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The opening events of the French Revolution have stood as some of the most familiar in modern European history. Traumatic Politics emerges as a fresh voice from the existing historiography of this widely studied course of events. In applying a psychological lens to the classic problem of why the French Revolution’s first representative assembly was unable to reach a workable accommodation with Louis XVI, Barry Shapiro contends that some of the key political decisions made by the Constituent Assembly were, in large measure, the product of traumatic reactions to the threats to the lives of its members in the summer of 1789. As a result, Assembly policy frequently reflected a preoccupation with what had happened in the past rather than active engagement with present political realities. In arguing that the manner in which the Assembly dealt with the king bears the imprint of the behavior that typically follows exposure to traumatic events, Shapiro focuses on oscillating periods of traumatic repetition and traumatic denial. Highlighting the historical impact of what could be viewed as a relatively “mild” trauma, he suggests that trauma theory has a much wider field of potential applicability than that previously established by historians, who have generally confined themselves to studying the impact of massively traumatic events such as war and genocide. Moreover, in emphasizing the extent to which monarchical loyalties remained intact on the eve of the Revolution, this book also challenges the widely accepted contention that prerevolutionary cultural and discursive innovations had “desacralized” the king well before 1789.

Neuropsychological evidence suggests that dissociation might disturb emotional learning, which is a fundamental mechanism of psychotherapy. However, a recent meta-analysis on the impact of dissociation on treatment outcomes in psychotherapy trials for posttraumatic stress disorder (PTSD) reported inconsistent results and concluded that further high-quality clinical trials are needed to test whether dissociation affects the efficacy of psychotherapies. We had two main aims: First, to test whether the efficacy of two evidence-based psychotherapies for individuals with trauma-related PTSD is affected by the level of pretreatment dissociation. Second, we investigated whether a significant reduction in dissociation at an early stage of treatment is beneficial for subsequent efficacy. The potential impact of dissociation on efficacy was studied in 193 women with PTSD related to childhood abuse who were randomized to dialectical behavior therapy for PTSD (DBT-PTSD) or cognitive processing therapy (CPT). Efficacy was operationalized as a change in the Clinician-Administered PTSD Scale (CAPS). Dissociation was assessed with the Dissociation Tension Scale (DSS). The analyses accounted for major confounders (in particular initial PTSD severity). Two main findings emerged from this study. First, baseline dissociation was a negative predictor for treatment efficacy. Second, a significant drop in dissociation at the initial stages of treatment was beneficial for subsequent efficacy. Dissociation likely reduces the efficacy of trauma-focused therapies. Accordingly, successful reduction of dissociation at an early stage of treatment assists the efficacy of trauma-focused psychotherapies.

Background: Post-traumatic stress disorder (PTSD) with co-occurring severe psychopathology such as borderline personality disorder (BPD) is a frequent sequel of childhood sexual abuse (CSA). CSA-related PTSD has been effectively treated through cognitive-behavioural treatments, but it remains unclear whether success can be achieved in patients with co-occurring BPD. The aim of the present study was to determine the efficacy of a newly developed modular treatment programme (DBT-PTSD) that combines principles of dialectical behaviour therapy (DBT) and trauma-focused interventions. Methods: Female patients (n = 74) with CSA-related PTSD were randomised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list. About half of the participants met the criteria for co-occurring BPD. Individuals with ongoing self-harm were not excluded. The primary outcomes were reduction of PTSD symptoms as assessed by the Clinician-Administered PTSD Scale (CAPS) and by the Posttraumatic Stress Diagnostic Scale (PDS). Hierarchical linear models were used to compare improvements across treatment groups. Assessments were carried out by blinded raters at admission, at end of treatment, and at 6 and 12 weeks post-treatment. Results: Under DBT-PTSD the mean change was significantly greater than in the control group on both the CAPS (33.16 vs. 2.08) and the PDS (0.70 vs. 0.14). Between-group effect sizes were large and highly significant. Neither a diagnosis of BPD nor the severity or the number of BPD symptoms was significantly related to treatment outcome. Safety analyses indicated no increase in dysfunctional behaviours during the trial. Conclusion: DBT-PTSD is an efficacious treatment of CSA-related PTSD, even in the presence of severe co-occurring psychopathology such as BPD.

Self-harm and suicidal behaviors are prevalent among autistic adults without intellectual disability (ID). Emotion dysregulation (ED), the difficulty in modulating emotions, has been identified as an important risk factor. Dialectical behavior therapy (DBT) has been proved effective to treat ED in disorders other than autism spectrum disorder. Our study aimed at assessing the feasibility, acceptability and preliminary efficacy of DBT in seven autistic adults without ID exhibiting self-harm and/or suicidal behaviors linked to severe ED. Our results suggest that DBT is feasible and highly acceptable to autistic adults without ID. Additionally, mean scores on the Difficulties in Emotion Regulation Scale decreased significantly post-treatment and at 4-month follow-up, suggesting that DBT might be efficacious in reducing ED in this population.

High dropout and low treatment attendance rates among patients with posttraumatic stress disorder (PTSD) and personality disorders (PDs) continue to pose a significant challenge. Despite numerous studies focusing on enhancing treatment attendance, the identification of consistent and reliable predictors in patients with PTSD and comorbid PDs remains limited. This study aims to investigate a wide range of potential predictors of treatment attendance, encompassing demographic, patient-severity, treatment, and therapist-related variables in patients with PTSD and comorbid borderline and/or cluster C PDs. Utilizing data from 255 patients participating in two randomized controlled trials comparing trauma-focused treatment with or without concurrent PD treatment, candidate predictors were individually analyzed in univariate regression models. Significant predictors were then combined in a multiple ordinal regression model. In total, 40% of patients attended fewer trauma-focused treatment sessions than the minimum recommended in treatment guidelines. Out of the 38 candidate predictors examined, five significant, independent predictors of treatment attendance emerged in a multiple ordinal regression model. Higher baseline PTSD severity (OR = 1.04, p = .036), higher education level (OR = 1.22, p = .009) and a stronger patient-rated working alliance (OR = 1.72, p = .047) with the therapist predicted higher treatment attendance. Conversely, inadequate social support from friends (OR = 0.90, p = .042) and concurrent PD treatment and trauma-focused treatment (OR = 0.52, p = .022) were associated with lower treatment attendance. In conclusion, this constitutes the first study investigating predictors of treatment attendance in patients with PTSD and comorbid PDs. The results highlight the complexity of pinpointing reliable predictors. Nevertheless, the identification of five predictors provides valuable insights, aiding clinicians in customizing treatment strategies for individual patients and enhancing overall treatment attendance. •High dropout and low treatment attendance in comorbid PTSD and PDs poses a challenge.•A wide range of potential predictors of treatment attendance of trauma-focused treatment were investigated in patients with PTSD and PDs.•40% of patients attended fewer trauma-focused sessions than recommended.•Higher baseline PTSD severity, education level and working alliance predicted higher treatment attendance.•Inadequate social support from friends and concurrent personality disorder treatment predicted lower treatment attendance.

People suffering from post-traumatic stress disorder (PTSD) may experience symptoms such as anxiety, fear, insomnia, flashbacks, anger, depression, and even addiction. The Dialectical Behavior Therapy Skills Workbook for PTSD offers pragmatic skills grounded in evidence-based dialectical behavior therapy (DBT) to help readers find lasting relief from trauma. The practical interventions in this workbook can be used on their own, or in conjunction with therapy.

Background Comorbidity between Posttraumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD) is high. There is growing motivation among clinicians to offer PTSD treatments – such as Eye Movement Desensitization and Reprocessing (EMDR) - to patients with PTSD and comorbid BPD. However, a large subgroup with comorbid BPD does not sufficiently respond to PTSD treatment and is more likely to be excluded or to dropout from treatment. Dialectical Behaviour Therapy (DBT) for BPD is well established and although there is some evidence that DBT combined with DBT Prolonged Exposure (DBT + DBT PE) is twice as effective in reducing PTSD symptoms than DBT alone, the comparative efficacy of integrated PTSD-DBT and PTSD-only treatment has not been investigated yet. The current study will therefore evaluate the comparative clinical efficacy and cost-effectiveness of EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD. Moreover, it is not clear yet what treatment works best for which individual patient. The current study will therefore evaluate neurobiological predictors and mediators of the individual response to treatment. Method A randomized controlled trial comparing the clinical efficacy and cost-effectiveness of integrated EMDR-DBT ( n  = 63) and EMDR-only (n = 63) in treatment-seeking adult patients with PTSD and comorbid (sub)clinical BPD. In addition, neurobiological predictors and mediators of treatment outcome, such as hair cortisol, FKBP5 and BDNF protein levels and FKBP5 and BDNF methylation status, are measured through hair and blood samples. Discussion This is the first study to compare the clinical efficacy and cost-effectiveness of integrated EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD, while simultaneously identifying individual predictors and mediators of treatment response. Results will reveal which treatment works best for which individual patient, thereby guiding individual treatment choices and personalizing psychiatry. Trial registration Clinical Trials, NCT03833453 . Retrospectively registered, 15 March 2019.

Predicting symptom improvement in psychotherapy is a complex challenge. This study aims to extend traditional prediction methods by examining the potential roles of therapists' and senior advisors' clinical judgments and of their levels of liking of patients in predicting symptom improvement. Eighty women with PTSD related to childhood abuse treated with either cognitive processing therapy (CPT) or dialectical behaviour therapy for PTSD (DBT-PTSD) were included in the study. Four general linear models were used for predicting pre-to-post changes in the Clinician-Administered PTSD Scale (ΔCAPS) from (i-ii) the therapists' and senior advisors' intuitive predictions of symptom change, and (iii-iv) the therapists' and senior advisors' liking of their patient. These four ratings were assessed after the fourth therapy session. Therapists', but not clinical senior advisors' intuitive predictions emerged as a strong and significant predictor of ΔCAPS (  = 11.37,  = .0012,  = 0.1348, and  = 1.04,  = .3799). Liking ratings of both the therapist and the senior advisor were largely unrelated to treatment success ( -values > .15;  < 0.0270). None of the four predictor*group interactions were significant. Firstly, therapists may have a good sense of whether the symptoms of their patient will improve after only four therapy sessions. Further research should clarify whether early clinical assessment by therapists is a substantive source of information that can be expanded upon and integrated into individualized treatment, or whether it acts as a self-fulfilling prophecy. Secondly, the lack of substantial association between therapist's low liking of their patients is encouraging, given that ratings ranged from as low as 4/10 to 10/10, yet outcomes remained stable within these structured and supervised PTSD protocols. Further research should clarify whether this advantage also applies to treatments with a low degree of manualization and supervision. German Clinical Trials Register identifier: DRKS00005578..

Intrusive memories are a core symptom of posttraumatic stress disorder (PTSD), yet their retrospective assessment is prone to biases, making real-time methods such as e-diaries essential. While trauma-focused treatments target intrusive symptoms, their efficacy has not yet been evaluated using real-time assessments. This study aimed to use e-diaries to assess and compare the effects of dialectical behavior therapy for PTSD (DBT-PTSD) and cognitive processing therapy (CPT) on intrusive memories and related inner tension in a large sample of women with childhood abuse-related PTSD and co-occurring borderline personality disorder (BPD) symptoms. In a multicenter randomized controlled trial, 193 women with PTSD related to childhood sexual or physical abuse and at least 3 BPD criteria were randomized to receive either DBT-PTSD or CPT. e-Diary assessments were conducted at 3 time points: before treatment, after 6 months, and after 12 months of therapy. At each time point, participants reported intrusive memories and related inner tension over 5 consecutive days using an event-based design. Both intrusive memories and related inner tension decreased significantly over time (intrusions: ß=-0.53, P<.001; inner tension: ß=-0.15, P<.001). While reductions in intrusion frequency did not differ significantly between treatment groups (ß=0.05, P=.45), DBT-PTSD was associated with significantly greater reductions in intrusion-related inner tension compared with CPT (ß=-0.16, P<.001). This study provides the first real-time evaluation of trauma-focused PTSD treatments using e-diaries in daily life. Both interventions were associated with reduced intrusion frequency, while DBT-PTSD showed greater reductions in associated emotional distress-potentially reflecting its emphasis on emotion-regulation strategies and distress tolerance, which may be particularly relevant for individuals with comorbid BPD symptoms. These findings highlight the value of e-diaries for capturing treatment-related symptom change in ecologically valid contexts.

Background Posttraumatic stress disorder (PTSD) after childhood abuse (CA) is often related to severe co-occurring psychopathology, such as symptoms of borderline personality disorder (BPD). The ICD-11 has included Complex PTSD as a new diagnosis, which is defined by PTSD symptoms plus disturbances in emotion regulation, self-concept, and interpersonal relationships. Unfortunately, the empirical database on psychosocial treatments for survivors of CA is quite limited. Furthermore, the few existing studies often have either excluded subjects with self-harm behaviour and suicidal ideation — which is common behaviour in subjects suffering from Complex PTSD. Thus, researchers are still trying to identify efficacious treatment programmes for this group of patients. We have designed DBT-PTSD to meet the specific needs of patients with Complex PTSD. The treatment programme is based on the rules and principles of dialectical behavioural therapy (DBT), and adds interventions derived from cognitive behavioural therapy, acceptance and commitment therapy and compassion-focused therapy. DBT-PTSD can be provided as a comprehensive residential programme or as an outpatient programme. The effects of the residential programme were evaluated in a randomised controlled trial. Data revealed significant reduction of posttraumatic symptoms, with large between-group effect sizes when compared to a treatment-as-usual wait list condition (Cohen’s d = 1.5). The first aim of this project on hand is to evaluate the efficacy of the outpatient DBT-PTSD programme. The second aim is to identify the major therapeutic variables mediating treatment efficacy. The third aim is to study neural mechanisms and treatment sensitivity of two frequent sequelae of PTSD after CA: intrusions and dissociation. Methods To address these questions, we include female patients who experienced CA and who fulfil DSM-5 criteria for PTSD plus borderline features, including criteria for severe emotion dysregulation. The study is funded by the German Federal Ministry of Education and Research, and started in 2014. Participants are randomised to outpatient psychotherapy with either DBT-PTSD or Cognitive Processing Therapy. Formal power analysis revealed a minimum of 180 patients to be recruited. The primary outcome is the change on the Clinician-Administered PTSD Scale for DSM-5. Discussion The expected results will be a major step forward in establishing empirically supported psychological treatments for survivors of CA suffering from Complex PTSD. Trial registration German Clinical Trials Register: registration number DRKS00005578 , date of registration 19 December 2013.