Adapting IPT-G for Patients with Eating Problems and Childhood Relational Trauma
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Adapting IPT-G for Patients with Eating Problems and Childhood Relational Trauma Psychologist Juliane Monstad Therapist Kristian Dirdal Modum Bad, Department for Trauma Treatment and Interpersonal Therapy. Disposition. Background Method Treatment model Discussion Conclusion .

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Adapting IPT-G for Patients with Eating Problems and Childhood Relational TraumaPsychologist Juliane Monstad Therapist Kristian DirdalModum Bad, Department for Trauma Treatment and Interpersonal Therapy


Disposition
Disposition Childhood Relational Trauma

Background

Method

Treatment model

Discussion

Conclusion


Disposition1
Disposition Childhood Relational Trauma

Background

Method

Treatment model

Discussion

Conclusion


Ipt g history at modum bad
IPT-G history at Modum Bad Childhood Relational Trauma

  • Since 2002, IPT has been provided for groups with social phobia and depression. The group modality has been based on Wilfley/MacKenzie’s IPT-group manual (Wilfley et al., 2000)

  • Childhood sexual abuse and avoidant personality disorder predicted non-response course for patients with longstanding eating disorders (Vrabel et al., 2010)

  • High prevalence of childhood sexual abuse among patients with eating disorders (Palmer et al., 1990)

  • A new treatment was tailored to help patients with childhood relational trauma (history of childhood neglect, violence and/or sexual abuse), who, as a consequence, have trauma reactions and eating problems as adults


Disposition2
Disposition Childhood Relational Trauma

Background

Method

Treatment model

Discussion

Conclusion


Treatment conditions
Treatment conditions Childhood Relational Trauma

  • The groups of patients (7 people) are in a closed group, where about 80 % of the therapy is conducted in diverse group modalities. We use out-door activities as an important part of the program

  • 13 patients have completed phase 2, while 26 have finished phase 1. So far no patients have completed the one-year follow-up


The patient group
The patient group Childhood Relational Trauma

  • Most of the patients have posttraumatic stress disorder (PTSD). Comorbid diseases are eating disorders, depression, psychosomatic disorders and personality disorders


Complex ptsd
Complex PTSD Childhood Relational Trauma

  • Besides symptoms of PTSD, the patients experience additional problems:

    • Affect dysregulation

    • Dissociative symptoms, both mental and psychosomatic

    • Negative self-perception (helplessness, shame, guilt and self-blame)

    • Interpersonal difficulties (fear and distrust)

    • Somatization and medical problems


Disposition3
Disposition Childhood Relational Trauma

Background

Method

Treatment model

Discussion

Conclusion


Ipt g adaptions for eating disorders
IPT-G adaptions for eating disorders Childhood Relational Trauma

  • Research supports an IPT effect on eating disorders (Agras et al., 2000; Fairburn et al.,1995; Wilfley et al., 1993)

  • IPT assumes that the development and maintenance of eating disorders occurs in a social and interpersonal context, and focuses on identifying and altering this context (Wilfley et al. 1993; 2000)

  • The treatment model focuses on exploring how eating difficulties are affected by challenges related to interaction with other people, self-esteem and affect regulation


Ipt g adaption to ptsd
IPT-G adaption to PTSD Childhood Relational Trauma

  • Few studies report IPT for PTSD

  • Some studies show that the IPT model is useful for treating PTSD (Bleiberg og Markowitz, 2005; Ray og Webster, 2010 Krupnick et al., 2008)

  • Chronicity of diagnosis

    • Longer treatment period

    • The treatment as a part of a longer treatment course


The new treatment model
The new treatment model Childhood Relational Trauma

  • This model assumes that eating problems are strategies to regulate painful emotions and need for control, developed through the childhood relational traumas

  • A main focus of the treatment is to help the patients understand the development of their problems as a consequence of childhood relational traumas

  • Stabilizing trauma treatment is a central part of the model

  • The goal is to help the patients feel more secure and increase interpersonal functioning and affect regulation

  • All the patients have interpersonal sensitivity as the main focus of the therapeutic work


Time schedule
Time schedule Childhood Relational Trauma


Stabilizing trauma treatment
Stabilizing trauma treatment Childhood Relational Trauma

The psychoeducation group addresses topics such as:

  • Coping with PTSD symptoms

  • Affect regulation strategies

    • Eating problems as affect regulation

      In all groups and the milieu:

    • Working with triggers

  • Window of tolerance


Window of tolerance
Window of tolerance Childhood Relational Trauma

Hyperarousal

Hypervigilance

Intrusive images and

emotions

Risktaking and

selfdestructive behavior

Panic and anxiety

Windowoftolerance

Feelingscan be tolerated

Able to think and feel

Hypoarousal

Flat affect, feeling numb

Cognitive functioning slowed

Feeling dead or empty

Feelings of shame and self-

loathing

(Odgen & Minton, 2000)


Group work
Group work Childhood Relational Trauma

  • Active use of the supportive therapeutic factors to build a cohesive group (universality, acceptance, altruism, normalization, and hope)

    Improve interpersonal functioning:

  • Attachment

  • Awareness of being safe

  • Self-compassion

  • Self-care

  • Relational boundaries

  • New relational experiences

    Establishing treatment focus in the initial phase:

  • Weekly goals and evaluation of these

  • Working with here-and-now situations


Disposition4
Disposition Childhood Relational Trauma

Background

Method

Treatment model

Discussion

Conclusion


Strengths of the treatment
Strengths of the treatment Childhood Relational Trauma

Longer treatment periods in different phases:

  • Opportunities to practice new skills in natural settings between phase 1 and 2, and further develop this work in phase 2

  • Integrating residential treatment in a community based treatment

    Multiplicity of therapeutic factors (Hoffart, 2007)

  • In groups, in the milieu, during home stay, etc.

    Integrating therapeutic work with both eating problems and trauma reactions


Challenges
Challenges Childhood Relational Trauma

  • Symptoms vs. interpersonal focus

  • Balancing stabilization (feeling secure) and interpersonal exposure

  • Addressing eating difficulties

  • Assessment and selection of patients

  • Personality pathology

    • Impulsivity, emotional instability, overlap of symptoms of borderline personality disorder and Complex PTSD

    • Conflictsbetweengroupmembers


Disposition5
Disposition Childhood Relational Trauma

Background

Method

Treatment model

Discussion

Conclusion


Conclusion
Conclusion Childhood Relational Trauma

  • The treatment program is continually re-evaluated. The first 1 ½ years of the program show promising results for some of the patients and less for others. Data from one-year follow-ups will give further knowledge of treatment results

  • The results suggest a decrease in depression

  • The residential treatment gives certain results, but the patients’ complex problems demand treatment over a longer period


References
References Childhood Relational Trauma

  • Agras, W. S., Walsh, B. T., Fairburn, C. G., Wilson, G. T., & Kraemer, H. C. (2000). A Multicenter Comparison of Cognitive-Behavioral Therapy and Interpersonal Psychotherapy for Bulimia Nervosa. Archives of General Psychiatry, 57 (5), 459-466.

  • Bleiberg, K. L., & Markowitz, J. C. (2005). A pilot study of interpersonal psychotherapy for posttraumatic stress disorder. The American Journal of Psychiatry, 162, 181-183.

  • Fairburn, C. G., Norman, P. A., Welch, S. L., O'Connor, M. E., Doll, H. A., & Peveler, R. C. (1995). A Prospective Study of Outcome in Bulimia Nervosa and the Long-term Effects of Three Psychological Treatments. Archives of General Psychiatry, 52 (4), 304-312.

  • Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.

  • Hoffart, A., Abrahamsen, G., Bonsaksen, T., Borge, F. M., Ramstad, R., & Markowitz, J. C. (2007). A residential interpersonal treatment for social phobia. New York: Nova Biomedical.

  • Krupnick, J. L., Green, B. L., Stockton, P., Miranda, J., Krause, E., & Mete, M. (2008). Group interpersonal psychotherapy for low-income women with posttraumatic stress disorder. Psychotherapy Research, 18 (5), 497 - 507.


  • Ogden, P. & Minton, K. (2000). Sensorimotor psychotherapy: One method for processing trauma. Traumathology, 6, 3.

  • Palmer, R. L., Oppenheimer, R., Dignon, A., Chaloner, D. A., & Howells, K. (1990). Childhood sexual experience with adults reported by women with eating disorders: an extended series. British Journal of Psychiatry, 156, 699-703.

  • Ray, R. D., & Webster, R. (2010). Group interpersonal therapy for veterans with posttraumatic stress disorder: A pilot study. International Journal of Group Psychotherapy, 60 (1), 131-140.

  • Vrabel, K. R., Hoffart, A., Rø, Ø., Martinsen, E. W., & Rosenvinge, J. H. (2010). Co-occurrence of avoidant personality disorder and child sexual abuse predicts poor outcome in long-standing eating disorder. Journal of Abnormal Psychology, 119 (3), 623-629.

  • Wilfley, D. E., MacKenzie, K. R., Welch, R. R., Ayres, V. E., & Weissman, M. M. (2000). Interpersonal Psychotherapy for Group. New York: Basic Books.

  • Wilfley, D. E., Agras, W. S., Telch, C. F., Rossiter, E. M., Schneider, J. A., Cole, A. G., et al. (1993). Group cognitive-behavioral therapy and group interpersonal psychotherapy for the nonpurging bulimic individual: a controlled comparison. Journal of Consulting and Clinical Psychology, 61, 296-305.


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