Presence of PTSD and Emotion Dysregulation Among Inpatients With Substance Use Disorder; a Feasibility Study of a Combined Treatment for Difficulties in Emotion Regulation and PTSD
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Post Traumatic Stress Disorder
- Sponsor
- Norwegian University of Science and Technology
- Enrollment
- 100
- Locations
- 1
- Primary Endpoint
- The intervention is feasible, accepted and safe - The dropout rate from treatment.
- Status
- Recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
There are high rates of co-occurring posttraumatic stress disorder (PTSD) among patients receiving treatment for substance use disorder (SUD). PTSD and SUD should be treated simultaneously, but adults in SUD treatment are often not assessed for PTSD nor offered PTSD-based interventions. One of the reasons for reluctance in offering trauma focused treatment is increased risk of drop out. PTSD and related emotion dysregulation are related to elevated psychological burden, higher dropout rates and increased risk of relapse. this is a feasibility study, where the plan is to integrate a combination of Dialectical Behaviour Therapy for Substance Use Disorder (DBT-SUD skills) a therapy targeting difficulties in emotion regulation and Narrative Exposure Therapy (NET) a trauma focused therapy, for patients with co-occurring PTSD symptoms into standard SUD treatment . The plan is to assess its potential benefits by assessing whether adding this combination to standard SUD treatment is relevant, feasible, acceptable, and safe. Treatment outcomes are 1) Prevalence of PTSD, suicidal behaviour, and self-harm, as well as the severity of difficulties in emotion regulation and emotional avoidance among patients (N approx. = 100) in inpatient treatment for SUD. 2) Change post-treatment and at 3 and 12 months follow up, from baseline in PTSD symptom severity, depressive symptoms, emotion regulation, emotion avoidance, and experience of shame. 3) Rates of dropout and relapse compared to previous rates.
This project can increase knowledge about psychological mechanisms in co-occurring PTSD and SUD and improve the quality of treatment for this vulnerable patient population.
Investigators
Eligibility Criteria
Inclusion Criteria
- •General inclusion criteria for the study:
- •Fit general inclusion criteria for the in-patient program.
- •Speak Scandinavian (Norwegian, Danish and/or Swedish).
- •Be willing to sign a consent.
- •Inclusion criteria for NET intervention:
- •Experience of an aversive event that fits criteria A for PTSD as defined by Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) (American Psychiatric Association \[APA\], 2013).
- •Experience symptoms of PTSD as defined by the DSM-V (APA, 2013), or subthreshold PTSD (Grubaugh et al., 2005), or experience clinically relevant symptoms as evaluated by a NET therapist.
- •Subthreshold PTSD is defined as having experienced a traumatic event (Criteria A), meeting Criteria B (re-experiencing symptoms), Criteria E (one-month symptom duration), and Criteria F (significant distress or functioning impairment) and either Criteria C (avoidance or numbing symptoms) or Criteria D (hyper arousal symptoms).
- •Inclusion criteria for DBT intervention:
- •Experience difficulties in emotion regulation evaluated by an assigned DBT therapist.
Exclusion Criteria
- •General exclusion criteria for the study:
- •Have a clinically significant low cognitive- and/or linguistic functioning that hinders the patient in understanding and answering the questions on the self-rapport instruments.
- •Exclusion criteria for NET and/or DBT-SUD skills
- •Being actively psychotic.
- •Have a Body Mass Index (BMI) under
- •Severe dissociation.
- •An ongoing traumatic contact with the perpetrator.
Outcomes
Primary Outcomes
The intervention is feasible, accepted and safe - The dropout rate from treatment.
Time Frame: From treatment start to compleation up to 9 months.
The dropout rate from the standard treatment, DBT- SUD skills and NET. Dropout is registered, and dichotomous variables are created (yes/no). In case of dropout, time from admission to dropout is registered.
The intervention is safe - Self-harm behaviour while in treatment.
Time Frame: From treatment start to compleation up to 9 months.
Prevelance of Self-harm behaviour before tratment and while in treatment is registrert with The Deliberate Self-Harm Inventory (DSHI). DSHI is a 17 -item behaviourally based, self-report instrument to assess deliberate self-harm (Gratz, 2001). In this project we create a continuous variable on frequency of self-harm behaviour and a dichotomous variable on presence of self-harm (Yes/No). e of the C-SSRS is a numerical score obtained from the categories (Posner et.al. 2011). The participants answer the DSHI at 5 weeks from treatment start and at treatment compleation.
The intervention is accepted - participation in DBT-SUD skills sessions.
Time Frame: From treatment start to compleation up to 9 months.
The percentage of DBT-SUD skills sessions participated in, as well as the percentage completion of homework.
The intervention is relevant - prevalence of traumatic experiences.
Time Frame: One time assessment 5 weeks after admission to treatment
The prevalence of traumatic experiences also as offenders is measured with Stressful Life Events Screening Questionnaire-Revised (SLESQ) is self-report instrument designed to map and assess 15 potentially traumatic experiences (Goodman et al., 1998). The score is used to identify experiences of potential traumatic events. For this project, items asking about experiences where the participant caused potentially traumatic experiences to others are added. This is to identify violent offenders.
The intervention is safe - Suicide behaviour while in treatment.
Time Frame: From treatment start to compleation up to 9 months.
Prevalance of suicide behavior before treatment and while in treatment is registrert with the Columbia-suicide severity rating scale (C-SSRS) a suicidal ideation and behaviour-rating interview created to evaluate suicide risk. The interview consists of 10 categories with binary responses (yes/no) to indicate a presence or absence of the behaviour. The outcome of the C-SSRS is a numerical score obtained from the categories (Posner et.al. 2011). The participants Answer the interview 5 weeks from treatment start and at treatment compleation.
The intervention is relevant - prevalence of PTSD /SUP PTSD.
Time Frame: One time assessment 5 weeks after admission to treatment
The prevalence of PTSD/SUB-PTSD is measured with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) a 30-item structured interview used to make current (past month) diagnosis of PTSD, make lifetime diagnosis of PTSD, and assess PTSD symptoms over the past week (Weathers et al., 2018). Frequency and intensity rating is summed to create an overall PTSD symptom severity score and is used to generate a categorical diagnosis (PTSD/Sub-PTSD vs non-PTSD). In this project, we will both use the categorical diagnosis to compare those with and without PTSD/Sub-PTSD, as using the overall PTSD symptom severity scores (Weathers et al., 2018).
The intervention is relevant - The severitiy of difficulties in emotion regulation.
Time Frame: One time assessment 5 weeks after admission to treatment
The severity of difficulties in emotion regulation will be measured with Difficulties in Emotion Regulation Scale (DERS) is a self-report instrument consisting of 36 items meant to measure difficulties in emotion regulation, higher scores ranging from 36- 144 indicate more significant difficulties in emotion regulation (Gratz \& Roemer, 2004). We will use the cut score of 97 to identify severe difficulties in emotion regulation (Bemmouna et. Al 2022; Neacsiu et. al., 2014).
The intervention is feasible and accepted - Objective experience of treatment.
Time Frame: From treatment start to treatment compleation up to 9 months.
A self-rapport questionnaire is designed to evaluate the experience of the treatment. Rating on a 5 Likert scale how different elements of the treatment are experienced on a 5-point scale. There are also open-ended questions about what in the treatment is most useful and what was the least helpful (see attachment 1-2 in protocol)
Secondary Outcomes
- The potential benefits of the intervention - Relapse to alcohol abuse at 3- and 12-months follow up.(From treatment completion to 3- and 12 month follow up - up to 12 months.)
- The potential benefits of the intervention - Relapse to substance abuse at 3- and 12-month follow up.(From treatment completion to 3- and 12 month follow up - up to 12 months.)
- The potential benefits of the intervention - Change in PTSD symptoms from base line to 3-and 12 month follow up.(From 5 weeks after admission to treatment to 12-month follow upp after treatment completion. Up to 21 months.)
- The potential benefits of the intervention - Change in Difficulties in emotion regulation from baseline to 3- to 12- month follow up.(From 5 weeks after admission to treatment to 12-month follow upp after treatment completion. Up to 21 months.)