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      The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder Translated title: El impacto del tratamiento centrado en el trauma, intensivo y breve para el TEPT, sobre los síntomas del trastorno límite de la personalidad Translated title: 针对PTSD简短密集型聚焦创伤治疗对边缘型人格障碍症状的影响

      research-article
      a , b , c , d , e , b , b , b , b , f , b , f
      European Journal of Psychotraumatology
      Taylor & Francis
      Posttraumatic stress disorder, borderline personality disorder, intensive trauma-focused treatment, prolonged exposure, EMDR therapy, Estrés postraumático, trastorno de personalidad limítrofe, tratamiento intensivo centrado en el trauma, exposición prolongada, Terapia EMDR, 创伤后应激障碍;边缘型人格障碍;密集型聚焦创伤治疗;延长暴露;EMDR疗法, • One of the few studies that investigated the effects of trauma-focused treatment on symptoms of borderline personality disorder (BPD) outside the context of Dialectic Behaviour Therapy.• No detrimental effects of intensive trauma-focused treatment on BPD symptoms occurred.• A combination of Exposure therapy and EMDR therapy is a valuable option to consider when PTSD patients are diagnosed with additional BPD.

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          ABSTRACT

          Background: It is generally recommended to exercise caution in applying trauma-focused treatment to individuals with posttraumatic stress disorder (PTSD) and comorbid borderline personality disorder (BPD).

          Objective: To investigate the effects of a brief, intensive, direct trauma-focused treatment programme for individuals with PTSD on BPD symptom severity.

          Methods: Individuals ( n = 72) with severe PTSD (87.5% had one or more comorbidities; 52.8% fulfilled the criteria for the dissociative subtype of PTSD) due to multiple traumas (e.g. 90.3% sexual abuse) participated in an intensive eight-day trauma-focused treatment programme consisting of eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE) therapy, physical activity, and psychoeducation. Treatment did not include any form of stabilization (e.g. emotion regulation training) prior to trauma-focused therapy. Assessments took place at pre- and post-treatment (Borderline Symptom List, BSL-23; PTSD symptom severity, Clinician Administered PTSD Scale for DSM-5, CAPS-5), and across the eight treatment days (PTSD Checklist, PCL-5).

          Results: Treatment resulted in significant decreases of BPD symptoms (Cohen’s d = 0.70). Of the 35 patients with a positive screen for BPD at pre-treatment, 32.7% lost their positive screen at post-treatment. No adverse events nor dropouts occurred during the study time frame, and none of the patients experienced symptom deterioration in response to treatment.

          Conclusion: The results suggest that an intensive trauma-focused treatment is a feasible and safe treatment for PTSD patients with clinically elevated symptoms of BPD, and that BPD symptoms decrease along with the PTSD symptoms.

           

          Antecedentes: generalmente se recomienda tener precaución al aplicar un tratamiento centrado en el trauma a las personas con trastorno de estrés postraumático (TEPT) y trastorno de personalidad límite comórbido (TPL).

          Objetivo: Investigar los efectos de un programa de tratamiento breve, intensivo y directo centrado en el trauma para personas con TEPT sobre la gravedad de los síntomas de TPL.

          Métodos: los participantes ( n = 72) con TEPT grave (87.5% tenían una o más comorbilidades; 52.8% cumplieron los criterios para el subtipo disociativo de TEPT) debido a múltiples traumas (por ejemplo, 90.3% abuso sexual) participaron en un programa intensivo de ocho días de tratamiento centrado en el trauma, consistente en EMDR, terapia de exposición prolongada (PE), actividad física y psicoeducación. El tratamiento no incluyó ninguna forma de estabilización (por ejemplo, entrenamiento de regulación emocional) antes de la terapia centrada en el trauma. Las evaluaciones se realizaron antes y después del tratamiento (Lista de síntomas límite, BSL-23; severidad de los síntomas de TEPT, Escala de TEPT administrada por clínicos para DSM-5, CAPS-5) y durante los ocho días de tratamiento (Lista de verificación de TEPT, PCL-5).

          Resultados: el tratamiento resultó en una disminución significativa de los síntomas de TPL ( d de Cohen = 0.70). De los 35 pacientes con un tamizaje positivo de TPL en el pretratamiento, el 32,7% perdió su tamizaje positivo en el postratamiento. No ocurrieron eventos adversos ni abandonos durante el período de tiempo del estudio, y ninguno de los pacientes experimentó deterioro de los síntomas en respuesta al tratamiento.

          Conclusión: Los resultados sugieren que un tratamiento intensivo centrado en el trauma es un tratamiento factible y seguro para pacientes con TEPT con síntomas clínicamente elevados de TPL, y que los síntomas de TLP disminuyen junto con los síntomas de TEPT.

           

          背景:通常建议对创伤后应激障碍 (PTSD) 并发边缘型人格障碍 (BPD) 的患者进行聚焦创伤治疗时要谨慎。

          目标:考查针对PTSD简短, 密集, 直接聚焦创伤的治疗流程对BPD症状严重程度的影响。

          方法:由于多重创伤 (例如90.3%的性虐待) 导致的严重PTSD (87.5%患有一种或多种并发症; 52.8%符合PTSD分离亚型的标准) 的72名个体, 参加了一次八天的密集型聚焦创伤治疗流程, 包括EMDR和延长暴露 (PE) 治疗, 体育锻炼和心理教育。在聚焦创伤治疗前, 疗程不包括任何形式的稳定治疗 (例如情绪调节训练) 。在治疗前后使用《边缘型症状列表》 (BSL-23) 和《临床用DSM-Ⅳ PTSD诊断量表》 (CAPS-5的PTSD量表) 进行评估, 在整个治疗的八天中使用《PTSD清单》 (PCL-5) 进行评估。

          结果:治疗使BPD症状显著减少 (Cohen’s d= 0.70) 。在治疗前BPD筛查阳性的35例患者中, 32.7%的患者在治疗后不再是阳性。在研究时间范围内无不良事件及流失现象出现, 并且没有患者因治疗而出现症状恶化。

          结论:结果表明, 针对BPD临床症状升高的PTSD患者, 密集型聚焦创伤治疗是一种可行且安全的疗法, 并且BPD症状随PTSD症状减轻而减轻。

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          Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans.

          This study examined the psychometric properties of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5; Weathers, Litz, et al., 2013b) in 2 independent samples of veterans receiving care at a Veterans Affairs Medical Center (N = 468). A subsample of these participants (n = 140) was used to define a valid diagnostic cutoff score for the instrument using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers, Blake, et al., 2013) as the reference standard. The PCL-5 test scores demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity. Consistent with previous studies (Armour et al., 2015; Liu et al., 2014), confirmatory factor analysis revealed that the data were best explained by a 6-factor anhedonia model and a 7-factor hybrid model. Signal detection analyses using the CAPS-5 revealed that PCL-5 scores of 31 to 33 were optimally efficient for diagnosing PTSD (κ(.5) = .58). Overall, the findings suggest that the PCL-5 is a psychometrically sound instrument that can be used effectively with veterans. Further, by determining a valid cutoff score using the CAPS-5, the PCL-5 can now be used to identify veterans with probable PTSD. However, findings also suggest the need for research to evaluate cluster structure of DSM-5. (PsycINFO Database Record
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            The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and Initial Psychometric Evaluation in Military Veterans.

            The Clinician-Administered PTSD Scale (CAPS) is an extensively validated and widely used structured diagnostic interview for posttraumatic stress disorder (PTSD). The CAPS was recently revised to correspond with PTSD criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). This article describes the development of the CAPS for DSM-5 (CAPS-5) and presents the results of an initial psychometric evaluation of CAPS-5 scores in 2 samples of military veterans (Ns = 165 and 207). CAPS-5 diagnosis demonstrated strong interrater reliability (к = .78 to 1.00, depending on the scoring rule) and test-retest reliability (к = .83), as well as strong correspondence with a diagnosis based on the CAPS for DSM-IV (CAPS-IV; к = .84 when optimally calibrated). CAPS-5 total severity score demonstrated high internal consistency (α = .88) and interrater reliability (ICC = .91) and good test-retest reliability (ICC = .78). It also demonstrated good convergent validity with total severity score on the CAPS-IV (r = .83) and PTSD Checklist for DSM-5 (r = .66) and good discriminant validity with measures of anxiety, depression, somatization, functional impairment, psychopathy, and alcohol abuse (rs = .02 to .54). Overall, these results indicate that the CAPS-5 is a psychometrically sound measure of DSM-5 PTSD diagnosis and symptom severity. Importantly, the CAPS-5 strongly corresponds with the CAPS-IV, which suggests that backward compatibility with the CAPS-IV was maintained and that the CAPS-5 provides continuity in evidence-based assessment of PTSD in the transition from DSM-IV to DSM-5 criteria. (PsycINFO Database Record
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              Is savage's independence axiom a universal rationality principle?

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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                ZEPT
                zept20
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8066
                2020
                14 February 2020
                : 11
                : 1
                : 1721142
                Affiliations
                [a ]Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam , Amsterdam, The Netherlands
                [b ]Psychotrauma Expertise Centre (PSYTREC) , Bilthoven, The Netherlands
                [c ]School of Health Sciences, Salford University , Manchester, UK
                [d ]Institute of Health and Society, University of Worcester , Worcester, UK
                [e ]School of Psychology, Queen’s University , Belfast, Northern Ireland
                [f ]Behavioural Science Institute (BSI), Radboud University Nijmegen , Nijmegen, The Netherlands
                Author notes
                CONTACT A. De Jongh a.de.jongh@ 123456acta.nl Gustav Mahlerlaan 3004, Amsterdam 1081 LA, The Netherlands
                [*]

                Current affiliation: Phrenos Center of Expertise for severe mental illness

                Author information
                http://orcid.org/0000-0001-6031-9708
                http://orcid.org/0000-0002-3116-8899
                http://orcid.org/0000-0001-6675-927X
                http://orcid.org/0000-0002-0685-0992
                http://orcid.org/0000-0001-7554-8343
                http://orcid.org/0000-0002-3099-8444
                Article
                1721142
                10.1080/20008198.2020.1721142
                7034475
                32128048
                1c30bbd0-9bc5-4889-b32c-88fb447302f3
                © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 May 2019
                : 08 January 2020
                : 12 January 2020
                Page count
                Figures: 3, Tables: 2, References: 49, Pages: 12
                Categories
                Clinical Research Article

                Clinical Psychology & Psychiatry
                posttraumatic stress disorder,borderline personality disorder,intensive trauma-focused treatment,prolonged exposure,emdr therapy,estrés postraumático,trastorno de personalidad limítrofe,tratamiento intensivo centrado en el trauma,exposición prolongada,terapia emdr,创伤后应激障碍;边缘型人格障碍;密集型聚焦创伤治疗;延长暴露;emdr疗法,• one of the few studies that investigated the effects of trauma-focused treatment on symptoms of borderline personality disorder (bpd) outside the context of dialectic behaviour therapy.• no detrimental effects of intensive trauma-focused treatment on bpd symptoms occurred.• a combination of exposure therapy and emdr therapy is a valuable option to consider when ptsd patients are diagnosed with additional bpd.

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