Traumatic foundations and intersecting paths Change mechanisms and treatment of childhood trauma, childhood-related posttraumatic stress disorder, and borderline personality disorder

We studied several interconnected concepts: childhood trauma (CT), posttraumatic stress disorder (PTSD), and borderline personality disorder (BPD). When we examined the link between five individual CT subtypes (i.e., sexual, physical, and emotional abuse, and physical and emotional neglect) and PTSD severity, only higher exposure to childhood emotional abuse was related to a higher PTSD severity. Additionally, we studied two PTSD treatments: eye-movement desensitization and reprocessing (EMDR) and imagery rescripting (ImRs). We examined the role of non-fear emotions (i.e., shame, guilt, anger, and disgust) in PTSD changes during treatment and found several differences between changes in these emotions and changes in PTSD symptoms in the short and the long term. We also directly compared the change mechanisms of EMDR and ImRs. The findings indicated that ImRs works via changes in the distress and encapsulated belief ratings related to the trauma memories. In contrast, our findings did not support the hypothesis that EMDR works via changes in memory vividness.
Moreover, we studied whether CT and dissociation were moderators of the effectiveness of different formats of schema therapy (ST) for BPD. We found that dissociation was associated with higher treatment retention for a combined individual and group ST format, compared to group ST and treatment-as-usual. Lastly, we examined the effectiveness of psychological treatments for BPD in a multilevel meta-analysis. We analyzed within-treatment effects, and we included a wide range of study designs. The findings indicated that several specialized treatments are related to higher effect sizes compared to the average of all treatments.