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
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• 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
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„PITT brings relieve to the patient but reduces
also the therapist burden“
Effects of the PITT Method on psychotherapists
Well-being – Anecdotical reports
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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
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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
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To explore the effect of a PITT Training on
the psychological distress and the
resilience skills of trauma therapists
Study Design
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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
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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
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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
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QUANTITATIVE RESULTS
Results
Maslach Burnout Inventory (MBI)
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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)
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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)
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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)
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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)
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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)
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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
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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
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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
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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
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Thank you for your attention
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