Korean Journal of Psychology: General
- KOREAN
- P-ISSN1229-067X
- E-ISSN2734-1127
- KCI
ISSN : 1229-067X
Psychotherapy of Complex PTSD: Focus on a Phase-Based Approach
Abstract
The purpose of this study is to explore and review the existing theories and empirical studies on the symptoms and treatment of complex PTSD separated into independent diagnostic categories in the recent International Classification of Diseases(ICD-11). Symptoms of complex PTSD can be explained in three categories: emotional control disorders, loss of self-integrity, and impairment of interpersonal skills. And it includes various symptoms such as depression, anxiety, extreme emotions, sleep disorders, nightmares, dissociation, self-harm and suicidal thoughts, somatization disorders, and interpersonal problems. Complex PTSD clients may find it difficult to form rapport and continue psychotherapy because processing traumatic experience is painful and representations of themselves and others are negative. Therefore, it is necessary to provide phase-based treatment to provide the client with a sense of safety. The phases for complex PTSD treatment consists of (1) stabilization, (2) process of traumatic memory, and (3) integration of treatment benefits. The contents of each phase of treatment and empirical researches were outlined and discussed for the future application and development of complex PTSD treatment.
- keywords
- 복합 외상, 복합 PTSD, 단계기반치료, 외상 치료, Complex trauma, Complex PTSD, phase-based treatment, trauma treatment
Reference
Ahn, H. N. (2007). An empirical review of complex trauma. Korean Journal of Psychology:General. 26(1), 105-119.
Ahn, H. N., Park, C. O., & Joo, H. S. (2012). A review of trauma-related emotions: Shame, guilt, and anger. Korean Journal of Counseling, 13(2), 839-854.
Ahn, H. N., Jang, J. Y, & Cho, H. N. (2009). Conceptualizing complex posttraumatic stress syndrome as the disruption of self-system. Korean Journal of Psychology: General, 28(2), 283-301.
Ahn, H. N., & Joo, H. S. (2011). The symptom structure of PTSD in simple and complex trauma type groups. Korean Journal of Psychology: General, 30(3), 869-887.
Allen, J. G. (2005). Coping with trauma: Hope through understanding (2nd de.). Washington, DC:. American Psychiatric Press.
American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington, DC: Author.
Andrews, B., Brewin, C. R., Rose, S., & Kirk, M. (2000). Predicting PTSD symptoms in victims of violent crime: The role of shame, anger, and childhood abuse. Journal of abnormal psychology, 109(1), 69.
Arntz, A., Tiesema, M., & Kindt, M. (2007). Treatment of PTSD: A comparison of imaginal exposure with and without imagery rescripting. Journal of behavior therapy and experimental psychiatry, 38(4), 345-370.
Bichescu, D., Neuner, F., Schauer, M., &Elbert, T. (2007). Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression. Behaviour research and therapy, 45(9), 2212-2220.
Boden, M. T., Kimerling, R., Jacobs‐Lentz, J., Bowman, D., Weaver, C., Carney, D., ... &Trafton, J. A. (2012). Seeking Safety treatment for male veterans with a substance use disorder and post‐traumatic stress disorder symptomatology. Addiction, 107(3), 578-586.
Bradley, R. G., & Follingstad, D. R. (2003). Group therapy for incarcerated women who experienced interpersonal violence: A pilot study. Journal of Traumatic Stress, 16(4), 337-340.
Briere, J. (2004). Psychological assessment of adult posttraumatic states: Phenomenology, diagnosis, and measurement. American Psychological Association.
Bryant, R. A. (2012). Simplifying complex PTSD:Comment on Resick et al.(2012). Journal of Traumatic Stress, 25(3), 252-253.
Chard, K. M. (2005). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of consulting and clinical psychology, 73(5), 965.
Choi, Y. K. (2017). Evidence-based treatment of posttraumatic stress disorder, Korean Journal of Clinical Psychology, 36(4), 526-549.
Choe, H. O., & Son, J. N. (2011). The effects of the Korean mindfulness-based stress reduction (K-MBSR) program on posttraumatic stress disorder symptoms, experiential avoidance, and shame in north Korean defectors. Korean journal of health psychology, 16(3), 469-482.
Classen, C. C., Pain, C., Field, N. P., & Woods, P. (2006). Posttraumatic personality disorder:A reformulation of complex posttraumatic stress disorder and borderline personality disorder. Psychiatric Clinics, 29(1), 87-112.
Classen, C. C., Palesh, O. G., Cavanaugh, C. E., Koopman, C., Kaupp, J. W., Kraemer, H. C., ... & Spiegel, D. (2011). A comparison of trauma-focused and present-focused group therapy for survivors of childhood sexual abuse: A randomized controlled trial. Psychological Trauma: Theory, Research, Practice, and Policy, 3(1), 84-93.
Cloitre, M., Cohen, L. R., & Koenen, K. C. (2006). Treating the trauma of childhood abuse:Therapy for the interrupted life. New York:Guilford.
Cloitre, M., Courtois, C. A., Charuvastra, A., Carapezza, R., Stolbach, B. C., & Green, B. L. (2011). Treatment of complex PTSD:Results of the ISTSS expert clinician survey on best practices. Journal of traumatic stress, 24(6), 615-627.
Cloitre, M., Courtois, C. A., Ford, J. D., Green, B. L., Alexander, P., Briere, J., & Van der Hart, O. (2012). The ISTSS expert consensus treatment guidelines for complex PTSD in adults. Retrieved November, 5, 2012.
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., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5(1), 25097.
Cloitre, M., Jackson, C., & Schmidt, J. A. (2016). STAIR for strengthening social support and relationships among veterans with military sexual trauma and PTSD. Military medicine, 181(2), e183-e187.
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., Stovall-McClough, K. C., Nooner, K., Zorbas, P., Cherry, S., Jackson, C. L., ... &Petkova, E. (2010). Treatment for PTSD related to childhood abuse: A randomized controlled trial. American journal of psychiatry, 167(8), 915-924.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York, NY, US:Guilford Press.
Cole, P. M., & Putnam, F. W. (1992). Effect of incest on self and social functioning: A developmental psychopathology perspective. Journal of consulting and clinical psychology, 60(2), 174.
Courtois, C. A. (2008) Complex trauma, complex reactions: assessment and treatment. Psychological Trauma: Theory, Research, Practice, and Policy, Vol S(1), 86-100.
Courtois, C. A., & Ford, J. D. (Eds.). (2009). Treating complex traumatic stress disorders: An evidence-based guide. Guilford Press.
Courtois, C. A., & Ford, J. D. (2012). Treatment of complex trauma: A sequenced, relationship-based approach. Guilford Press.
De Jongh, A., Resick, P. A., Zoellner, L. A., Van Minnen, A., Lee, C. W., Monson, C. M., ... & Rauch, S. A. (2016). Critical analysis of the current treatment guidelines for complex PTSD in adults. Depression and Anxiety, 33(5), 359-369.
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.
Duckworth, M. P., & Follette, V. M. (2011). Retraumatization: Assessment, treatment, and prevention. New York: Routledge.
Elklit, A., Hyland, P. & Shevlin, M. (2014). Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples. European Journal of Psychotraumatology, 5, 24221, doi:http://dx.doi.org/10.3402/ejpt.v5.2422
Foa, E. B. (2011). Prolonged exposure therapy:Past, present, and future. Depression and Anxiety, 28(12), 1043-1047.
Foa, E. B., Keane, T. M., Friedman, M. J., &Cohen, J. A. (Eds.). (2009). Effective treatments for PTSD: practice guidelines from the International Society for Traumatic Stress Studies (2nd ed.). New York, NY: Guilford Press.
Ford, J. D. (2012). Enhancing affect regulation in psychotherapy with complex trauma survivors. In D. Murphy, S. Joseph, & B. Harris (Eds.), Trauma, recovery, and the therapeutic relationship. London: Oxford University Press.
Ford, J. D., & Russo, E. (2006). Trauma-focused, present-centered, emotional self-regulation approach to integrated treatment for posttraumatic stress and addiction: Trauma adaptive recovery group education and therapy (TARGET). American journal of psychotherapy, 60(4), 335-355.
Ford, J. D., Steinberg, K., Hawke, J., Levine, J., & Zhang, W. (2012). Evaluation of traumaaffect regulation—Guide for education and therapy (TARGET) with traumatized girls involved in delinquency. Journal of Clinical Child and Adolescent Psychology, 41(1), 27-37.
Grunert, B. K., Weis, J. M., Smucker, M. R. &Christianson, H. F. (2007). Imagery rescripting and reprocessing therapy after failed prolonged exposure for psot-traumatic stress disorder following industrial injury. Journal of Behavior Therapy and Experimental Psychiatry, 38, 317-328.
Gudiño, O. G., Leonard, S., & Cloitre, M. (2016). STAIR-A for girls: A pilot study of a skills-based group for traumatized youth in an urban school setting. Journal of Child &Adolescent Trauma, 9(1), 67-79.
Han, Y. J., Lee, E., & Lee, H. (2019). A case study on sand play therapy for an adolescent with complex trauma experience. Korean Journal of Child Psychotherapy, 14(1), 21-47.
Harter, S. (1999). The construction of the self: A developmental perspective. Guilford Press.
Hembree, E. A., Street, G. P., Riggs, D. S., &Foa, E. B. (2004). Do assault-related variables predict response to cognitive behavioral treatment for PTSD?. Journal of Consulting and Clinical Psychology, 72(3), 531.
Herman, J. L. (1992a). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, 377–391.
Herman, J. L. (1992b). Trauma and recovery: The aftermath of violence—From domestic to political terror. New York: Basic Books.
Joo, S., & Son, J. N. (2015). Effects of acceptance and commitment therapy(ACT) on posttraumatic stress symptoms and complex posttraumatic stress symptoms of college students with interpersonal trauma. Korean Journal of Clinical Psychology, 34(2), 353-374.
Karatzias, T., & Cloitre, M. (2019). Treating adults with complex posttraumatic stress disorder using a modular approach to treatment: Rationale, evidence, and directions for future research. Journal of traumatic stress, 32(6), 870-876.
Karatzias, T., & Levendosky, A. A. (2019). Introduction to the Special Issue on Complex Posttraumatic Stress Disorder: The Evolution of a Disorder. Journal of Traumatic Stress, 32, 817-821.
Karatzias, T., Murphy, P., Cloitre, M., Bisson, J., Roberts, N., Shevlin, M., ... & Mason-Roberts, S. (2019). Psychological interventions for ICD-11 complex PTSD symptoms: Systematic review and meta-analysis. Psychological medicine, 49(11), 1761-1775.
Kim, I. K., & Hong, H. Y. (2013). The relationship between trauma related emotions and forgiveness of participants experiencing complex trauma: The moderating effect of cognitive emotion regulation strategies. Korean Journal of Psychology: General, 32(2), 453-487.
Kim, J. H. (2017). Effects of art therapy on complex posttraumatic stress symptoms and posttraumatic growth in adolescents with complex trauma. Journal of Arts Psychotherapy, 13(4), 281-310.
Kim, J. Y., Kim, J. M., & Cho, E. B. (2018). Development and Effect of Cognitive Behavioral Therapy Program for Post-Traumatic Growth of Child Abuse Survivors. Journal of Emotional & Behabioral Disorders, 34(3), 113-134.
Kim, N. H. (2006). Treatment of complex PTSD by using eye movement desensitization and reprocessing: A case report. Anxiety and Mood, 2(2), 142-146.
Kim, S. H., & Choi, B. N. (2013). The effectiveness of PTSD program of north Korean refugees: For north Korean female refugees. The Korean Journal of Woman Psychology, 18(4), 533-548.
Knefel, M., & Lueger-Schuster, B. (2013). An evaluation of ICD-11PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse. European Journal of Psycho traumatology, 4 22608, doi:http://dx.doi.org/10.3402/ejpt.v4i0.22608
Krakow, B., Johnston, L., Melendrez, D., Hollifield, M., Warner, T. D., Chavez-Kennedy, D., et al. (2001). An open-label trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD. American Journal of Psychiatry, 158, 2043–2047.
Landy, M. S., Wagner, A. C., Brown-Bowers, A., & Monson, C. M. (2015). Examining the evidence for complex posttraumatic stress disorder as a clinical diagnosis. Journal of Aggression, Maltreatment & Trauma, 24(3), 215-236.
Lee, E. A. (2018). Application of seeking safety to trauma and addiction counseling in Korea. Korean Journal of Psychology: General, 37(4), 471-502.
Lee, E. C. (2016). A case study on the sandplay therapy for an adolescent who underwent posttraumatic stress disorder. Korean Journal of Sandplay Counseling, 12(2), 1-26.
Linehan, M. (1993). Cognitive-behavioral Treatment of Borderline Personality Disorder. Guilford Press.
Marrow, M. T., Knudsen, K. J., Olafson, E., &Bucher, S. E. (2012). The value of implementing TARGET within a traumainformed juvenile justice setting. Journal of Child & Adolescent Trauma, 5(3), 257-270.
Meichenbaum, D. (1985). Stress inoculation training. New York
Moon, J. Y. (2009). Case study of music therapy that used improvisation and music imaging methods with complex PTSD patient. Korean Journal of Music Therapy, 11(2), 86-99.
Moon, S. (2016). A case study on the sandplay therapy to a woman in her 20s with complex PTSD. Korean Journal of Sandplay Counseling, 12(2), 1-38.
Najavits, L. (2002). Seeking safety: A treatment m anual for PTSD and substance abuse. New Y ork: Guilford Publications.
Norman, S. B., Wilkins, K. C., Tapert, S. F., Lang, A. J., & Najavits, L. M. (2010). A pilot study of seeking safety therapy with OEF/OIF veterans. Journal of Psychoactive Drugs, 42(1), 83-87.
Osterman, J. E., & Chemtob, C. M. (1999). Emergency intervention for acute traumatic stress. Psychiatric Services, 50(6), 739-740.
Paivio, S. C., & Nieuwenhuis, J. A. (2001). Efficacy of emotion focused therapy for adultsurvivors of child abuse: A preliminary study. Journal of Traumatic Stress, 14(1), 115-133.
Paivio, S. C., & Pascual-Leone, A. (2010). Emotion-focused therapy for complex trauma: An integrative approach. American Psychological Association.
Park, H. J., & Hong, C. H. (2010). Effects of forgiveness therapy through writing on the psychological adjustment of sufferers of interpersonal trauma. Korean Journal of Clinical Psychology, 29(1), 83-107.
Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. New York: Guilford Press.
Resick, P. A., Bovin, M. J., Calloway, A. L., Dick, A. M., King, M. W., Mitchell, K. S., ... &Wolf, E. J. (2012). A critical evaluation of the complex PTSD literature: Implications for DSM‐5. Journal of traumatic stress, 25(3), 241-251.
Resick, P. A., Nishith, P., & Griffin, M. G. (2003). How well does cognitive-behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial. CNS spectrums, 8(5), 340-355.
Resick, R A., & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage Publications.
Riggs, D. S., Dancu, C. V., Gershuny, B. S., Greenberg, D., & Foa, E. B. (1992). Anger and post‐traumatic stress disorder in female crime victims. Journal of Traumatic Stress, 5(4), 613-625.
Roth, S., Newman, E., Pelcovitz, D., Van Der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for posttraumatic stress disorder. Journal of traumatic stress, 10(4), 539-555.
Salo, J., Punamäki, R. L., & Qouta, S. (2004). Associations between self and other representations and posttraumatic adjustment among political prisoners. Anxiety, Stress &Coping, 17(4), 421-440.
Schauer, M., Neuner, F., & Elbert, T. (2011). Narrative exposure therapy: A short-term treatment for traumatic stress disorders. Hogrefe Publishing.
Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. Guilford Press, New York.
Shapiro, F. (2012). Getting past your past: Take control of your life with self-help techniques from EMDR therapy. Rodale.
Smucker, M. R. (2005). Imagery rescripting and reprocessing therapy. In Encyclopedia of cognitive behavior therapy (pp. 226-229). Springer, Boston, MA.
Stangier, U., Von Consbruch, K., Schramm, E., &Heidenreich, T. (2010). Common factors of cognitive therapy and interpersonal psychotherapy in the treatment of social phobia. Anxiety, Stress, & Coping, 23(3), 289-301.
Steil, R., Dyer, A., Priebe, K., Kleindienst, N., &Bohus, M. (2011). 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.
van der Kolk, B. A. (2005). Developmental Trauma Disorder-A more specific diagnosis than posttraumatic stress disorder should be considered for children with complex trauma histories. Psychiatric Annals, 35(5), 401-409.
van der Kolk, B. A., Spinazzola, J., Blaustein, M. E., Hopper, J. W., Hopper, E. K., Korn, D. L., & Simpson, W. B. (2007). A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance. Journal of clinical psychiatry, 68(1), 37.
van Dijke, A. (2008). The clinical assessment and treatment of trauma-related self and affect dysregulation. In Emotion regulation (pp. 150-169). Springer, Boston, MA.
You, S. B., & Son, J. N. (2018). Effects of acceptance and commitment therapy(ACT) on complex PTSD symptoms, acceptance, and post-traumatic growth of college students with childhood emotional abuse. Journal of Digital Convergence, 16(3), 561-572.
World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th revision). Retrieved from. https://icd.who.int/browse11/l-m/en
Zayfert, C., & Becker, C. B. (2006). Cognitive-behavioral therapy for PTSD: A case formulation approach. Guilford Press.
Zlotnick, C., Shea, T. M., Rosen, K., Simpson, E., Mulrenin, K., Begin, A., & Pearlstein, T. (1997). An affect-management group for women with posttraumatic stress disorder and histories of childhood sexual abuse. Journal of traumatic stress, 10(3), 425-436.
- Downloaded
- Viewed
- 0KCI Citations
- 0WOS Citations