Effects of trauma on the course of naturalistic CBT: A longitudinal study

Lifetime traumatic events are often a part of the biography of patients seeking psychotherapy. Traumatic events, especially in childhood, are a known risk factor for many mental disorders, including depressive and anxiety disorders. Analyses of data from highly standardized therapy trials also suggests that patients with a variety of disorders (e.g., depression, eating disorder) who experienced trauma profit less from standardized cognitive behavioural therapy (CBT). Yet, it remains unclear how lifetime traumatic events affect the course and outcome of treatment in naturalistic outpatient CBT. Prior traumatization may influence the course and effect of naturalistic CBT in multiple ways. For example, traumatic experiences may lead to a more complex clinical picture at the beginning of therapy (e.g., more comorbidity, more dysfunctional behaviour, more difficult social situation of the patient) or problems arising during therapy (e.g., difficulties in the therapeutic alliance). Therapists may react on this by adapting their therapy in both its structure (number of sessions, combination with other treatments) and its content (e.g., more focus on the therapeutic relationship, use of trauma-specific interventions). Together, these factors influence therapy outcome. In addition, the term “traumatic experience” spans a variety of different events including accidents (short-term and unintentional), interpersonal violence (intentional and often long lasting/ repetitive) and childhood abuse/ neglect of varying intensity. Therefore, a more nuanced view that takes into account the differences between trauma subgroups is needed. The effects of different kinds of traumatic experiences, including childhood trauma, on the course of naturalistic outpatient CBT and on symptom severity of depression and anxiety throughout therapy are studied. Data is sampled from patients seeking treatment at the “Hochschulambulanz für Psychotherapie der Universität Würzburg”, an outpatient clinic for psychotherapy at the Department of Psychology at the University of Würzburg in Germany. Longitudinal data form the database of the Hochschulambulanz will be anonymised and analysed for this purpose.