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Therapies for adults with a history of childhood abuse

What is psychotherapy for PTSD in people with a history of childhood abuse?

Adult survivors of childhood abuse tend to have more symptom complexity than other adults with PTSD. This complexity includes emotion dysregulation, interpersonal problems, impulsive and/or self-destructive behaviour, high levels of dissociation, substance-related problems, and unexplained physical symptoms.

For PTSD in general, the best evidence currently exists for trauma-focussed treatments such as cognitive behaviour therapy (CBT), exposure therapy, and eye movement desensitisation and reprocessing (EMDR). These interventions involve processing the memory of the trauma and its meaning based on theoretical models that emphasise the role of memory processes in the development and maintenance of PTSD. However, it is unclear whether the superiority of trauma-focused treatments holds for adult survivors of child-onset trauma or whether trauma-focussed treatments may even be damaging to these patients.

What is the evidence for psychotherapy for PTSD in people with a history of childhood abuse?

Moderate to low quality evidence found a large improvement in PTSD symptoms with active psychological treatments (CBT with or without trauma-focus, EMDR, interpersonal therapy, and emotion-focussed therapies) from before to after treatment and at longer-term follow-up (≥6 months) in adults with a history of childhood abuse. These improvements were larger than those observed in the pre-post analyses of no treatment controls and inactive treatment controls (e.g., treatment as usual).

In the direct comparisons of symptom severity immediately post-treatment with active treatments versus control conditions, the comparison with no treatment controls showed a significant, medium to large effect of greater improvements. However, the direct comparison with inactive treatment showed a non-significant medium-sized effect. Trauma-focussed treatments were found to be more efficacious than non-trauma-focussed interventions, and treatments with individual sessions were more efficacious than group treatments. Samples with complex PTSD showed smaller improvements than samples without complex PTSD.

August 2021

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Last updated at: 4:06 am, 13th October 2021
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