Impact of compassion-focused psychodynamic

trauma therapy on the resilience of trauma

therapists

Claudia L. Orellana-Rios, Stefan Schmidt and Luise Reddemann,

Clinic for Psychosomatic Medicine and Psychotherapy, Medical Center, University of

Freiburg, Germany

Clinic for Palliative Medicine, Medical Center, University of Freiburg, Germany

14.07.2018

Background

Folie 2 14.07.2018

• Trauma therapists,specially of complex traumatized patients, are exposed to high emotional stress (Reddemann, 2001)

• Secondary traumatization

→ traumatization without sensory perception

→ cummulative empathizing

Online survey (n =1124):

30% of the surveyed

German trauma therapists

reported moderate to severe PTSD symptoms (Daniels, 2006)

Effects of the PITT Method on psychotherapists -

Anecdotical reports

Folie 3 14.07.2018

„PITT brings relieve to the patient but reduces

also the therapist burden“

Effects of the PITT Method on psychotherapists

Well-being – Anecdotical reports

Folie 4 14.07.2018

Focus on compassion, ressources and self-healing rather

than neutrality and confrontation

Feels coherent for the therapists

Is emotionally less exhausting

Focus on therapistʼs self-compassion and self-soothing skills:

Allows connectedness with the patients suffering from a

common-humanity perspective →Prerequisite for building

a compassionate working alliance

Fosters therapist confidence in the patients capability for

developing self-soothing skills and self-compassion

Self-care, mindfulness and compassion practices

Boosts therapist ressources

Builds an inner counterweight during confrontation

Interaction

aspect

Individual

aspect

The PITT curriculum for

psychotherapists

Folie 5 14.07.2018

3 modules (3 days each) over the period of a year

• Self-Experience → 50% of the training

First module

- Diagnostic aspects

- Transferance and countertransferance

- Stabilization though PITT (strenghtening of

ego functions)

Technique examples:

- Mindful description of daily joy

moments/ Mindful body perception

- Ressource Suitcase/ Joy biography

- Finding Horror counterimages

- Compassion practices

Second Module

- Ego state work with wounded inner states

- Ego-state work with perpetrator introjects

- Dealing with dissociative behavior

Technique examples:

- Inner safe space/ Inner helpers

- Inner stage concept

- - Integration of perpetrator introjects

through reconciliation

Third module

- Trauma confrontation with the observer

technique

Technique examples

- Distancing techniques: the TV-

Screen Exercise

- Affect-regulation techniques

- Observer technique

Aim

Folie 6 14.07.2018

To explore the effect of a PITT Training on

the psychological distress and the

resilience skills of trauma therapists

Study Design

Folie 7 14.07.2018

Single arm interventional-study with 3 measurement times: Prä, Post and

Follow-Up

At training After training 6-months

start completion after training (t1) (t2) (t3)

Training day 1 1 year later 1,5 years later

Cohorts from 5 cities across Germany:

Heidelberg (2x), Münster, München, Berlin

and Bernried

6 training cohorts

96 therapists

recruited,

60 completed 2

measurement

times

48 completed all 3

Completion rate =

46%

Methods

Folie 8 14.07.2018

Quantitative Measurements (online survey)

- Questionnaires and visual analogue scales

- Maslach Burnout Inventory for the social services (MBI)

- Perceived Stress Questionnaire (PSQ-20)

- Emotion Regulation Skills Questionnaire (ERSQ-27)

- Self-Compassion Scale (SCS-34)

- Self-Soothing Skills (Numeric Rating Scales; Lampe et al., 2008)

- Hamburg Modules for the Assessment of Psychosocial Health (HEALTH-49)

- Work Situation (Satisfaction, Enforcemente, Enjoyment; numeric rating scales)

Analysis strategy: Repeated Measures ANOVA (Bonferroni corrected Post Hoc Test)

Qualitative Evaluation (online survey):

- Free text answers on the perceived effects of PITT on work and personal life

Analysis strategy: Content analysis

Demographics

Folie 9 14.07.2018

Mean Age (years), ± SD, Range 49.74 ± 7.24 (Range 33-62)

Gender

Female

Male

Professional experience with trauma

patients in years ± SD, Range

N = 45 (94 %)

N =3(6 %)

12± 8.88 (Range 0-34)

Profession (frequencies)

Nurses

Physicians

Social workers

Psychologists

Others

1

14

2

19

11

Folie 10 14.07.2018

QUANTITATIVE RESULTS

Results

Maslach Burnout Inventory (MBI)

Folie 11 14.07.2018

7

9

11

13

15

17

19

21

t1 t2 t3

Scal

e 0

- 5

4

Measurement time

MBI - Emotional exhaustion

0

1

2

3

4

5

6

7

t1 t2 t3

Scal

e 0

-3

0

Measurement time

MBI - Depersonalization

M = 3.31 M = 3.33 M = 3.44

36

38

40

42

44

46

48

t1 t2 t3

Scal

e 0

-4

8

Measurement time

MBI - Personal accomplishment

Personal accomplishment

better

better

p =.740

p = 1.00 p = 1.00 p = 1.00

p =.209 p = 1.00

Cut-off

EE: ≥27

DP: ≥10

PA: ≤33

M = 16.06 M = 17.39

M = 15.00

M = 41.65

M = 42.73

M = 41.54

Cut-off

EE: ≥27

Results

Perceived Stress Questionnaire (PSQ-20)

Folie 12 14.07.2018

0

0,1

0,2

0,3

0,4

0,5

t1 t2 t3

Sc

ale

0 -

1

Measurement time

PSQ – Global score

better

p =.042*

p =.001**

* p = 0.05; ** p = 0.01

Norm

Healthy

adults: 0.33

M = 0.40

M = 0.36

M = 0.33

Results

Emotion Regulation Skills Questionnaire (ERSQ-27)

Folie 13 14.07.2018

70

72

74

76

78

80

82

84

86

t1 t2 t3

Sc

ale

(0

- 1

08

)

Measurement time

ERSQ- 27

better

p =.009** p =.004**

* p = 0.05; ** p = 0.01

M = 77.92

M = 82.33

M = 83.33

Results

Self-Compassion Scale (SCS-34)

Folie 14 14.07.2018

better

2,4

2,6

2,8

3

3,2

3,4

3,6

3,8

4

t1 t2 t3

Sc

ale

(1

– 5

)

Measurement time

SCS-24

p =.004** p =.002**

* p = 0.05; ** p = 0.01

M = 3.16

M = 3.43 M = 3.47

German

sample:

3.05

(n = 1164)

Results

Self-Soothing Skills (Numeric Rating Scales)

Folie 15 14.07.2018

better

6

6,5

7

7,5

8

8,5

t1 t2 t3

Sc

ale

0 -

10

Measurement time

Self Soothing Skills

I can sooth myself

I can control feelings that disturb me/scare me

I can control thoughts that disturb me/ scare me

p =.009**

p =.000**

p =.059

p =.001**

p =.012**

p =1.00

* p = 0.05; ** p = 0.01

Results

Hamburg Modules for the Assessment of Psychosocial Health (HEALTH-49)

Folie 16 14.07.2018

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

t1 t2 t3

Scal

e 0

- 4

Measurement time

HEALTH-49

Interactional problems

Depressiveness

better

No significant changes:

- Somatoform complaints

- Phobic anxiety

- Psychological well-being

- Activity and participation

p =1.00

p =.021*

p =.005**

p =.000**

M = 0.74

M = 0.67

M = 0.63

M = 1.26

M = 0.98

M = 0.87

Cut-off

Depressiveness

Healthy: 0.21

Psychosom stat. Patients: 1.83

Cut-off

Interaction problems

Healthy: 0.50

Psychosom stat. Patients: 1.90

Conclusions

Folie 17 14.07.2018

Being trained in a compassion-focused trauma therapy

method might help to reduce distress of psychotherapists

and might improve their resilience skills, also on a mid-

term

Some variables showed a delayed effect indicating that

some skills needed to be consolidated with practice

Strenghts and limitations

Folie 18 14.07.2018

Strengths

Psychotherapists were recruited across 5 cities in Germany

Longitudinal design

Quantitative and qualitative data

Limitations

• No control group

• Small sample size

• Sex differences

• Selection effect?

Outlook

Folie 19 14.07.2018

The results give hints at potential efffects of PITT and can

be used as an orientation for future studies

Future studies schould differentiate between a potential

effect of PITT at work (with traumatized patients) and an

effect in personal life. For example:

Three-armed Study design

PITT self-care

learning unit +

PITT patient work

unit

Control group:

other trauma

therapy method

PITT Self-Care

learning unit

Folie 20 14.07.2018

Thank you for your attention

Folie 21 14.07.2018