Phase-based treatment versus immediate prolonged exposure for childhood abuse-related PTSD: The role of emotion regulation improvement in predicting PTSD symptom reduction.

OBJECTIVE: Among phase-based treatments for adults with childhood abuse-related posttraumatic stress disorder (CA-PTSD), one commonly used format combines Skills Training for Affective and Interpersonal Regulation (STAIR) in the first half of treatment with trauma-focused treatment (Prolonged Exposure; PE) in the second half. The present study tested two key assumptions of this format: that STAIR improves Emotion Regulation (ER) more than PE in the first half of treatment, and that such ER improvement predicts greater PTSD symptom reduction during PE in the second half.

METHOD: Participants with CA-PTSD (N = 96) were randomly assigned to phase-based treatment (8 STAIR sessions followed by 8 PE sessions; n = 49) or PE-only (16 PE sessions; n = 47). Both treatments consisted of 16 weekly sessions. ER difficulties and PTSD symptoms were assessed every session. Mixed-effects models were used to compare ER change during sessions 1-8 (STAIR vs PE) and to examine whether this change predicted PTSD symptom change in sessions 9-16.

RESULTS: Both treatments resulted in significant ER improvements during Sessions 1-8 and PTSD symptom reductions during Sessions 9-16, with no significant difference between treatment conditions. Neither ER difficulty changes during sessions 1-8 nor mid-treatment ER difficulties predicted PTSD symptom change during sessions 9-16, and ER did not mediate treatment effects.

CONCLUSION: These findings do not support the assumptions underlying phase-based treatment that ER skills training enhances ER beyond PE or that ER improvement contributes to subsequent PTSD symptom reduction, indicating that adults with CA-PTSD may benefit equally from starting PE immediately.