Eye movement desensitization and reprocessing (EMDR) is a useful method for treatment of PTSD victims. You can find many research articles.

Prolonged exposure has been researched by many, e.g. Edna Foa. Also Mindfulness is proving to be an effective adjunctive therapy, e.g. Jon Kabat-Zinn, Richard Davidson...There are many.

MAPS – the Multidisciplinary Association for Psychedelic Studies – is an organization that has done intriguing  work in MDMA-assisted psychotherapy for PTSD, including scientific studies (working with the FDA and the VA) to study whether or how such therapy can help heal the psychological and emotional damage caused by sexual assault, war, violent crime, and other traumas.

To quote from the MAPS web site (http://www.maps.org/):

In MDMA-assisted psychotherapy, MDMA is only administered a few times, unlike most medications for mental illnesses which are often taken daily for years, and sometimes forever. MDMA is not the same as "Ecstasy" or "molly." Substances sold on the street under these names may contain MDMA, but frequently also contain unknown and/or dangerous adulterants. In laboratory studies, pure MDMA has been proven sufficiently safe for human consumption when taken a limited number of times in moderate doses.

MAPS is undertaking an eight-year, $18.5 million plan to make MDMA into an FDA-approved prescription medicine by 2021, and is currently the only organization in the world funding clinical trials of MDMA-assisted psychotherapy. For-profit pharmaceutical companies are not interested in developing MDMA into a medicine because the patent for MDMA has expired. The idea of using MDMA to assist psychotherapy of any kind for any specific clinical indication has long been in the public domain.

Thanks for reminding me of EMDR’s usefulness in the treatment of PTSD, Abdolghani. I came across two articles in EMDR and the phased-based treatment of complex PTSD by Deborah Horn (2002, 2009). I wonder if you know of any recent articles on the subject and whether you have applied EMDR to individuals who suffer from complex PTSD.

Thank you, Jennifer, for reminding me of Foa's (2007, 2009) prolonged exposure therapy and the mindfulness-based practices by Kabat-Zinn and others as an adjunct therapy in the treatment of PTSD. I am curious to know whether there are recent studies on the treatment of complex PTSD from these perspectives.

It was interesting to hear about MDMA-assisted therapy, Neva. This was new to me. Thanks.

Prolonged exposure and mindfulness, as Jennifer has said, has a good deal of research. That being said, finding current research-within the past year is a tad more difficult. And like any treatment modality there are those who do not endorse this type of therapy for PTSD.

Thanks, Margaret, for your comments. I agree with you in that some people might not use prolonged exposure or mindfulness despite their effectiveness supported by empirical evidence. The matching between modalities/methods and various variables (e.g., the therapist, the client, the client's situations, and the relationship between the client and the therapist, etc.) seems to be very important.

May I assume that your team at Rogers Memorial Hospital applies prolonged exposure and mindfulness? I'm very interested to learn how efficacious prolonged exposure and mindfulness have been with your clients with complex PTSD at your hospital.

At Rogers Hospital we have 2 PTSD Partial Hospitalization Programs at 2 separate locations. The main treatment  utilizes prolonged exposure. Mindfulness exercises are incorporated in daily ACT and /or FAP groups.Additionally, we close each day with mindfulness. Most of the patients we have treated thus far exhibit complex PTSD. Using PE with the more difficult patients has been fairly successful as long as  they have a "feeling" of core safety which can be instilled utilizing the principles of mindfulness.That being said, I recommend caution with patients who have a history of dissociating in that PE may trigger flashbacks and treatment staff have to be prepared and skilled in dealing with those.

Our team at Rogers Memorial Hospital is very close at looking at initial results of the program so I hope to be able to find this thread again and provide you with more information Stephen.  We have a fairly extensive initial assessment and give weekly measures.  Some of the first analyses will be about indicators of treatment success and others will be about predictors of drop-out (for whatever reason).

Thanks for your info, Chad. I look forward to hearing from you about your results in the future.

You might visit Hebrew University website.  They have done & continue to do a lot of research into PTSD.

Thanks for your response, Denise.

It looks line no one has read that you asked for post-2012 developments in complex ptsd. I was happy to see that Van der Kolk has some (relatively reverent- 2013) articles posted on here in support of a new diagnosis, or at least conceptualization, based on the recognition of the impact of repeated trauma on childhood (personality?) development, as I've noticed over the years a range of traits that I refer to as "cluster b" as shorthand that really could be better explained if they were examined from within a framework based on the developmental stage in which the trauma are occurring. 

Thanks for your comment, Kristin. I agree with you and am delighted that more conceptual and empirical work has been done in complex PTSD.

I think Judith Herman (1997) in her book Trauma and Recovery began to discuss borderline personality disorder in relation to complex trauma. 

https://books.google.com.hk/books/about/Trauma_and_Recovery.html?id=3cn2R0KenN0C&redir_esc=y

Agreed.  Her conceptualization removes so much of the "victim blaming" inherent to the borderline description. It's been a long time since I read her work, but I think we could get deeper insight (when the trauma begins in childhood) by paying even more attention to the attachment-related developmental tasks the child is working on as key traumas are occurring.  I just found this book on the istss conference website, which looks promising:

"Niki Gomez-Perales, therapist and author of Attachment-Focused Trauma Treatment for Children and Adolescents: Phase-Oriented Strategies for Addressing Complex Trauma Disorders (Routledge, June 2015), explores the integration of attachment focused and phase oriented treatments in real world therapy situations.  Current research and theory in neurobiology supports the integration between attachment theory and therapy geared towards the resolution of childhood trauma."

Just found this, as well.

Article Real Life Heroes in Residential Treatment: Implementation of...

Thanks, Kristin, for your insightful comments and references.

Hi Kristin,

I appreciated your recent references. I liked Real Life Heroes (RLH) because it is structured with activities.

I wonder if anyone has tried some of these approaches and would share his/her experiences with us. Thanks,

Stephen

Hi Stephen,

An expert in this field is Christine Courtois so I would recommend visiting her website. http://www.drchriscourtois.com/  

I would also recommend these articles that describe best practices.

Cloitre, M., Courtois, C. A., Charuvastra, A., Carapezza, R., Stolbach, B. C., & Green, B. L. (2011). Treatment of complex PTSD: Results of the ISTSS expert clinician survey on best practices. Journal of Traumatic Stress, 24(6), 615-627.

Pearlman, L. A., & Courtois, C. A. (2005). Clinical applications of the attachment framework: Relational treatment of complex trauma. Journal of Traumatic Stress, 18(5), 449-459.

I am also attaching two documents on trauma-informed care that are Canadian, but I think applicable to other contexts.

Toula

Thank you for Christine Courtois' website, Toula. There she posted more recent publications including the one that integrated spirituality.

I also appreciated Jean Tweed's document. Thanks.

Dear Stephen, 

There are many down-votings on this thread so it seems risky to give an input:

Treatment for Post-Traumatic Stress Disorder, Operational Stress Injury, or Critical Incident Stress: A Review of Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2015 Apr 27.

"After all the traumas my body has been through, I feel good that it is still working."--Basic Body Awareness Therapy for traumatised refugees. Stade K, Skammeritz S, Hjortkjær C, Carlsson J. Torture. 2015;25(1):33-50.

The DSM 5 and the Istanbul Protocol: Diagnosis of psychological sequels of torture. Wenzel T, Frewer A, Mirzaei S.Torture. 2015;25(1):51-61

Cochrane Database Syst Rev. 2014 Nov 11;11:CD009317. doi: 10.1002/14651858.CD009317.pub2. Psychological, social and welfare interventions for psychological health and well-being of torture survivors.

Patel N, Kellezi B, Williams AC.

Cochrane Database Syst Rev. 2013 Dec 13;12:CD003388. doi: 10.1002/14651858.CD003388.pub4.

Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C.

Evid Based Child Health. 2013 May;8(3):1004-116. doi: 10.1002/ebch.1916.

Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents (Review).

Gillies D, Taylor F, Gray C, O'Brien L, D'Abrew N.

Thanks for the recent references, Beatrice. I appreciate them.

Thank you, Jacques.

Dear Stephen, i tried many ways in my life, always ready to learn more without prejudice, not thinking of a socalled reputation. Look at things critically in a real scientific way, but give them a Chance. So here we go: there is a System based on trad. Chin. medicine (TCM) further developped first for Russian space medicine, then brought to Germany  - i participated in the research - and then further developped in the Netherlands ( https://www.i-health.com/) including now a new System to treat traumatized patients. I treated a dozen p. and it worked better than many other methods, but of course not always. As i am about to publish a book on the cultures of mankind, i will come back to this Topic only after that. But they speak English in NL and may this is of some help for you, giving you some new challenging ideas.

Best regards, Thomas

Dear Stephen, i tried many ways in my life, always ready to learn more without prejudice, not thinking of a socalled reputation. Look at things critically in a real scientific way, but give them a Chance. So here we go: there is a System based on trad. Chin. medicine (TCM) further developped first for Russian space medicine, then brought to Germany  - i participated in the research - and then further developped in the Netherlands ( https://www.i-health.com/) including now a new System to treat traumatized patients. I treated a dozen p. and it worked better than many other methods, but of course not always. As i am about to publish a book on the cultures of mankind, i will come back to this Topic only after that. But they speak English in NL and may this is of some help for you, giving you some new challenging ideas.

Best regards, Thomas

Dear Stephen, i tried many ways in my life, always ready to learn more without prejudice, not thinking of a socalled reputation. Look at things critically in a real scientific way, but give them a Chance. So here we go: there is a System based on trad. Chin. medicine (TCM) further developped first for Russian space medicine, then brought to Germany  - i participated in the research - and then further developped in the Netherlands ( https://www.i-health.com/) including now a new System to treat traumatized patients. I treated a dozen p. and it worked better than many other methods, but of course not always. As i am about to publish a book on the cultures of mankind, i will come back to this Topic only after that. But they speak English in NL and may this is of some help for you, giving you some new challenging ideas.

Best regards, Thomas

Hi Thomas,

Thanks for your response. The treatment in the video was quite interesting. I wonder if you'd speak a little about how to apply the "Raymedy raymedys" to individuals struggling with complex PTSD and the outcomes of treatment from your experience. Thanks,

Stephen 

 Dear Anas,

Thanks for your references. They are interesting.

Warm regards,

Stephen

Hi Stephen,

I am not too fit in the field, but there you have my view, I hope it could help you.

There is a relative new form of somatic therapie that lies an similar principles of EMDR. It was developed to the treatment of the victims of 9/11, so it is relatively new. Brainspotting. I have not used it and a colleague who has made the courses says he feels much more comfortable wit EMDR, but I guess that could vary from therapist to therapist. It may be another option.

I recommend you to read about Milton H. Erickson and his concept of "Utilization" and indirect communication. It has in my opinion similarities with the client-centered therapy and in some points is quite revealing. It is quite difficult to implement and not indicated for all patients, but used in the right moment has incredible results.

I hope it helps,

Wish you all best

Juanjo

Hi Juanjo,

Thanks for your input. I knew there are some evidences to support the efficacy of EMDR for PTSD. I'll look up Brainspotting.

There are anecdotal evidences that Milton Erickson's naturalistic hypnosis yielded great results for a lot of disorders including PTSD. I attended training seminars in Ericksonian hypnosis, but it would take much time and effort to master it.

Thanks for your ideas,

Stephen

Many of the comments don't seem to relate to complex PTSD specifically, don't seem evidence-based or expert practice based (e.g., developed by experts on complex PTSD), or "since 2012".

This authoritative work was published 2012:

https://books.google.com/books/about/Treatment_of_Complex_Trauma.html?id=7j12fb6VgZwC

And in 2013:  https://books.google.com/books?id=WecQAAAAQBAJ&printsec=frontcover&dq=Treating+Complex+Traumatic+Stress+Disorders+in+Children+and+Adolescents&hl=en&sa=X&ved=0CCwQ6AEwAGoVChMI85nL5OD5xwIVRZqACh3_GASi#v=onepage&q=Treating%20Complex%20Traumatic%20Stress%20Disorders%20in%20Children%20and%20Adolescents&f=false

Also see http://www.ejpt.net/index.php/ejpt/article/view/25097

and

http://www.ejpt.net/index.php/ejpt/article/view/20706

https://books.google.com/books/about/Treatment_of_Complex_Trauma.html?id=7j12fb6VgZwC

https://books.google.com/books?id=WecQAAAAQBAJ&printsec=frontcover&dq=Treating+Complex+Traumatic+Stress+Disorders+in+Children+and+Adolescents&hl=en&sa=X&ved=0CCwQ6AEwAGoVChMI85nL5OD5xwIVRZqACh3_GASi#v=onepage&q=Treating%20Complex%20Traumatic%20Stress%20Disorders%20in%20Children%20and%20Adolescents&f=false

http://www.ejpt.net/index.php/ejpt/article/view/25097

http://www.ejpt.net/index.php/ejpt/article/view/20706

Many thanks for your excellent references, Eve.

I'd also welcome any recent practice-based evidences on the treatment of complex PTSD.

 Dear Stephen,

I think the impression of treatment of complex PTSD depends on the person that is treated and after determining his/ her characteristics we should decide about the method of treatment. There is not a fixed method for all of the victims.

Regards,

Dr.Aghakhani

I agree with Nader. Eventhough there are guidelines for treatment not everyone responds positively. Prolonged exposures are a good tool for most and not for everyone depending on their level of anxiety, the severity of the trauma and any additional diagnosis. Because BPD and PTSD can present  with similar symptoms, I believe it is important to not rush  with a BPD diagnosis too early.

I agree with your comments, Nader and Margaret. There are definitely individual differences and we, as clinicians, need to tailor make our treatment in order to meet the specific needs of our clients. Some of our clients suffer from PTSD, while others, from complex PTSD.

Since Judith Herman coined the termed "complex PTSD" in 1992/1997, there have been many publications and some treatment guidelines for the same subject. The aforementioned literature has provided us with more knowledge and skills to treat complex PTSD, which is generally much more complex, enduring, and intractable than PTSD. While I like the new development in our knowledge in the past decades, I certainly value the importance of customizing our treatment to each individual client.

Thanks for your input,

Stephen

Hi Stephen, a really good source for treating PTSD is  Dr. Bessel A. van der Kolk.  Laurel Parnell, PhD is another good resource on the treatment of PTSD as is Linda Curran, BCPC, LPC, CAC-D, CCDP.  They work to train clinicians through PESI @ PESIeducation.com.  In fact, Dr van der Kolk is teaching a series about the treatment of PTSD and trauma that will provide clinicians with a certificate of specialty.  I don't know if those seminars are still open, but you can go to PESIeducation.com and find out.

Good luck!

Denise Goins

Hi Denise,

Thanks for your input. Bessel van der Kolk is indeed one of the gurus in the field of trauma. Like Judith Herman, van der Kolk (1995) discussed simple PTSD and complicated PTSD in his book chapter "Approaches to the Treatment of PTSD".

One of our doctoral students completed an intensive course with Dr. van der Kolk and he liked it a lot. 

http://www.trauma-pages.com/a/vanderk.php

Hello-

I recently completed a research paper on the therapeutic use of ayahuasca for complex, unresponsive PTSD. There is a ton of research, both current and past, on this topic. Currently in Boulder there is an organization called MAPS (Multidisciplinarty Association for Psychedelic Studies- maps.org) conducting world wide research on the use of MDMA, LSD and other psychedelics for PTSD, addiction and abuse. There are many journal articles on this topic that can be found in the Journal of Psychoactive Drugs. Much of the current research in Boulder is working with Veterans of War with nonresponsive PTSD and the use of psychedelics. I found this to be very interesting and learned a lot from reading about current research and the benefits they are finding. Hope this helps!

Thanks for your input, Ashley. 

We just published the results of emdr or exposure treatment in the subgroup of chronic psychotic patients that also fulfill the criteria of Complex PTSD

https://www.researchgate.net/publication/305888721_Effectiveness_of_trauma-focused_treatment_for_patients_with_psychosis_with_and_without_the_dissociative_subtype_of_post-traumatic_stress_disorder

Article Effectiveness of trauma-focused treatment for patients with ...

Dear Leonhard,

Thank you for valuable input.

 Dear Mark,

Thanks for your excellent article.

a great deal may be learned from an organization called MAPS; see maps.org | mdmaptsd.org.  The Executive Director is Rick Doblin, Ph.D.

Thanks, Neva, for your input.