Første nationale konference for traumeforskere i Danmark
Abstractbog, januar 2020
sdu.dk#sdudk
Det danske netværk for traumeforskere
Jessica Carlsson Lohmann (Kompetencecenter for Transkulturel Psykiatri, Region Hovedstaden), Søren Bo Andersen (Veterancenteret), Cæcilie Buhmann, Lise Møller og Erik Simonsen (Psykiatrisk Forskningsenhed, Region Sjælland, Slagelse), Mikkel Arendt (Klinik for PTSD og
Angst, Region Midt), Sarah Bøgelund Dokkedahl og Ask Elklit (Videnscenter for Psykotraumatologi, Syddansk Universitet) og Marie Høgh Thøgersen (DIGNITY).
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Introduktion
Denne abstraktbog indeholder alle de abstracts, som præsenteres til den første
nationale konference for traumeforskning den 29. januar 2020. Konferencen vil samle forskere på tværs af landet til en inspirerende dag, hvor den nyeste forskning inden for PTSD og psykotraumatologi vil blive præsenteret og diskuteret. Dagen vil give et fint overblik over udviklingen og den aktuelle forskning inden for feltet i Danmark.
Det er en stor glæde, at så mange har indvilliget i at dele deres viden og præsentere deres forskning under konferencen. Vi har i alt optaget 47 forskningsprojekter, hvor af mange udspringer af klinisk praksis.
Vi ser frem til at høre interessante indlæg på konferencens fire symposier, og vi håber, at alle vil få stort udbytte af konferencen, samt blive inspireret til efterfølgende at fortsætte diskussionen og det gode samarbejde om traumeforskning i Danmark Med venlig hilsen,
Det Danske Netværk for Traumeforskere:
Jessica Lohmann Carlsson (Kompetencecenter for Transkulturelt Psykiatri, Region
Hovedstaden), Søren Bo Andersen (Veterancenteret), Cæcilie Buhmann og Lise
Møller (Forskningsenheden Psykiatrien Vest, Slagelse), Mikkel Arendt (Klinik for
PTSD og Angst, Region Midt) Sarah Bøgelund Dokkedahl og Ask Elklit (Center for
Psykotraumatologi, Institute for Psykologi, SDU) Marie Høgh Thøgersen (Dansk
Institute mod Tortur, DIGNITY)
Program
8.30 - 9.00 ANKOMST
9.00 - 9.45 Introduktion med velkomst og oplæg fra “de tre pionerer” Ask Elklit, Jessica Carlsson Lohmann og Søren Bo Andersen.
9.45 – 10.00 PAUSE (inkl. kaffe/te)
10.00 – 11.00 Symposium I – SDU (Chair: Ask Elklit) - Screening af traumatiserede børn
v. Sille Schandorph Løkkegaard
- Rehabilitering efter interpersonelle traumer (krisecentre) v. Sarah Dokkedahl
- Epilepsihospitalet Filadelfia: sygdomsramte familier v. Anne Vagner Jakobsen
- Arbejdsrelaterede traumer (vold i psykiatrien) - v. Sara Al Ali
11.00-11.15 PAUSE
11.15 – 12.15 Symposium II – Flygtninge /Transkulturel psykiatri (Chair: Jessica Carlsson Lohmann)
- Posttraumatic stress disorders and changes in the brain’s white matter v. Sigurd Uldall
- Den Danske Traume Database for Flygtninge; (DTD): De første resultater v. Marie Høgh Thøgersen
- Nat og dag – kan bedre søvn give traumatiserede flygtninge en hverdag?
Resultater fra et randomiseret kontrolleret studie v. Hinuga Sandahl
- Pain and Posttraumatic Stress Disorder in refugees who survived torture: The role of pain catastrophizing and trauma-related beliefs
v. Linda Nordin
12.15 – 13.15 FROKOST OG POSTERVANDRING
13.15 – 14.15 Symposium III – Veteraner (Chair: Søren Bo Andersen)
- Veteraner, traumer og mentalt helbred: registreringsstudier og spørgeskemaundersøgelser
v. Mia S. Vedtofte og Anni B.S. Nielsen
4 - Brug af nyere (datadrevne) metoder til identifikation af sårbarhed og
personalisering af behandling
v. Karen-Inge Karstoft, Kasper Eskelund og Sofie Folke
- Profilbaseret behandling af veteraner: Kliniske interventionssudier v. Sofie Folke, Nikolai C. Roitmann og Kasper Eskelund
14.30 – 14.30 PAUSE (inkl. kaffe/te)
14.30– 15.30 Symposium IV – Regionerne (Chair: Mikkel Arendt)
- ICD-11 PTSD og Kompleks PTSD i psykiatrien – resultater fra et Ph.d.- projekt
v. Lise Møller
- PTSD hjælp – et randomiseret studie af en PTSD sundhedsapp v. Frederik Bernt Scharff
- Behandling af PTSD hos patienter med psykose v. Cæcilie Buhmann
- EMDR-behandling af danske ambulante patienter med PTSD: potentialet af B-BAT som supplement
v. Monica Stougaard
15.30 – 16.30 RECEPTION OG POSTERVANDRING
Abstracts
I det følgende er abstracts fordelt efter symposium I, II, III og IV og derefter efter førsteforfatter
Abstracts fordelt efter Symposium I, II, III, og IV
Symposium I SDU ... 8
#1: Sex differences in associations between peritraumatic physiological arousal and PTSD severity in accident survivors ... 8
#2: Problems with the revised DSM-5 A criterion: The case of infant loss. ... 9
#3: The Psychological Subtype of Intimate Partner Violence and its Effect on Mental Health: A
Systematic Review and Meta-Analysis ... 10
#4: Workplace Critical incidents and impact on mental health: Systematic review of longitudinal studies on the association between critical incident and mental health in non-military work ... 11
#5: Everyday Violence, under what circumstances is occupational violence detrimental to mental health?
... 12
#6: Screening for secondary traumatisation among Danish child protection workers: A latent variable approach ... 13
#7: Effectiveness of the STEPS-intervention: Findings from an observational-study of posttraumatic stress in survivors of rape ... 14
#8: The Structure of Adjustment Disorder, PTSD, and Complex PTSD, and their association with
childhood adversities, stressors, and traumas ... 15
#9: The relationship between polyvictimization and ICD-11 PTSD and CPTSD: An Israeli population study ... 16 Symposium II Flygtninge/transkulturel psykiatri ... 17
#10: The Effect of Integrating Cross-sectoral Collaboration with the Municipality in Psychosocial
Treatment of Trauma-affected Refugees; Study Design of a Randomised Controlled Trial ... 17
#11: The use of a Patient-Generated Outcome, the Goal Attainment Scaling in treatment of trauma-
affected refugees ... 18
#12: “Being Gone?”: Theoretical and Empirical perspectives on the risk and protective factors of
dissociation and avoidant coping among trauma-survivors ... 19
#13: A comparison of trauma history, psychopathology and treatment efficiency in two trauma-affected populations with PTSD: refugees versus persons family reunified with a refugee ... 20
#14: Validity of the ICD-11 proposal for posttraumatic stress disorder (PTSD) and complex PTSD
(CPTSD) in a heterogeneous sample of treatment-seeking refugees: A latent class analysis ... 21
#15: Traumatic Brain Injury And Cognitive processing in Tortured and Traumatized Refugees ... 22
#16: Posttraumatic Stress Reactions in Tortured Refugees: The relationship to pain ... 23
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#17: Nat og dag – kan bedre søvn give traumatiserede flygtninge en bedre hverdag? Resultater fra et
randomiseret kontrolleret studie ... 24
#18: Predictors of treatment outcomes for refugees with posttraumatic stress disorder ... 25
#19: Posttraumatic stress disorder and changes in the brain´s white matter ... 26
#20: The Danish Trauma and Refugee Database (DTD): The effectiveness of multidisciplinary treatment for traumatized refugees, across four specialized Danish rehabilitation centers. ... 27
#21: Musikterapi og standardbehandling af flygtninge med PTSD – et randomiseret studie ... 28
#22: “Previous experiences of violence and neglect among adult offenders involved in serious and/or organized crime participating in a Community based Crime Prevention Programme” ... 29
Symposium III Veteraner ... 30
#23: Body therapy for the rehabilitation of veterans with PTSD: Study design and preliminary results .... 30
#24: ICD-11 PTSD and Complex PTSD in Treatment-seeking Danish Veterans: A Latent Profile Analysis ... 31
#25: Profilbaseret behandling af veteraner – kliniske interventionsstudier ... 33
#26: ”Modular CBT for Complex-PTSD” (MCC projektet) ... 34
#27: Brug af virtual reality i eksponeringsterapi til PTSD ... 35
#28: Neurofeedback as a treatment for hyperarousal in treatment-resistant PTSD ... 36
#29: Pretreatment Predictors of Dropout from Cognitive Behavioral Therapy for PTSD in a Military Psychology Clinic ... 37
#30: Virker kropsterapi i PTSD-behandlingen? Evaluering af “Basic Body Awareness Therapy” til veteraner som del af tværfaglig traumebehandling ... 39
#31: Trajectories of depression symptoms from pre- to post- deployment: does previous trauma predict symptom increase? ... 40
#32: Brug af nyere (datadrevne) metoder til identifikation af sårbarhed og personalisering af behandling 42 #33: Active Self-Tracking of Subjectively Experienced PTSD Symptoms: Case Studies in Military PTSD ... 44
#34: Transdiagnostic symptom clusters in posttraumatic stress reactions: ... 45
A data-driven approach to improve screening and personalize treatment ... 45
#35: Combat exposure and risk of suicide attempt among military personnel ... 47
#36: Veteraner, traumer og mentalt helbred: registerstudier og spørgeskemaundersøgelser ... 49
Symposium IV Regioner ... 50
#37: Use of Psychoactive Drugs in Patients with Posttraumatic Stress Disorder ... 50
#38: PTSD help – a randomized controlled study of a PTSD mobile health App ... 51
#39: Musikterapi og standardbehandling af flygtninge med PTSD – et randomiseret studie ... 52
#40: Behandling af PTSD hos patienter med psykose – et pilotstudie ... 54
#41: Prevalence trauma in patients with mental illness compared with persons without mental illness – The DanFunD study ... 55
#42: Childhood trauma, stressful life events, and suicidality in Danish psychiatric outpatients ... 56
#43: Cochrane Review om psykosociale interventioner til behandling af konversations- og dissociative tilstande ... 57
#44: Bodyfocused Schema Therapy for PTSD - A study design for research at a specialized trauma team at a psychiatric hospital in Copenhagen ... 58
#45: Ændringer af tilknytningsmønstre i forbindelse med musikterapeutisk behandling af flygtninge med PTSD ... 59
#46: ICD-11 PTSD og kompleks PTSD i ambulantpsykiatrien ... 60
#47: EMDR-behandling af danske ambulante patienter med PTSD: potentialet af BBAT som supplement ... 61
#48:Trauma informed care & practice - implementing a trauma informed approach in psychiatric wards 62
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Symposium I SDU
#1: Sex differences in associations between peritraumatic physiological arousal and PTSD severity in accident survivors
Dorte Mølgaard Christiansen, Danish National Center of Psychotraumatology, University of Southern Denmark.
Introduction: Whereas some survivors respond to trauma with acute physiological hyperarousal (e.g. increased heart rate, blood pressure (BP), respiratory rate (RR)), others respond with
dissociation, which has been linked to hypo-arousal. Both hyperarousal and dissociation are known risk factors of PTSD and may be moderated by sex. It is thus possible that the association between arousal and PTSD severity (PTSS) is curvilinear and may be moderated by sex.
Method: This study examined the effect of acute physiological arousal on self-reported PTSS 1-2 years later in a consecutive sample of 341 male and 165 female injured accident survivors.
Results: The association between BP and PTSS was non-significant. For RR the quadratic model was not superior to the linear model, neither in the total sample nor when men and women were examined separately. However, there was a significant moderation effect. The linear association between RR and PTSS was significant and positive in men but significant and negative in women.
Discussion: The 2:1 male:female ratio may explain why the curvilinear model was not superior to the linear in spite of the significant moderation effect for RR. The present results call for future studies to use non-linear methods to examine associations between arousal and PTSD and point to the importance of including sex/gender as a possible moderator in PTSD research in general.
#2: Problems with the revised DSM-5 A criterion: The case of infant loss.
Dorte Mølgaard Christiansen, Danish National Center of Psychotraumatology, University of Southern Denmark.
Introduction: Parents who have lost an infant prior to, during, or following birth often interpret the event as highly traumatic and many develop a multitude of symptoms. The A criterion in the DSM- 5 PTSD diagnosis requires that a loss must either be witnessed by the parent or be violent or accidental in nature in order to qualify for a PTSD diagnosis. As many types of infant loss do not fulfill these requirements, the changes make it more relevant than ever to establish whether PTSD exists as an independent diagnosis in parents following infant loss.
Method: This systematic review included 46 articles of PTSD in parents who had lost an infant either during pregnancy or birth or within one year of life.
Results: The PTSD prevalence in mothers differed widely across studies with estimated rates at 0.6-39%. Fewer studies focused on fathers reporting prevalence rates at 0-15.6%. Neither type of loss nor gestational age consistently predicted PTSD severity.
Discussion: This review confirms the potentially traumatic nature of different types of infant loss.
The finding that neither type nor timing of the loss appears to affect PTSD levels speaks against the DSM-5 distinction between the types of loss that qualify as potentially traumatic and calls into question the legitimacy of the revised A criterion. Failure to accept infant loss as a potential trauma in DSM-5 may have serious consequences.
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#3: The Psychological Subtype of Intimate Partner Violence and its Effect on Mental Health: A Systematic Review and Meta-Analysis
Sarah Dokkedahl, National Center of Psychotraumatology, University of Southern Denmark.
Co-authors: Robin Kok, Siobhan Murphy, Trine Rønde Kristensen, Ditte Bech-Hviid, and Ask Elklit.
Background: Psychological violence is the most common form of Intimate partner violence (IPV;
FRA, 2014), but research on the independent effect on mental health is scarce. Moreover, the lack of a clear and consistent definition of psychological violence have made results difficult to
compare.
Objective: The present study aims to consolidate knowledge on psychological violence by
conducting a random-effects meta-analysis on the association between psychological violence and posttraumatic stress disorder (PTSD), when controlling for other types of violence (e.g. physical and sexual).
Method: The systematic review is registered in PROSPERO (#CRD42018116026) and the study design follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis
(PRISMA) guidelines. A dual search will be conducted in the electronic databases PsycINFO, PubMed, EMBASE, and Web of Science. A meta-analysis will further be conducted using the programming language R. The “Quality Assessment Tool for Quantitative Studies” (National Collaborating Centre for Methods of and Tools, 2018), will help assess the quality of the included studies.
Results: Preliminary results on the individual effect of psychological violence on PTSD will be presented with meta- and subgroup analyses.
Discussion: The present review will help consolidate knowledge on psychological violence by evaluating whether frequency, severity, or actual “type” of psychological violence produces the most harm.
#4: Workplace Critical incidents and impact on mental health: Systematic review of longitudinal studies on the association between critical incident and mental health in non- military work
Jesper Pihl-Thingvad, Dep. of Occupational and Environmental Medicine, Odense University Hospital
Co-presenters: Nina Beck Hansen, Sara Al Ali, and Ask Elklit.
Background: Workplace psychotrauma is a well-known phenomenon, in occupations such as first responders Health and service work, prison & probation industries and in public transportation.
Reactions to traumatic events includes both Posttraumatic stress disorder, depression, adjustment disorders other anxiety disorders and personality disorders. Within the occupational setting, reactions to critical events might differ from civilian life, due to selection and training of staff and because workplace critical incidents are often repeated, and occurring for prolonged periods of time (Mcfarlane, 2012). Research on the consequences of workplace critical incidents is heterogeneous.
A systematic overview is needed to establish a platform for planning and decision- making regarding workers health.
Objective: To conduct a systematic review on longitudinal studies on workplace critical incidents and mental health outcomes within non-military work.
Method: The review will be conducted in adherence to the Meta-Analysis of Observational studies in epidemiology guidelines (Stroup et al., 2000). Searches will be conducted in PubMed, CINAHL, EMBASE, and PsycINFO, Web of science, Scopus, complemented by citation chaining. Data extraction will be conducted from February - March 2019 including results from peer reviewed publications and grey literature in English and Scandinavian languages from 1995 – 2019.
Results: Results will be presented schematically based on year, population, exposure (type and frequency), design main results and study quality assessed using the Newcastle – Ottawa Quality Assessment Scale for Cohort studies (Wells et al., 2005).
Conclusions: A much needed overview will be presented and conclusions on the research field of workplace traumatization will be made.
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#5: Everyday Violence, under what circumstances is occupational violence detrimental to mental health?
Jesper Pihl-Thingvad, Dep. of Occupational and Environmental Medicine, Odense University Hospital. Co-authors J., Brandt, L.P.A., Andersen, L.L., Hogh, A., Elklit, A.
Background: It is well known that occupational violence has a negative impact on mental health.
However, little is known on the whether the frequency of occupational violence is important to these detrimental effects. Also, there is a lack of knowledge on whether other work environment factors contribute to the negative effects of occupational violence.
Aim: To investigate if:
- Frequency of workplace violence is positively associated with the level of burnout, and if this association is mediated by a decrease in sense of security at the workplace?
- The indirect effect of violence on burnout, through decrease in sense of security, is moderated by the level of perceived demands in the workplace?
Method: Based on the baseline sample of the everyday violence cohort, a regression based moderated mediation analysis was conducted. The sample consisted of 3212 social educators working with disabled or marginalized adults. Analysis was based on survey data collected using already validated scales form the Copenhagen psychosocial questionnaire. Analysis was conducted with the Process Macro version 2.0 using 10.000 bootstrap re-samplings, in IBM SPSS version 24.
Results: The presented preliminary results show a significant positive association between the frequency of violence and level of burnout (b= 0.25, p<.001). Further, a significant indirect effect of violence on burnout through reduced sense of security was found, which was further moderated by the level of quantitative demands (Indirect effects( High demands) = 0.43, 95% CI [0.35-0.51], indirect effect (Medium demands) = 0.36, CI[0.30 – 41] and indirect effect (low demands) = 0.28, 95% CI [0.21-0.35].
Conclusions: These preliminary cross-sectional results indicate that not only is the frequency of violence significantly associated with burnout. To fully understand the mechanism leading from violence to burnout, there is a need to include factors of the general psychosocial work environment namely the general sense of safety and quantitative demands. This knowledge could be pivotal in future preventive strategies on the detrimental effects of workplace violence.
#6: Screening for secondary traumatisation among Danish child protection workers: A latent variable approach
Maria Louison Vang, School of Psychology Ulster University, Danish National Center of Psychotraumatology.
Co-authors: Pihl-Thingvad, J. & Shevlin, M.
Background: International research suggest that child protection workers might be at increased risk for developing symptoms of traumatisation following indirect exposure to trauma compared to professionals working with other client groups. However, available tools for screening for the risk of secondary traumatisation are not available in Danish and have displayed inadequate
psychometric properties in international research
Aim: To translate the ProQoL-5 into Danish and validate a new cut-off to identify participants at risk for secondary traumatisation.
Methods: A committee and back-translation approach was used to translate the ProQoL-5. This translation was tested in a survey of 670 child protection workers. Data was analysed using latent class analysis and classes were validated using sum scores of anxiety, depression, general well- being and scores on the ProQol-5.
Results: A small group of child protection workers were at risk for secondary traumatisation. These participants differed in their response patterns on the ProQoL-5.
Discussion: The present study indicates that a revised scoring procedure for ProQoL-5 might be useful to screen employees at risk for secondary traumatisation among Danish child protection workers.
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#7: Effectiveness of the STEPS-intervention: Findings from an observational-study of posttraumatic stress in survivors of rape
Authors: Vang, M.L., Ali, S.A., Christiansen, D., Dokkedahl, S., & Elklit, A.
Introduction: The group-based intervention program ‘STEPS’ for adolescent survivors of sexual assault was translated from Dutch to Danish and expanded to adults as well as to an individual intervention at a Danish Centre for Rape Victims through 2011 to 2014.
Methods: A prospective longitudinal study monitored symptoms of posttraumatic stress before treatment, after treatment and at six and 12 months follow up for 103 referrals. Multilevel
modelling was used to assess the development of symptom severity and to assess the moderating effect of age-group and mode of delivery.
Results: There was a large and statistically significant decline in symptomatology over time, and the effect was not moderated by age-group or intervention-type. Dropout rates were independent of intervention-type and age. There was a decline in CPTSD caseness over time.
Discussion: The adaption of the STEPS program to adults and as an individual intervention is feasible and maintains effect-sizes comparable to those observed in the original intervention.
Further research using randomized controlled trials is needed to ascribe the observed effect to the STEPS program.
#8: The Structure of Adjustment Disorder, PTSD, and Complex PTSD, and their association with childhood adversities, stressors, and traumas
Authors: Vang, M.L., Shevlin, M., Karatzias, T., Ben-Ezra, M. & Hyland, P.
Background: Adjustment disorder (AD) has been included alongside PTSD and CPTSD in ICD-11 in the category of trauma- and stressor-related disorders, reflecting a continuum of severity in stressor-related reactions. The present study investigates the latent structure and degree of
distinctiveness between AD, PTSD and CPTSD, and to investigate their association to life-stressors and traumatic life-events across child- and adulthood.
Methods: Confirmatory factor analysis was used to test 5 alternative factor analytical models of AD, PTSD and CPTSD in a sample of 331 participants referred for psychotherapy at the National Health Service trauma centre, Edinburgh, Scotland. Participants reported symptoms of AD, PTSD and CPTSD as well as exposure to stressful life-events and traumatic life-events in child- and adulthood.
Results: A correlated 3 second-order and 8 first-order factor model reflecting AD, PTSD and CPTSD as distinct constructs best represented the latent structure of the data. Participants reported high rates of trauma and stressor-endorsement across the life-span and 83.3 % of those that met the criteria for AD also met the criteria for PTSD or CPTSD. There was evidence of specificity in the relationships between different types of trauma/stressor exposure and childhood trauma and the AD, PTSD and CPTSD latent variables.
Conclusion: AD is conceptually distinct from but highly correlated with trauma-related disorders.
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#9: The relationship between polyvictimization and ICD-11 PTSD and CPTSD: An Israeli population study
Authors: Vang, M.L., Ben-Ezra, M. & Shevlin, M.
Introduction: Evidence is accumulating for the conceptual validity of the ICD-11 proposal for PTSD and CPTSD, but studies using advanced statistical methods to investigate the relationship between trauma-exposure and ICD-11 proposals of traumatic stress are lacking.
Methods: Trauma-exposure as reported by a general population sample of the Israeli adult
population (n=834) was analysed using latent class analysis, and the resultant classes were used in regression models to predict PTSD and CPTSD operationalised both dimensionally and
categorically.
Results: Four distinct groups were identified that were differentially related to PTSD and CPTSD with only child and adult interpersonal victimization consistently predicting CPTSD and DSO.
Discussion: These findings support the use of trauma-typologies for predicting PTSD and CPTSD and provide important insight into the distribution of trauma-exposure in the Israeli population.
Symposium II Flygtninge/transkulturel psykiatri
#10: The Effect of Integrating Cross-sectoral Collaboration with the Municipality in Psychosocial Treatment of Trauma-affected Refugees; Study Design of a Randomised Controlled Trial
Maja Bruhn, Henriette Laugesen, Matilde Kroman-Larsen, Carsten Hjorthøj, Lene Eplov, Jessica Carlsson.
Kompetencecenter for Transkulturel Psykiatri, Psykiatrisk Center Ballerup, maja.bruhn.kristiansen.03@regionh.dk
Introduction: Postmigration conditions in resettlement countries e.g. employment status and finances can moderate or exacerbate mental health outcomes in trauma-affected refugees. Cross- sectoral collaboration and coordination of municipal social interventions and regional mental health services are currently limited. The aim of this study is to investigate the effect of psychosocial treatment with a focus on social stressors in an integrated cross-sectoral collaboration with the municipality for trauma-affected refugees compared to treatment as usual (TAU).
Methods: The study is being conducted at Competence Centre for Transcultural Psychiatry (CTP).
Included in the study are refugees with post-traumatic stress disorder (PTSD), who are unemployed and attending a municipal job centre in one of the five collaborating municipalities; Frederikssund, Gladsaxe, Hillerød, København or Lyngby-Taarbæk. 228 patients will be included. The randomised controlled trial is comparing TAU comprising 10 sessions with a medical doctor (pharmacological treatment and psycho-education) and 16-20 sessions with a psychologist (manual-based cognitive behavioural therapy) with add-on of the social intervention. Overall, the intervention seeks to integrate working with social stressors alongside treatment for trauma-related mental health problems. This is done in two ways; by a cross-sectoral collaboration with municipality through collaborative meetings and by a systematic focus on social stressors during the treatment.
The primary outcome is functioning, measured by WHODAS 2.0 12 item version together with a variety of secondary outcomes measuring mental health symptoms, quality of life and degree of social stressors.
Results: Inclusion for the study will begin in February 2020.
Discussion/conclusion: The study is expected to bring forward new perspectives and knowledge on psychosocial treatment of trauma-affected refugees as well as cross-sectoral collaboration.
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#11: The use of a Patient-Generated Outcome, the Goal Attainment Scaling in treatment of trauma-affected refugees
Authors: Jessica Carlsson*, Maria Barhoma, Charlotte Sonne, Erik Lykke Mortensen
*Competence Centre for Transcultural Psychiatry
*Email: jessica.carlsson@regionh.dk
Introduction: When measuring treatment outcome among trauma-affected refugees it is challenging to find valid and relevant measurements. In a randomised trial comparing the effectiveness of stress management (SM) versus cognitive restructuring (CR) in trauma-affected refugees with PTSD the Goal Attainment Scaling (GAS) was studied as a potential useful patient- generated outcome measure (PGOM). Results from the RCT with 126 trauma-affected refugees have already been published, but results evaluating GAS have not been reported yet.
Methods: The GAS was used in the first sessions of psychotherapy and again at finalization of psychotherapy.
Results/Discussion/Conclusion: Preliminary finding points to that the use of GAS could strengthen intercultural sensitivity, treatment motivation as well as therapeutic alliance. However, for patients with a high burden of comorbidity and severe disability the clinical experience was that the GAS had low utility. Presently a thorough evaluation of the use of GAS in the trial is carried out and results will be presented.
#12: “Being Gone?”: Theoretical and Empirical perspectives on the risk and protective factors of dissociation and avoidant coping among trauma-survivors
Helle Harnisch, Institute for Psychology, Copenhagen University and DIGNITY - Danish Institute Against Torture, Copenhagen. Email: Helle.harnisch@gmail.com or heha@videnscenteret-ams.dk
In psychiatric nosology and trauma theory and studies, dissociation and avoidant coping tend to be perceived primarily in regard to their pathological features; including as symptoms related to traumatization in general and PTSD specifically. This paper, however, offers a theoretically and empirically informed interdisciplinary conceptualization of dissociation, which discusses the risk and protective factors related with avoidant coping and dissociation among survivors of trauma, with an emphasis on the protective factors, since these are less studied in psycho-traumatology.
Based on 10 months of fieldwork over the duration of four years in the war-torn Acholi region in northern Uganda, and two months of fieldwork at a Danish institution for Danish Youth with a variety of psychiatric diagnosis and histories of trauma, this qualitative study draws on the experiences and narratives of 36 Acholi who were violently abducted into the militia The Lord´s Resistance Army – as well as empirical case-stories with 2 institutionalized Danish Youth. Excerpts of narrative interviews and case-stories from both groups of informants show variations of and first-person experiences with past and current dissociation. Results show how dissociative experiences in the data from northern Uganda are understood as external forces; spirits roaming as remnants of vengeful killings during war-time, and not related to human reactions to difficult war experiences. In the two case-stories from Denmark, dissociation is experienced as frightening, as a reason for admission to a psychiatric hospital with first-episode psychosis; and thus related to their mental health pathology. The paper discusses the potential and pitfalls of explanatory styles for dissociation and underlines how research is called for, which explores dissociation as placed within a continuum of coping, while backgrounding diagnostic pursuits in order to conceptualize what dissociation means to the subjects who dissociate and how dissociation influences their self-evaluation and daily functioning in social relationships and society.
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#13: A comparison of trauma history, psychopathology and treatment efficiency in two trauma-affected populations with PTSD: refugees versus persons family reunified with a refugee
Ane Brøndum Lange
Background and objectives:
More than 25 million people in the world have a refugee status (United Nations, 2019). Studies suggest an increase in mental illness such as PTSD within this population (Steel et al. 2009).
Research on treatment for this group focuses mainly on refugees and knowledge of specific subgroups is limited.
Both pre-, peri- and post migratory factors play a part in development of mental illness (Bhugra D et al 2011, Porter M et al 2015, Bruhn M et al 2018). The clinical impression suggests that trauma- affected refugees and trauma-affected persons family reunified with a refugee differ as to migratory factors such as sociodemographic factors, trauma history and treatment outcome. This study aims to investigate differences between the two groups regarding sociodemographic factors, trauma
exposure, psychopathology at baseline as well as difference in treatment efficiency.
Methods: The study is a retrospective comparative cohort study that includes 892 trauma-affected refugees and persons reunified with a refugee, all with PTSD. All participants have finished treatment at Competence Centre of Transcultural Psychiatry (CTP). They have all answered questions about sociodemographic factors, trauma history and have all completed a collection of rating scales on mental health and functioning before and after treatment.
The cohort is divided into two groups based on whether patients were refugees or persons family reunified with a refugee. The two groups will be compared using descriptive analysis. Multiple regression analysis is used to compare whether being a refugee or being family reunified with a refugee is a predictor for treatment outcome.
Results: Statistical analyses are ongoing.
#14: Validity of the ICD-11 proposal for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in a heterogeneous sample of treatment-seeking refugees: A latent class analysis
Nielsen, S.B., Vang, M.L., Auning-Hansen, M., & Elklit, A.
Introduction: The recently published ICD-11 has introduced a reconceptualization of posttraumatic stress under the diagnoses PTSD and CPTSD. The current study is among the first to test the
validity of these disorders in a heterogeneous sample of refugees in clinical practice.
Methods: Latent class analysis was used to test the validity of the ICD-11 PTSD and CPTSD distinction in a heterogeneous group of 284 highly symptomatic refugees registered for treatment at the Rehabilitation Center for Torture Survivors – Jutland (RCT-Jutland).
Results: Two classes were found, one that reported elevated levels of PTSD-symptoms and symptoms of affective dysregulation, and one that reported elevated levels of symptoms corresponding to CPTSD. The CPTSD group was considerably larger than the PTSD-group.
Discussion: The current study supports the ICD-11 distinction between PTSD and CPTSD in a sample of treatment-seeking refugees. The assistance of interpreters was needed for some of the participants, which affected the reliability of the assessment.
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#15: Traumatic Brain Injury And Cognitive processing in Tortured and Traumatized Refugees
Name: Linda Nordin, DIGNITY (Danish Institute Against Torture)/ Lund University
Email: ln@dignity.dk
Introduction: Traumatized refugees often report traumatic brain injuries (TBIs) as part of their traumatic exposure. They are more likely than the general population to have experienced physical assaults, injuries and/or torture but relatively few studies have investigated the prevalence or consequences of traumatic brain injuries (TBIs) in this population.
Objectives: We compare cognitive impairment measured with Symbol Digit Modality Test (SDMT) on tortured and traumatized refugees with and without TBIs. To investigate the
relationship between head trauma, cognitive impairments, and posttraumatic stress disorder (PTSD) in refugees. Second, we examine the relationship between cognitive functioning, history of TBI, and the severity of symptoms.
Method: 141 adult refugees referred to the Danish Institute Against Torture (DIGNITY) in
Copenhagen were assessed on PTSD, depression, pain, disability and SDMT. Half of the population were screed for head trauma (HTQ). With an ANOVA we tested for differences on the measures between participants who had or had not lost consciousness during the ordeal.
Results: A high proportion (88%) of the participants in this study provided evidence of significant cognitive impairment. Participants scored, on average, 1.5 to 3.1 standard deviations published norms, putting the present sample between the 0.1 and 7th percentiles for cognitive functioning when compared to the general population. When compared to refugees who reported a head trauma but no loss of consciousness, those with TBIs (all of whom were above threshold for PTSD) had significantly higher levels of cognitive impairment and health-related disability.
Conclusion: The present study provides important information on the level of cognitive functioning in tortured refugees with a history of TBIs.
#16: Posttraumatic Stress Reactions in Tortured Refugees: The relationship to pain Name: Linda Nordin, DIGNITY (Danish Institute Against Torture)/ Lund University
Email: ln@dignity.dk
Introduction: Among the various forms of comorbidity found alongside PTSD and depression in traumatized refugees, pain is one of the most common. When both PTSD and pain are present, the severity, duration and functional impact tends to increase. The study presented, investigates the extent to which pre-treatment pain predicts treatment outcomes. The effects of gender, age, and the number of treatment sessions, were also evaluated.
Method: Participants were traumatized refugees (n = 276; 170 men, 106 women) referred to DIGNITY (Copenhagen) for outpatient treatment over a three-year period. The treatment is a multidisciplinary approach. Treatment outcome was analyzed using a 2-level, mixed multi-level model design. Effect size was calculated with Cohen’s d.
Results: Patients in this study reported high levels of functional disability, PTSD, depression, anxiety, pain symptoms, interference from pain, pain, levels that often exceed those found in other traumatically-exposed populations. The treatment program yielded moderate effect size reductions in PTSD, depression, and anxiety, and small effects for the number of pain locations. No
improvements in pain severity, pain interference, or health-related disability, except for a single domain of functioning (participation in society), were observed. Improvements were maintained at the 9-month follow-up for PTSD, depression, and participation in society. No improvements occurred for participants while on the waitlist for treatment. Multilevel modelling suggested that participants with higher levels of pain interference at pre-treatment experienced a poorer response to treatment in respect of PTSD, depression, and anxiety.
Discussion/Conclusion: The present study adds to a small but growing body of literature suggesting that traumatized refugees with PTSD and comorbid pain are more symptomatic overall and respond less well on treatment. Adding interventions that are specific to dysfunctional pain responses, or that target transdiagnostic processes like experiential avoidance, to current interventions may improve outcomes.
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#17: Nat og dag – kan bedre søvn give traumatiserede flygtninge en bedre hverdag?
Resultater fra et randomiseret kontrolleret studie
Hinuga Sandahl1,2, Poul Jennum3, Lone Baandrup4, Erik Lykke Mortensen2 and Jessica Carlsson Lohmann1,2
1 Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup; 2 University of Copenhagen; 3 Danish Center for Sleep Medicine, Rigshospitalet-Glostrup; 4 Mental Health Centre Copenhagen
Introduction: In previous research on sleep disturbances in trauma-affected refugees, 99 percent in a sample of 752 undergoing psychiatric treatment at Competence Centre for Transcultural Psychiatry reported sleep disturbances.
The present study examined sleep enhancing treatment in trauma-affected refugees with posttraumatic stress disorder (PTSD). We aimed to assess if add-on treatment to treatment as usual with mianserin and/or Imagery Rehearsal Therapy (IRT) improved sleep disturbances, symptoms of PTSD and depression, functioning and quality of life.
Method: The study was a randomised controlled superiority trial with a 2x2 factorial design. It included 230 refugees, diagnosed with PTSD, randomised to four groups.
TAU; pharmacological treatment according to algorithm and manual based Cognitive Behavioural Therapy
TAU and add-on treatment with mianserin TAU and add-on treatment with IRT
TAU and add-on treatment with mianserin and IRT
The primary endpoint was sleep quality measured on Pittsburgh Sleep Quality Index (PSQI).
Secondary outcome measures were nightmares, PTSD and symptoms of depression, quality of life and level of functioning.
Results: The presentation will provide preliminary results on the effect of the two active treatment components compared to treatment as usual, measured through the above-mentioned outcomes.
Discussion: There is currently a lack of knowledge on treatment of sleep disturbances in trauma- affected refugees. This study is expected to bring forward new knowledge on both psychopharmacological and psychotherapeutic treatment of sleep disturbances, and based on findings, we will discuss the effect of treatment focusing on sleep disturbances in trauma-affected refugees.
#18: Predictors of treatment outcomes for refugees with posttraumatic stress disorder Authors: Charlotte Sonne (1), Erik Lykke Mortensen (2), Derrick, Silove (3), Sabina Palic (1) and Jessica Carlsson (1,2)
1. Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup, Denmark; 2. University of Copenhagen, Denmark; 3. University of New South Wales, Sydney, Australia
Presenting author: Charlotte Sonne: charlotte.sonne@regionh.dk
Background: The treatment effects in trials with trauma-affected refugees vary considerably, both between studies and between patients within the single study. As few studies have analysed
predictors of treatment outcome we know little about why some patients benefit more from treatment than others. The objective of the present study was therefore to identify predictors of treatment outcome for trauma-affected refugees.
Methods: Data was derived from two randomised controlled trials, with a total number of 321 adult trauma-affected refugees with post-traumatic stress disorder, enrolled in a six-seven months
multidisciplinary treatment programme. Outcome measures for the current study were the Harvard Trauma Questionnaire, Hopkins Symptom Checklist-25, and Hamilton Depression and Anxiety rating scales. Correlations were analysed between pre- to post-treatment score changes and baseline variables including sociodemographics, trauma variables and symptoms. Bivariate analyses as well as hierarchical multiple regression analyses were undertaken.
Results: Bivariate analyses identified a number of predictors that correlated with treatment response on one or more of the rating scales. All predictors with a p-value of <0.05 were included in the regression analyses, where the following variables were found to correlate with positive treatment outcome on one or more of the ratings: Young age, short time in host country, being family reunified (rather than being a refugee), full-time occupation and a high level of functioning.
Combat experience and being a Muslim were negatively correlated to treatment outcome.
Sociodemographic variables explained more of the variance than the trauma variables across all ratings.
Discussion: Results and their impact for clinical practice as well as future research projects are discussed. Further analyses such as Latent Growth Mixture Modelling on larger datasets are warranted.
Conclusion: Several variables were found to correlate significantly to outcome, which may explain some of the variability in treatment success between studies as well as differences between
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#19: Posttraumatic stress disorder and changes in the brain´s white matter Oplæg ved læge, ph.d., Sigurd Uldall
Sigurd Wiingaard Uldall, Henrik Lundell, William F.C. Baaré, Hartwig Roman Siebner, Tim B.
Dyrby, Egill Rostrup, Jessica Lohmann Carlsson
Abstract: The number of studies on white matter characteristics in PTSD is increasing fast.
Typically, studies use diffusion-weighted magnetic resonance imaging (DW-MRI) from which metrics such as fractional anisotrophy (FA) and mean diffusivity (MD) can be derived. While these measures are sensitive to changes in white matter, they are also unspecific and may reflect a number of effects ranging from microscopic cellular effects, mesoscopic axonal architecture and alignment up to macroscopic differences. After showing data from a DW-MRI study on PTSD among trauma- affected refugees this talk will discuss the possible mechanisms underlying changes in white matter in PTSD.
#20: The Danish Trauma and Refugee Database (DTD): The effectiveness of
multidisciplinary treatment for traumatized refugees, across four specialized Danish rehabilitation centers.
Authors: Marie Høgh Thøgersen, Cæcilie Stall Køhler DIGNITY (Danish Institute Against Torture) Email: Marieht@dignity.dk
Introduction: The aim of this study was to evaluate the effectiveness of multidisciplinary treatment in four specialized Danish rehabilitation centers and to explore possible predictors of treatment outcome.
Methods: Pre and post clinical outcome measures were derived from 491 traumatized refugees with post-traumatic stress disorder, referred to treatment across four national rehabilitation clinics. Data was collected through the Danish Trauma and Refugee Database (DTD,) and results were compared with a waitlist control group.
Results: The 491 traumatized refugees were comparable across centers, although there were slight sociodemographic and clinical differences. The effectiveness of the treatment was higher in the intervention group than in the waitlist control group. Several possible predictors for treatment outcome were found.
Discussion: Results and their impact for clinical practice as well as future research projects incorporating data from the Danish Trauma and Refugee Database are discussed.
Conclusion: The first results from the DTD constitutes and interesting starting point for further studies.
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#21: Musikterapi og standardbehandling af flygtninge med PTSD – et randomiseret studie
Bolette Daniels Beck, Aalborg Universitet samt Klinik for traumatiserede flygtninge, Region Sjælland. Bolette@hum.aau.dk
Steen Theis Lund, Klinik for traumatiserede flygtninge, Region Sjælland samt Københavns universitet. smey@regionsjaelland.dk
Baggrund: Behandling af traumatiserede flygtninge med verbal psykoterapi har genereret en lille- medium effekt på traumesymptomer i metaanalyse (Turini et al., 2019). På baggrund af et
feasibility studie hvor musikterapi med 16 patienter viste sig velegnet til stabilisering,
ressourceopbygning og traumeeksponering (Beck et al., 2017), blev metoden afprøvet i en RCT (Beck et al., 2018).
Metode:74 voksne flygtninge diagnosticeret med posttraumatisk stress syndrom blev randomiseret til 16 ugentlige sessioner med enten standardbehandling (psykologsamtaler, TAU) eller musikterapi med samtale, musiklytning og billeddannelse (tr-MI). Medicinsk behandling og andre ydelser i den tværfaglige behandling blev tildelt alle deltagere efter behov. Ved hjælp af et non-inferiority design med 6 mdr.s follow-up testede vi, om tr-MI er lige så effektiv som standardbehandling primært i forhold til traumesymptomer (HTQ) med en klinisk signifikans på 0,3; sekundært i forhold til dissociative symptomer (SDQ-20, DSS), tilknytning (RAAS) og trivsel (WHO-5). Som eksplorativ del af designet indsamlede vi spyt med henblik på analyse af oxytocin og betaendorfin.
Resultater:De to grupper var sammenlignelige på demografiske parametre. Frafald var 8 % hos tr- MI og 40 % hos TAU. Non-inferiority i forhold til traumesymptomer var signifikant. Positive signifikante ændringer af trivsel og selvrapporteret ambivalent tilknytning blev fundet i tr-MI- gruppen ved follow-up. Analyse af biomarkører er igangværende.
Diskussion:Fastholdelse i behandling er en vigtig problemstilling i målgruppen af traumatiserede flygtninge. Det store frafald i standardbehandlingsgruppen sammenlignet med musikterapigruppen kan muligvis skyldes, at musikterapi kan være en mere indirekte og skånsom vej til
traumeeksponering end verbal terapi. Musikterapipatienterne lærte at anvende musik hjemme, hvilket kan have bidraget til den gode behandlingseffekt.
Konklusion: Undersøgelsen viser at Traumefokuseret musik og billeddannelse er lige så effektiv som psykologbehandling (TAU) i forhold til at reducere PTSD symptomer og forøge trivsel hos traumatiserede flygtninge, og kan muligvis anvendes med et bredere spektrum af PTSD- patienter.
#22: “Previous experiences of violence and neglect among adult offenders involved in serious and/or organized crime participating in a Community based Crime Prevention Programme”
Katrine Due (fs5v@kk.dk), Lise Elmer Houmann, Dea Seidenfaden, Enheden for Kriminalpræventive Indsatser (EKI), The City of Copenhagen
Introduction: People involved in criminal activities are frequently exposed to violence and traumatic experiences that affect them psychologically (1). In this study, we examine the previous experiences of violence (both as victims and perpetrators), neglect and psychological wellbeing among adult offenders who are pursuing a non-criminal lifestyle.
Method:The LS/RNR consists of 43 interviewer- administered items which is supplied with data from various sources. The RNR model underlies some of the most widely used risk-needs offender assessment instruments and is used to assess and rehabilitate offenders around the world, including Denmark.
We have analysed 160 LS/RNR interviews, conducted in EKI over time, which offers a nuanced description of the risk profiles and the criminogenic risk factors among the participants at the time of their admittance to the programme.
Results: From 160 LS/RNR interviews we found that 36% (58) report being victims of domestic violence, 59% (95) victims of violence, 35% (56) report childhood neglect, 74% (118) are offenders of violence, 63% (100) have used weapons, 54% (86) lack anger control, 39% (63) report
depressive tendencies and 81% (129) have drug issues. The data above are primarily self-reported.
The clinical impression is that the numbers concerning e.g. perceptions of upbringing and mental health are higher than reported by the participants.
Discussions: The results suggest that several risk factors for PTSD are increased among the participants of the study. This is supported by a recent metastudy which conclude, that lifetime prevalence estimates of PTSD were 18% in male and 40% in female prison populations (1). As a result, it is expected that numerous individuals are suffering from physical and psychological effects of these experiences. However, there is no systematic screening or intervention targeting these effects. It could be hypothesized that a lack of specialised screening and intervention on PTSD among the group of high-risk individuals lead to poorer outcome of the crime prevention interventions.
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Symposium III Veteraner
#23: Body therapy for the rehabilitation of veterans with PTSD: Study design and preliminary results
Nanna Gram Ahlmark1*, Anders Dahl2*, Henrik Steen Andersen3, Tine Tjørnhøj-Thomsen4, Susan Andersen5
*Denotes equal first authors
1,2,4,5: National institute of Public Health, University of Southern Denmark 3: Danish Military Psychiatric Center, Capital Region of Denmark
Corresponding author: Nanna Gram Ahlmark, National Institute of Public Health, University of Southern Denmark
Background: PTSD implies complex physical and psychosocial problems for the affected veterans and their families. Treatment options today are primarily medically and psychologically founded but show limited effects. Body therapy regarding PTSD is subject of increased attention. In 2015, a Danish pilot study was conducted exploring body therapy for PTSD. The study showed positive results and formed basis for this trial.
Methods: The intervention will be evaluated in a two-arm randomised controlled trial (1:1). The study population is 42 in total. The control group receives treatment as usual. The intervention group receives treatment as usual and body therapy as add-on. The intervention includes physical treatment of the body along with meditation. Participants will complete four web-based
questionnaires assessing PTSD, depression, quality of life, function level and body awareness: at baseline, 3 months post-baseline, 6 months post baseline and at 12-months follow-up. Linear regression and mixed effects models will be used to assess intervention effects. Furthermore, an ethnographic study based on in-depth interviews, focus group and participant observations will examine participants’ experiences of the body treatment and changes in their everyday life.
Data collection: The data collection is finished for baseline and midways assessments with very promising response rates; 100% and 98%, respectively. The data collection for post-intervention is on-going with a preliminary response rate of 90%. The qualitative data generation is almost
complete with 15 interviews and 7 participant observation and 1 focus group.
Conclusion: This study will examine the efficacy of body therapy for PTSD and how the treatment is affecting daily life. Once our data collection is completed, we will examine intervention effects and how durability of intervention sessions may impact outcomes.
#24: ICD-11 PTSD and Complex PTSD in Treatment-seeking Danish Veterans: A Latent Profile Analysis
Sofie Folke, PhD1, 2, Anni B. S. Nielsen, PhD1, 3, Søren Bo Andersen, PhD1, Thanos Karatzias, PhD4, 5, Karen-Inge Karstoft, PhD1, 6
1 Research and Knowledge Centre, the Danish Veterans Centre, Ringsted, Denmark.
2 Department of Military Psychology, the Danish Veterans Centre, Copenhagen, Denmark.
3 The Research Unit and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
4 School of Health and Social Care, Edinburgh, Napier University, Edinburgh, UK.
5 Rivers Centre for Traumatic Stress, NHS, Lothian, Edinburgh, UK.
6 Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
Email-addresses:
SF: vetc-mpa43@mil.dk ABSN: vetc-vic004@mil.dk SBA: vetc-chvic@mil.dk TK: t.karatzias@napier.ac.uk KIK: vetc-vic01@mil.dk
Abstract
Introduction: The WHO International Classification of Diseases, 11th version (ICD-11), includes a trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD) distinct from
posttraumatic stress disorder (PTSD). Results from previous studies support the validity of this distinction. However, no studies to date have evaluated the ICD-11 model of PTSD and CPTSD in treatment-seeking military veterans. The aim of the present study was to determine if the
distribution of symptoms in treatment-seeking Danish veterans were consistent with the ICD-11 PTSD and CPTSD symptom profiles. Based on previous studies, we hypothesized that separate classes representing PTSD and CPTSD would be found, that membership of a potential CPTSD- class would be predicted by a larger number of childhood traumas, and that a potential distinction between PTSD and CPTSD would be supported by differences in sociodemographic and functional outcomes.
Method: Participants (N =1,541) were formerly deployed Danish soldiers who completed proxy
32 report measures of traumatic life events, prior to starting treatment at the Military Psychology Department of the Danish Defence.
Results: All hypotheses were supported. Latent profile analysis (LPA) revealed separate classes representing PTSD and CPTSD. In comparison to the PTSD-class, membership of the CPTSD-class was predicted by more childhood traumatic experiences, and members of this class were more likely being single/divorced/widowed and more likely to use psychotropic medication. Besides a PTSD-class and a CPTSD-class, LPA revealed a Low Symptoms-class, a Moderate DSO-class, a Hyperarousal-class, and a High DSO-class, with clear differences in functional outcomes between classes.
Discussion and conclusion: Findings replicate previous studies supporting the distinction between ICD-11 PTSD and CPTSD. In addition, there seems to be groups of treatment-seeking military veterans that do not fulfill full criteria for a trauma-related disorder. Further research should explore subsyndromal PTSD and CPTSD profiles in veterans and other populations.
#25: Profilbaseret behandling af veteraner – kliniske interventionsstudier Sofie Folke1, 2, Nikolai C. Roitmann1 og Kasper Eskelund Folke1, 2
1 Militærpsykologisk Afdeling, Veterancentret, København, Danmark
2 Veterancentrets Videnscenter, Ringsted, Danmark Sofie Folke: vetc-mpa43@mil.dk
Nikolai C. Roitmann: vetc-mpa202@mil.dk Kasper Eskelund: vetc-mpa41@mil.dk Abstracts:
Generel indledning
Militærpsykologisk Afdeling (MPA) under Veterancentret tilbyder psykologisk behandling til danske krigsveteraner og deres pårørende. Som udgangspunkt tilbydes evidensbaserede
psykologiske behandlingsmetoder såsom prolonged exposure (PE) og cognitive processing therapy (CPT), mens nye og mere eksperimentelle behandlingsformer tilbydes i forskningsprojekter, hvor effekten af behandlingen monitoreres, og hvor klienterne giver informeret samtykke til at deltage.
Vi vil i dette oplæg præsentere tre aktuelle kliniske interventionsstudier ved MPA. Det første projekt er et udviklingsprojekt hvor et modulopbygget behandlingsprogram til veteraner med kompleks-PTSD udvikles og evalueres. Det andet projekt er et pilotprojekt, hvor 10 danske
krigsveteraner, udsendt til enten Afghanistan eller Irak, modtager virtual reality eksponeringsterapi (VRET). Pilotprojektet undersøger, hvorvidt VRET er relevant og gennemførbart for danske soldater med PTSD. Det tredje projekt er et feasibility-studie hvor 20 veteraner, der ikke havde responderet på gentagne behandlingsforsøg modtog neurofeedback-behandling med fokus på regulering af hyperarousal.
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#26: ”Modular CBT for Complex-PTSD” (MCC projektet)
Introduktion: Den nye ICD-11 diagnose Kompleks-PTSD (KPTSD) kalder på længerevarende behandlingstilbud ift. eksisterende behandlingstilbud til PTSD, samt mulighed for at kunne personalisere behandlingen til den enkelte klients præferencer og mest fremtrædende symptomer.
Formålet med MCC projektet er at udvikle og evaluere et modulopbygget behandlingsprogram til veteraner med KPTSD. Formålet med det modulopbyggede program er at behandlingsmodulerne skal kunne kombineres på forskellig vis, således at de matcher klientens præferencer og mest fremtrædende symptomer.
Metode: I 2019 er fem CBT behandlingsmoduler, der fokuserer på 1) PTSD-symptomer, 2)
vanskeligheder med emotionsregulering, 3) negativt selvbillede, 4) interpersonelle problemer og 5) søvnproblemer og traumerelaterede mareridt, blevet udviklet ved MPA i samarbejde med forskere ved Edinburgh Napier Universitet i Skotland. Primo 2020 vil det modulopbyggede program blive afprøvet i en række velkontrollerede kliniske casestudier ved MPA. Ultimo 2020 vil MCC
programmet blive evalueret i et randomiseret kontrolleret forsøg, hvor veteraner med KPTSD (N=60) randomiseres til MCC versus ”treatment as usual” ved MPA.
Resultater, Diskussion og Konklusion: Med den nye ICD-11 diagnose KPTSD, som er
kendetegnet ved flere symptomer og større funktionsnedsættelse end PTSD, ses der et behov for at udvikle og afprøve nye, mere længerevarende, behandlingsformer til klienter med KPTSD
(Karatzias et al., 2019). I sin opbygning søger MCC projektet at muliggøre individualisering af behandlingen samt at medinddrage klienter i behandlingsbeslutninger (ved at klienten er med til at vælge rækkefølgen og antal behandlingsmoduler), hvilket forventes at øge den terapeutiske alliance og reducere dropout.
#27: Brug af virtual reality i eksponeringsterapi til PTSD
Introduktion: Virtual reality eksponerings terapi (VRET) har vist sig at være ligeså effektivt til at behandle PTSD symptomer, som traditionel eksponeringsterapi (Gonçalves, Pedrozo, Coutinho, Figueira, & Ventura, 2012; Greg M. Reger et al., 2016). I Danmark er teknologien endnu ikke afprøvet i forbindelse med behandling af PTSD, hvilket understreger behovet for at undersøge, hvorvidt VRET er relevant og gennemførbart for danske soldater med PTSD, som har været udsendt til enten Afghanistan eller Irak.
Metode: Et ikke-kontrolleret, mixed-method studie, der følger 10 danske krigsveteraner med PTSD før, under og efter deres VRET behandlingsforløb. Behandlingens effekt måles på PTSD
symptomer ved CAPS-5 (primært outcomemål), samt på depression, angst, livskvalitet og psykosocial funktion (sekundære outcomemål). Endvidere afsøges kvalitativt, hvordan VR teknologien opleves, accepteres og tages i mod af deltagerne. Herunder deltagernes eventuelle forslag til forbedringer og eventuelle behov for danske tilpasninger af den amerikanske software.
Resultater: Univariat deskriptiv statistik anvendes til at beskrive demografiske og kliniske
variabler for samplet ved baseline. Effektanalyse i form af ”paired t-test” og Wilcoxon signed ranks test” (præ-post, præ-3 mdr, post-3 mdr) for primære og sekundære outcomemål.
Diskussion: En prædiktor for dropout af PTSD behandling for danske krigsveteraner er lavere alder (Folke et al. 2019) I en klinisk setting vurderes VRET at være en mere attraktiv mulighed for især den yngre del af målgruppen end traditionel eksponeringsterapi og kan medvirke til at motivere og fastholde veteraner i PTSD behandlingen.
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#28: Neurofeedback as a treatment for hyperarousal in treatment-resistant PTSD
Introduction: Hyperarousal is a common symptom following exposure to trauma and a core PTSD symptom. Unfortunately, the presence of pronounced hyperarousal is associated with lower
treatment outcomes for other trauma-related symptoms. This underlines the need for treatments addressing this specific symptom. EEG-neurofeedback may provide a route to specifically regulating hyperarousal.
Method: Participants (N=20) were recruited among Danish treatment-seeking veterans, selected for presenting a symptom combination with pronounced and primary hyperarousal and having been participating in multiple unsuccessful treatment attempts. Neurofeedback was given as a treatment in 36 sessions with three sessions per week, each consisting of 20-35 minutes of active training. The neurofeedback protocol was designed in NeuroGuide (Applied Neuroscience, Inc.), targeting power and connectivity in source-localized EEG between fronto-limbic regions and within prefrontal cortex in areas associated with hyperarousal and in the frequency range 1-30 hz. Training targets were set in relation to a normative database of EEG in healthy adults. Trauma-related
symptomatology was assessed with PCL-C and DASS-42.
Results: 50% of participants reported a substantial reduction in PTSD symptoms. Affective and anxiety symptoms as registered by DASS-42 were largely unchanged. However, stress symptoms recorded with DASS-42 showed a substantial decrease.
Discussion: In 50% of a sample that had not responded to previous treatments, neurofeedback was effective in reducing trauma-related symptomatology. The change was mainly seen in stress symptoms. This is expected as the intervention was specifically targeting hyperarousal. Potential and limitations of neurofeedback as a therapy for trauma reactions as well as lessons learned are presented.
#29: Pretreatment Predictors of Dropout from Cognitive Behavioral Therapy for PTSD in a Military Psychology Clinic
Sofie Folke1, 2, Nikolai C. Roitmann1, Dorte Hjortkjær1, Søren Bo Andersen2, Anni B. S. Nielsen2,3
1 Department of Military Psychology, the Danish Veterans Centre, Copenhagen, Denmark.
2 Research and Knowledge Centre, the Danish Veterans Centre, Ringsted, Denmark.
3 The Research Unit and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
Sofie Folke: vetc-mpa43@mil.dk
Nikolai C. Roitmann: vetc-mpa202@mil.dk Dorte Hjortkjær: vetc-ldkl@mil.dk
Søren Bo Andersen: vetc-chvic@mil.dk Anni B.S. Nielsen: vetc-vic004@mil.dk
Introduction: Cognitive-behavioral therapies (CBTs) for posttraumatic stress disorder (PTSD) have been shown to be effective, though they can be limited by relatively high treatment dropout rates. Dropout rates have generally been reported to be higher in “real world” military PTSD clinics (32-72%; Jefrey et al., 2014; Zayfert et al., 2005) as compared to research studies (12-39%;
Steenkamp et al., 2015). The current study examined pre-treatment predictors of dropout from CBT for PTSD in a “real world” military psychology clinic within the Danish Defence.
Methods: Study participants were 89 Danish military veterans with probable PTSD (DSM-IV) who received individual CBT for PTSD (primarily prolonged exposure and cognitive processing
therapy) at the Military Psychology Department within the Danish Defense. Participants were included if they started treatment in 2014 to 2018. Multivariate logistic regression analysis with inclusion of possible risk factors was used to predict treatment dropouts versus treatment completion. Results are presented as Odds ratios with 95% confidence interval (CI).
Results: Twenty-four veterans (27%) dropped out of treatment prematurely. Multivariate logistic regression analysis found higher odds for lower age (OR: 0.89; 95% CI: 0.82-0.97) and alcohol consumption exceeding weekly recommendations (OR: 7.47; 95% CI: 1.46-38.29) among treatment dropouts (n=24) versus treatment completers (n=65).
