Is emotion-focused therapy effective for treating Complex Post-Traumatic Stress Disorder (Complex PTSD)?

From the Guidelines

Emotion-focused therapy (EFT) is a valuable approach for treating Complex Post-Traumatic Stress Disorder (Complex PTSD), as it directly addresses emotional dysregulation, a core feature of the condition, and can be effectively combined with other evidence-based therapies like trauma-focused cognitive behavioral therapy (TF-CBT) or Eye Movement Desensitization and Reprocessing (EMDR) for optimal outcomes. EFT helps patients identify, experience, accept, and transform difficult emotions stemming from traumatic experiences, which is particularly relevant for Complex PTSD. The therapy typically involves weekly sessions over 16-20 weeks, though treatment duration varies based on individual needs and trauma severity. During sessions, therapists guide patients through emotional processing techniques such as empty chair work, two-chair dialogues, and focusing exercises to access and transform maladaptive emotional responses.

According to the study by Jongh et al. 1, the assumption that individuals with PTSD and a history of childhood abuse have greater emotion regulation deficits than those without such a background is not supported, and improving emotion regulation skills may not be necessary before processing traumatic memories. This is in line with results from a meta-analysis of prolonged exposure showing that trauma history, including type of trauma and repeated traumatization, did not influence benefit from treatment 1.

The research also fails to support the view that trauma-focused interventions precipitate dropout from treatment for those suffering from symptoms of cPTSD, with data from multiple RCTs consistently showing that dropout is similar across child sexual abuse and adult trauma groups 1.

Key points to consider when using EFT for Complex PTSD include:

• EFT is effective in addressing emotional dysregulation and can be used in conjunction with other therapies for optimal outcomes.
• The therapy typically involves weekly sessions over 16-20 weeks, with variable treatment duration based on individual needs and trauma severity.
• Techniques such as empty chair work, two-chair dialogues, and focusing exercises are used to access and transform maladaptive emotional responses.
• EFT can help patients develop healthier emotional responses and self-soothing capabilities, and improve interpersonal functioning, which are often severely impacted in Complex PTSD.

Overall, EFT is a valuable approach for treating Complex PTSD, and its effectiveness is supported by research, including studies by Jongh et al. 1 and the ISTSS Expert Consensus Treatment Guidelines for cPTSD in Adults 1.

From the Research

Emotion-Focused Therapy for Complex PTSD

• Emotion-focused therapy is an evidence-based approach that has been shown to be effective in treating a range of psychological problems, including those related to trauma 2.
• The therapy focuses on accessing and processing emotions, and has been found to lead to significant improvements in symptoms of PTSD and complex PTSD 2.
• However, there is limited research specifically on the effectiveness of emotion-focused therapy for complex PTSD, and more studies are needed to fully understand its potential benefits and limitations.

Comparison to Other Therapies

• Trauma-focused cognitive behavioral therapies (TF-CBT) have been shown to be effective in treating complex PTSD, particularly in youth populations 3.
• Phase-oriented therapies, which take a more gradual approach to treatment, may also be effective for complex PTSD, although more research is needed to fully understand their benefits and limitations 4.
• Emotion-focused therapy may be more effective than other therapies in certain situations, such as when clients are struggling with intense emotions or have difficulty regulating their emotions 5.

Mechanisms of Change

• The therapeutic relationship and emotional processing of problematic material are thought to be the primary mechanisms of change in emotion-focused therapy 5.
• Emotional change processes, including awareness, regulation, reflection, and transformation of emotion, are also important components of the therapy 5.
• The effectiveness of emotion-focused therapy may be due in part to its ability to help clients develop greater emotional awareness and regulation skills, which can be particularly beneficial for individuals with complex PTSD 2.

Limitations and Future Directions

• More research is needed to fully understand the effectiveness of emotion-focused therapy for complex PTSD, particularly in comparison to other therapies 4.
• Studies should investigate the mechanisms of change in emotion-focused therapy, and explore the potential benefits and limitations of the therapy in different populations and contexts 5, 2.
• Clinicians should consider a blended approach to treating complex PTSD, incorporating elements of emotion-focused therapy and other evidence-based therapies as needed 4.