When a client presents with complex PTSD (cPTSD), they often have high levels of distress, which may be difficult to manage. This has prompted experts to consider how to manage these clients. Guidelines have been developed, however these guidelines have since been questioned regarding their necessity and impact on client outcomes and access to effective treatments.

There is much debate about the validity of the cPTSD construct. However, it is a construct that is in popular use in the clinical and general population. It is discussed elsewhere on this blog.

In 2012 the International Society of Traumatic Stress Studies (ISTSS) released guidelines, for psychotherapy of complex PTSD. These guidelines recommended that treatment should begin with a stabilization phase. This, (phase 1) would be aimed at ensuring the individual’s safety by reducing self-regulation problems and improving emotional, social, and psychological competencies. Phase 2 would focus directly on the review and reappraisal of trauma memories. Phase 3 would be a transition out of therapy to greater engagement in community life.

However, this has since been questioned. In 2015 Bicanic and colleagues reported on their examination of the need for a stabilisation phase for complex PTSD and they concluded;

“there is certainly no compelling evidence to support the assumption that well-organised and carefully administered evidence-based treatment has to be preceded by a stabilisation phase”

Similarly in 2016 the ISTSS guidelines were re-examined by 21 experts in the trauma field (Jonhg et,al, 2016) and it was concluded, the evidence did not support the recommendation for a stabilization phase prior to providing trauma-focused treatment in persons with cPTSD, or related severe or complicated presentations of PTSD.

They concluded that the recommendation for an initial stabilization phase for clients with complex PTSD presentations has the potential to result in a delay effective trauma-focused treatment.

They went on to say:

“Delaying trauma-focused treatment could also be demoralizing to patients by inadvertently communicating to them that they are not capable of dealing with their
traumatic memories, thereby reducing self-confidence and motivation for more active trauma processing.”

“Labelling a patient as “complicated” or “complex” has a potential iatrogenic effect of giving the patient the impression that “traditional” treatments will not be effective
or that special or longer treatments are necessary.” pg 367

Summary
While the debate on Complex PTSD still goes on and the proposed ICD-11 may reduce the current number of PTSD diagnoses. A stabilisation phase is not supported by the current evidence. Furthermore, the notion of the need for a stabilisation phase may result in delaying treatment and clients believing that they need something “special” in order to recover from traumatic experiences.

References
Bicanic I, de Jongh A, Ten Broeke E. Stabilisation in trauma treatment: necessity or myth?. Tijdschr Psychiatr. 2015; 57(5):332-9.

Jongh, A. , Resick, P. A., Zoellner, L. A., Minnen, A. , Lee, C. W., Monson, C. M., Foa, E. B., Wheeler, K. , Broeke, E. t., Feeny, N. , Rauch, S. A., Chard, K. M., Mueser, K. T., Sloan, D. M., Gaag, M. , Rothbaum, B. O., Neuner, F. , Roos, C. , Hehenkamp, L. M., Rosner, R. and Bicanic, I. A. (2016), CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS. Depress Anxiety, 33: 359-369. doi:10.1002/da.22469