ABSTRACT
BACKGROUND: Institutional childhood abuse can have a long-term impact on the survivors' mental health, however, treatment for this group is limited and not always accessible. An internet-based intervention was developed, with the aim to reduce psychological sequelae relating to institutional abuse. OBJECTIVE: This study aimed to examine the efficacy of an online imagery rescripting intervention for survivors of institutional abuse, through assessing symptoms of depression, anxiety, PTSD, and CPTSD. PARTICIPANTS AND SETTING: Seventy-two adult survivors of institutional childhood abuse in the former German Democratic Republic were randomized either to the intervention (n = 38) or to the waitlist condition (n = 34). The intervention consisted of 10 modules, based on written imagery rescripting, and involved asynchronous therapist contact. METHODS: Primary outcomes included symptoms of depression (PHQ-9), anxiety (GAD-7), PTSD (ITQ), and CPTSD (ITQ DSO). The intervention condition was assessed at baseline, post-intervention, 3-, and 6-month follow-up. RESULTS: Intention-to-treat analyses revealed a significant symptom reduction from baseline to post-assessment with medium to large effects for all main outcomes (d = 0.45 to d = 0.76), in favor of the intervention condition. Significant interactions between condition (intervention vs. wailist) and time (baseline vs. post-assesment) were revealed for all main outcomes (p < .001 to p = .024). The effects were maintained at follow-up. CONCLUSIONS: The results suggest online writing-based imagery rescripting as a promising treatment option for adults formerly institutionalized in residential care. Future research is needed to explore its effectiveness for other groups of patients suffering from abuse and neglect.
Subject(s)
Adult Survivors of Child Abuse , Imagery, Psychotherapy , Adult , Humans , Anxiety/therapy , Anxiety Disorders , Imagery, Psychotherapy/methods , Internet , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Post-Traumatic/psychologyABSTRACT
Background: From 1949 to 1990, about 500,000 children and adolescents in the former German Democratic Republic (GDR) were placed in institutional care. Many of these individuals experienced physical and sexual abuse as well as general maltreatment. While this population group is in great need of psychosocial support, few low-threshold interventions aimed at the needs of adult survivors of institutional childhood abuse exist. Objective: This pilot study examines the efficacy of an internet-based imagery rescripting intervention in reducing psychopathological symptoms, within a population of survivors of institutional abuse from state childcare institutions, in the former GDR. Additionally, a case study is presented, depicting the treatment of a woman suffering from PTSD after having been institutionalised in the former GDR. Method: Participants received 10 internet-based writing assignments, based on the principles of imagery rescripting, specifically tailored to the needs of survivors of institutional childhood abuse in the GDR. The participants received personalised feedback on their assignments. Symptoms of posttraumatic stress disorder (PTSD), complex posttraumatic stress disorder (CPTSD), depression, and anxiety were assessed at pre- and post-treatment. Results: A total of 15 participants completed the intervention (mean age 56.2 years; 66.7% female). Paired t-tests showed a significant reduction of PTSD, CPTSD, depression, and anxiety symptoms. Large effect sizes were found for PTSD (d = 1.26), CPTSD (d = .97), depression (d = 1.08) and anxiety (d = 1.20). Conclusion: The results of this pilot study provide preliminary evidence for the efficacy and feasibility of the intervention in treating psychopathological symptoms in survivors of institutional abuse in the GDR. The case study additionally demonstrates the applicability of the intervention. A randomised controlled trial should be applied to further evaluate the intervention and its effects. Trial registration: German Clinical Trials Register identifier: DRKS00020266..
Antecedentes: Desde 1949 a 1990, alrededor de 500.000 niños y adolescentes en la antigua República Democrática Alemana (RDA) fueron internados en instituciones. Muchas de estas personas experimentaron abuso físico y sexual, así como malos tratos en general. Si bien este grupo de población tiene una gran necesidad de apoyo psicosocial, existen pocas intervenciones elementales dirigidas a las necesidades de los sobrevivientes adultos de abuso infantil institucional.Objetivo: Este estudio piloto examina la eficacia de una intervención de reescritura de imágenes vía Internet para reducir los síntomas psicopatológicos, en una población de sobrevivientes de abuso institucional de instituciones estatales de cuidado infantil, en la antigua RDA. Además, se presenta un estudio de caso que describe el tratamiento de una mujer que sufre de TEPT después de haber sido institucionalizada en la antigua RDA.Método: Los participantes recibieron 10 asignaciones de escritura vía Internet, basadas en los principios de la reescritura de imágenes, específicamente adaptadas a las necesidades de los sobrevivientes de abuso infantil institucional. Los participantes recibieron comentarios personalizados sobre sus tareas. Los síntomas del trastorno de estrés postraumático (TEPT), el trastorno de estrés postraumático complejo (TEPT-C), la depresión y la ansiedad se evaluaron antes y después del tratamiento.Resultados: Un total de 15 participantes completaron la intervención (edad media 56,2 años; 66,7% mujeres). Las pruebas t pareadas mostraron una reducción significativa de los síntomas TEPT, TEPT-C, depresión y ansiedad. Se encontraron tamaños de efecto grandes para TEPT (d = 1,26), TEPT-C (d = 0,97), depresión (d = 1,08) y ansiedad (d = 1,20).Conclusión: Los resultados de este estudio piloto proporcionan evidencia preliminar de la eficacia y viabilidad de la intervención en el tratamiento de síntomas psicopatológicos en sobrevivientes de abuso institucional en la RDA. El estudio de caso demuestra además la aplicabilidad de la intervención. Se debe aplicar un ensayo controlado aleatorizado para evaluar más a fondo la intervención y sus efectos.
Subject(s)
Imagery, Psychotherapy , Survivors , Adolescent , Adult , Child , Female , Germany, East , Humans , Imagery, Psychotherapy/methods , Internet , Male , Middle Aged , Pilot Projects , Survivors/psychologyABSTRACT
Between 1945 and 1989, approximately 300 000 persons were imprisoned because of political reasons in Eastern Germany. There is that evidence the detainees' offspring are affected by the trauma of their parents. In a study with cross-sectional design, depressive (PHQ-9), somatoform (PHQ-15) and anxiety symptomatology (GAD-7), and Posttraumatic Stress (IES-R) were assessed with self-rating measures in 43 children of former political prisoners. In comparison to 2 representative gender education and age matched samples from the general population, offspring of former political detainees show higher levels of psychopathological symptoms. The life-time prevalence for PTSD was 9.1%. Regarding the psychopathology, children who were born after their parents' imprisonment did not differ from those who were already born when the imprisonment happened. First evidence for the transgenerational transmission of traumatisation and the methods will be discussed critically.
Subject(s)
Anxiety Disorders/etiology , Child of Impaired Parents/psychology , Depressive Disorder/etiology , Politics , Prisoners/psychology , Somatoform Disorders/etiology , Stress Disorders, Post-Traumatic/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety Disorders/psychology , Child , Child of Impaired Parents/statistics & numerical data , Cross-Sectional Studies , Depressive Disorder/psychology , Female , Germany/epidemiology , Germany, East , Health Status , Humans , Male , Middle Aged , Neuropsychological Tests , Somatoform Disorders/psychology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires , Young AdultABSTRACT
OBJECTIVE: By recent estimates, 200,000 persons were imprisoned for political reasons in the German Democratic Republic (GDR) between 1949 and 1989. Former political prisoners suffer from the experience of political persecution also in a long-term. The aim of this study was to assess long-term effects on anxiety and depression. METHODS: Anxiety and depression were assessed by using the Hospital Anxiety and Depression Scale, German version (HADS). RESULTS: The anxiety of the former political detainees is significantly increased in comparison to an age- and gender matched subsample of the general population (10 vs. 4,8; p < 0,001, effect size d = 1,33). The same applies to the depression (9.7 vs. 5,6; p < 0,001; effect size d = 0,92). CONCLUSIONS: Even many years after the political detention people report highly increased anxiety and depression.