Modum Bad is a research-based psychiatric hospital in Norway that offers highly specialized inpatient psychotherapeutic treatment for complex treatment-resistant mental disorders.
Co-authors
Peter Sele, Specialist in Clinical Psychology/PhD-candidate
Heidi Berg Houmb, MD, Specialist in Psychiatry, head of the Department for Anxiety Disorders
Ellen Kjærulf Jepsen, MD, PhD, Specialist in Psychiatry
Modum Bad was originally founded as a spa and health resort in the mid nineteenth century and has kept a long tradition of incorporating a holistic approach to treatment. This includes a focus on cultural, aesthetic, physical, as well as social and spiritual dimensions and needs, with a strong belief in the potential of human resources.
This tradition has largely been kept also when the resort was reinvented as a psychiatric hospital in the mid twentieth century. All the patients at Modum Bad participate in physical exercise. Many of them see the chaplains for pastoral care and counselling, and others find meaning and inspiration in the cultural events.
The hospital has five clinical departments, and two of them, the Department for Anxiety Disorders and the Department for Trauma Treatment, offer psychotherapeutic treatment of psychological trauma.
The Department for Anxiety Disorders offers treatment for patients suffering from PTSD after traumatic events experienced in adult life, including atrocities of war. The Department for Trauma Treatment focuses on the treatment of survivors of early-onset relational trauma and attachment trauma, including childhood sexual abuse, physical abuse, emotional abuse and severe neglect.
Clinical experience with trauma-focused treatment since the 1990’s has taught us that psychological trauma comes in many different forms and degrees, and these may need different forms of treatment. To reflect this diversity, Modum Bad offers different multi-component trauma treatment programs aiming to tailor interventions to the patients’ dominant symptoms.
The Department for Anxiety Disorders treats survivors of adult trauma with PTSD, often suffering from severe intrusions (flashbacks, nightmares), hyperarousal and avoidance. The treatment in one team is based on Edna Foa’s Prolonged Exposure model (Foa, 2021), with a combination of systematic imaginal and in vivo exposure, and treatment in the other team is based on Adrian Wells metacognitive therapy model (Wells, 2011), using in vivo exposure and subsequent metacognitive restructuring.
The Department for Trauma Treatment treats survivors of childhood trauma, often with complex forms of PTSD and dissociative disorders. The patients often suffer from a range of co-morbid disorders as well as PTSD-symptoms. The treatment there is based on various models for the treatment of complex trauma, including the structural dissociation theory (van der Hart, 2006), Sensorimotor Psychotherapy (Ogden, Minton, Pain, 2005) and STAIR Narrative Therapy (Cloitre, 2020).
Of the four treatment teams in the Department for Trauma Treatment, one focuses primarily on complex dissociative disorders, two teams focus on treatment of complex PTSD with a focus on improving bodily regulation, emotional tolerance and relational skills, and one team treats complex PTSD with a more exposure-based approach.
Research in the area of complex trauma is scarce and evidence-based practices are lacking. The clinical departments and research institute at Modum Bad therefore collaborate closely to find more effective ways to treat complex trauma. Research efforts in recent years include three randomized controlled trials, one comparing imaginal exposure to imagery rescripting, another comparing CBT to metacognitive therapy and the last comparing phase-based treatment to prolonged exposure and skills-training. In addition, we have studied the efficacy of different approaches in the long-term treatment of complex dissociative disorders.
Our research findings have supported the need for differentiating treatment strategies for complex PTSD and complex dissociative disorders. Findings indicate that dissociative patients need a gradual approach focusing on overcoming dissociation, increasing the tolerance for being in the “here-and-now”, increasing the tolerance for positive affect and fostering internal collaboration, while patients with complex posttraumatic symptoms (but no dissociative disorder) to a greater degree can benefit from more directly exposure-based treatment.
Please click on images to expand them. These pictures are from the Modum Bad archive.
References on request
Wells, Hollon, Leahy, Basco, Brewin: “Metacognitive Therapy for Anxiety and Depression” (2011).
Wells, Hollon, Leahy, Basco, Brewin: “Metacognitive Therapy for Anxiety and Depression” (2011)
Van der Hart, Nijenhuis, Steele: “The Haunted Self” (2006).
Ogden, Minton, Pain: “Trauma and the Body” (2006).
Cloitre, Cohen, Ortigo, Jackson, Cohen: “Treating Survivors of Childhood Abuse and Interpersonal Trauma: STAIR Narrative Therapy” (2020).
Langkaas, T. F., Hoffart, A., Øktedalen, T., Ulvenes, P. G., Hembree, E. A., & Smucker, M. (2017). Exposure and non-fear emotions: A randomized controlled study of exposure-based and rescripting-based imagery in PTSD treatment. Behaviour research and therapy, 97, 33-42.
Jepsen, E. K. K., Langeland, W., Sexton, H., Heir, T. (2013). Inpatient treatment for early sexually abused adults: A naturalistic 12-month follow-up study. Psychological Trauma: Theory, Research, Practice, and Policy. http://dx.doi.org/10.1037/a0031646
Kaspersen, K., Hol, G., & Jepsen, E. K. K. (2021). Negative affective responses to positive events and stimuli in patients with complex dissociative disorders: a mixed-methods pilot study. European Journal of Psychotraumatology, 12(1): 1976954. doi: 10.1080/20008198.2021.1976954.
Johnson, S. U., Hoffart, A., Nordahl, H. M., & Wampold, B. E. (2017). Metacognitive therapy versus disorder-specific CBT for comorbid anxiety disorders: a randomized controlled trial. Journal of anxiety disorders, 50, 103-112.