Emotion Regulation, Post Traumatic Stress Disorder, Self-harm, Substance Use Disorders, Suicide
Conditions
Keywords
Dialectical Behaviour Therapy, Narrative Exposure Therapy
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.
Interventions
BEHAVIORALNarrative Exposure Therapy
The intervention period will be from (May 2021- October 2024). All patients will participate in standard treatment at MBS. Dialectical Behaviour Therapy -Substance Use Disorder skills training (DBT-SUD skills) will be offered to all patients at MBS in the project period that experience difficulties in emotion regulation and manage to commit to participating in the DBT- skills training evaluated by their DBT therapist. Narrative Exposure Therapy (NET) will be offered to all patients with relevant traumatic experience and symptoms of PTSD depending on clinical evaluation.
Sponsors
Møre og Romsdal Hospital Trust
Oslo University Hospital
Norwegian University of Science and Technology
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This is a repeated measures follow-up feasibility study without control group.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* General inclusion criteria for the study: 1. Fit general inclusion criteria for the in-patient program. 2. Speak Scandinavian (Norwegian, Danish and/or Swedish). 3. Be willing to sign a consent. Inclusion criteria for NET intervention: 1. 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). 2. 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. 1. 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: 1. Experience difficulties in emotion regulation evaluated by an assigned DBT therapist. 2. Manage to commit to participating in the DBT- skills training.
Exclusion criteria
* General
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The intervention is feasible and accepted - Objective experience of treatment. | 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) |
| The intervention is feasible, accepted and safe - The dropout rate from treatment. | 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 - Suicide behaviour while in treatment. | 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 safe - Self-harm behaviour while in treatment. | 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. | 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 PTSD /SUP PTSD. | 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 - prevalence of traumatic experiences. | 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 relevant - The severitiy of difficulties in emotion regulation. | 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). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 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. | difficulties in emotion regulation measured with Difficulties in Emotion Regulation Scale (DERS) 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 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. | Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screening instrument to assess severity of alcohol consumption, drinking behaviours, and alcohol-related problems. Audit scores range from 0-40 with higher scores indicating greater problems related to alcohol consumptions (Aasland, Amundsen, Bovi, Fauske & Mørland, 1990). In this project, the consumption score (question 1) with cut-of score 3 and over (drinking alcohol 2 -3 times a week) is coded into a dichotomous variable of current alcohol use (yes/no) and sum score used to assess severity of alcohol related problems. At 3 months or 12 months evaluation a cut-off score 3 and over on question 1 is registered as relapse. |
| 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. | Realalse to substance abuse is evaluated with the Drug Use Disorder Identification Test (DUDIT), a nine item self-report instrument developed for identification of individuals with drug-related problems. DUDIT scores range from 0-44 with higher scores indicating more drug use and drug related problems (Berman, Palmstierna, Källmén, & Bergman, 2007). In this project, the substance use frequency score (question 1) is used to identify current substance use with cut-off score score 3 and over (using substances 2-3 times a week) will be coded into a dichotomous variable (yes/no). The sum score is used to assess severity of substance related problems. At 3 months or 12 months evaluation a cut-off score 3 and over on question 1 is registered as relapse. |
| 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. | Evaluate the change post-treatment and at 3 and 12 months follow up, from baseline in PTSD symptom severity, measured with PTSD Checklist for DSM-5 (PCL-5), a self-report instrument developed for quick screening of PTSD symptoms. Sum scores range from 0-80, with a score over 33 indicating the presence of PTSD (Weathers et al., 2013). |
Countries
Norway
Contacts
Primary ContactJohanna Vigfusdottir
Backup ContactEdvard Breivik
Outcome results
None listed