized controlled trial. Journal of Anxiety Disorders, 100. https://doi.org/10.1016/j.janxdis.2023.102786

Researchers studying trauma disorder at Modum Bad: