眼动脱敏和再加工与认知行为疗法对创伤后应激障碍患者生活质量的效果比较

目的:比较眼动脱敏和再加工(EMDR)与认知行为疗法(CBT)对创伤后应激障碍(PTSD)患者生活质量改善的效果。方法:将符合纳入标准的研究对象随机分为EMDR组和CBT组,每组各27人,采用世界卫生组织生存质量测定量表(WHOQOL-Bref)在治疗前、治疗后及3个月后随访对两组患者的生活质量进行评估。结果:治疗结束后,两组的失访率分别为29.6%(EMDR)、7.4%(CBT),两组患者在生理、心理、社会关系及环境4个领域均有显著性提高,在心理领域和环境领域,CBT效果优于EMDR(t=-2.258,P=0.028;t=-2.740,P=0.008),重复测量方差分析验证了这一结果。结论:EMDR和CBT均能有效提高PTSD患者的生活质量,由于EMDR组存在较高的失访率,因此当引用CBT在心理和环境两个领域优于EMDR这一结论时应慎重。     

Treatment for Children With Posttraumatic Stress Disorder: Current Status and Future Directions

Although the treatment-efficacy literature for adults with posttraumatic stress disorder (PTSD) has advanced considerably with the publication of several methodologically rigorous contributions during the past decade, the child-focused PTSD literature has yet to extend beyond case illustrations and open trials. Central to this article is a review of the treatment-outcome literature for children with PTSD. Because few treatment studies have targeted trauma-exposed children relative to their adult counterparts, results of some methodologically rigorous investigations with adults are also cited in this review. From these investigations and from the available treatment-outcome data with children, we derive suggestions for future research.     

Eye movement desensitization and reprocessing (EMDR) in the treatment of war veterans

Recent practice guidelines and meta-analyses have designated eye movement desensitization and reprocessing (EMDR) as a first-line treatment for trauma. Eye movement desensitization and reprocessing is an eight-phase therapeutic approach guided by an information-processing model that addresses the combat veteran's critical incidents, current triggers, and behaviors likely to prove useful in his or her future. Two case examples of combat veterans illustrate the ability of EMDR to achieve symptom reduction in a variety of clinical domains (e.g., anxiety, depression, anger, physical pain) simultaneously without requiring the patient to carry out homework assignments or discuss the details of the event. The treatment of phantom limb pain and other somatic presentations is also reviewed. The ability of EMDR to achieve positive effects without homework indicates that it can be effectively employed on consecutive days, making it especially useful during combat situations.     

创伤后应激障碍的眼动脱敏再加工整合团体疗法

眼动脱敏再加工整合团体疗法是一种专门针对创伤后应激障碍开发的快速高效的成套团体心理治疗方案。它以适应信息加工模型为理论基础,综合运用了个体EMDR疗法、团体治疗、艺术治疗、蝴蝶拍脱敏技术等多种治疗成分,已广泛应用于儿童和成人创伤后应激障碍(PTSD)患者。未来研究需要在改进研究方法的基础上加强治疗机制的研究,开展其在国内成人和儿童PTSD患者中的研究和应用。     

Trauma-Informed Treatment Decreases Posttraumatic Stress Disorder Among Women Offenders

Traumatic experiences among women offenders can impact their psychological well-being and patterns of substance use and offending. However, rigorous research in this area for women offenders with a history of trauma is sparse. This study combined data from 2 previous studies of women offenders in order to provide greater statistical power in examining the psychological trends found in the individual studies. Specifically, women in gender-responsive treatment (GRT; n = 135) were compared to women in non-GRT (n = 142) in regard to their change in posttraumatic stress disorder (PTSD) and related symptomatology from baseline to follow-up. The pooled sample of women were predominantly White (58%) or Hispanic (22%), and many had never been married (47%); their mean age was 36 years (SD = 8.9), and, on average, they had 12 years (SD = 1.8) of education. Methamphetamine was their primary drug (71%). Moreover, 55% of the women reported histories of sexual abuse and 37% physical abuse. Finally, 31% had a diagnosis of PTSD. Using generalized estimation equations, we detected significant Group?×?Time interactions in PTSD (odds ratio [OR] = 0.17) and some related symptomatology (reexperiencing: OR = 0.42; and avoidance: OR = 0.24). Given the aggregate impact of trauma in the lives of women offenders, these women, their families, and their communities could benefit from research on how trauma influences their lives and on services that mitigate the negative impact of such histories.     

Efficacy of Posttraumatic Stress Disorder Treatment for Comorbid Panic Disorder: A Critical Review and Future Directions for Treatment Research

A systematic review of trauma treatment outcome literature was conducted to determine the impact of treatment on comorbid panic symptoms. Major databases were searched (from 1989 to 2013) and 64 randomized controlled trials using cognitive behavioral approaches to treat acute stress disorder, subthreshold posttraumatic stress disorder (PTSD), and full PTSD met inclusion criteria for this review. Results showed that 41% of the studies reviewed did not assess for Axis I psychiatric comorbidity at any point during the course of treatment. Only 5% of the studies reviewed reported rates of comorbid panic disorder (PD) at more than one time point during the study. Results indicate that approximately 56% of people no longer meet PD criteria following PTSD treatment.     

军人创伤后应激障碍探究性眼动与事件相关电位分析

目的评价探究性眼动分析(EEM)和事件相关电位(ERP)对军人创伤后应激障碍患者认知功能评估的临床价值。方法采用EEM和ERP对某三级甲等部队医院心理科收治的96例创伤后应激障碍官兵(研究组)和随机抽取某部100名官兵(对照组)进行测定,并将结果进行比较。结果①军人创伤后应激障碍患者EEM凝视点数(NEF)、反应探索评分(RSS)及D值与对照组相比,两者差异有统计学意义(P0.01);②军人创伤后应激障碍患者ERP测定,N2、P3波潜伏期较对照组延长,P3波幅较对照组降低,其差异比较均有显著性意义(P0.01);③相关分析显示,研究组N2、P3波潜伏期与NEF、RSS呈负相关(r=-0.19~-0.42,P0.05或0.01),与D值呈正相关(r=0.30,0.48;P0.01);P3波幅与NEF、RSS呈正相关(r=0.38,0.51;P0.01),与D值呈负相关(r=-0.32,P0.01)。结论 EEM和ERP测定具有良好的一致性,可作为判断军人创伤后应激障碍患者认知功能的重要指标。     

Posttraumatic Stress Disorder and Co‐Occurring Substance Use Disorders: Advances in Assessment and Treatment

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are prevalent and frequently co‐occur. Comorbid PTSD/SUD is associated with a more complex and costly clinical course when compared with either disorder alone, including increased chronic physical health problems, poorer social functioning, higher rates of suicide attempts, more legal problems, increased risk of violence, worse treatment adherence, and less improvement during treatment. In response, psychosocial treatment options have increased substantially over the past decade and integrated approaches—treatments that address symptoms of both PTSD and SUD concurrently—are fast becoming the preferred model for treatment. This article reviews the prevalence, etiology, and assessment practices as well as advances in the behavioral and pharmacologic treatment of comorbid PTSD and SUDs.     

Acupuncture for the Treatment of Adults with Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis

Acupuncture has been suggested as a treatment for posttraumatic stress disorder (PTSD), yet its clinical effects are unclear. This review aims to estimate effects of acupuncture on PTSD symptoms, depressive symptoms, anxiety symptoms, and sleep quality for adults with PTSD. We searched 10 databases in January 2016 to identify eligible randomized controlled trials (RCTs). We performed random effects meta-analyses and examined quality of the body of evidence (QoE) using the GRADE approach to rate confidence in meta-analytic effect estimates. Seven RCTs with 709 participants met inclusion criteria. We identified very low QoE indicating significant differences favoring acupuncture (versus any comparator) at post-intervention on PTSD symptoms (standardized mean difference [SMD] = ?0.80, 95% confidence interval [CI] [?1.59, ?0.01], 6 RCTs), and low QoE at longer follow-up on PTSD (SMD = ?0.46, 95% CI [?0.85, ?0.06], 4 RCTs) and depressive symptoms (SMD = ?0.56; 95% CI [?0.88, ?0.23], 4 RCTs). No significant differences were observed between acupuncture and comparators at post-intervention for depressive symptoms (SMD = ?0.58, 95% CI [?1.18, 0.01], 6 RCTs, very low QoE), anxiety symptoms (SMD = ?0.82, 95% CI [?2.16, 0.53], 4 RCTs, very low QoE), and sleep quality (SMD = ?0.46, 95% CI [?3.95, 3.03], 2 RCTs, low QoE). Safety data (7 RCTs) suggest little risk of serious adverse events, though some participants experienced minor/moderate pain, superficial bleeding, and hematoma at needle insertion sites. To increase confidence in findings, sufficiently powered replication trials are needed that measure all relevant clinical outcomes and dedicate study resources to minimizing participant attrition.     

Posttraumatic Stress Disorder: A Social‐Cognitive Perspective

This study offers a developmentally sensitive conceptual understanding of trauma by viewing posttraumatic stress disorder (PTSD) through the lens of social cognition. First, we justify our focus on social cognition by examining the literature on problematic interpersonal relationships associated with PTSD. Next, we link impaired social cognition to the developmental compromise of mentalizing capacity in attachment relationships. We then integrate the diverse research literature into a social‐cognitive model of the development of PTSD. We finally conclude by suggesting directions for future research, as it might be shaped by trends in social‐cognitive neuroscience.     

Investigating Cognitive Inhibition in Dissociative Identity Disorder Compared to Depression,Posttraumatic Stress Disorder and Psychosis

ABSTRACT

Cognitive inhibition refers to the mental capacity to suppress distracting stimuli that compete with target stimuli for processing resources. Using neutral word stimuli in a flanker task, a recent study suggested that dissociative identity disorder (DID) is characterized by weakened cognitive inhibitory functioning (Dorahy, Irwin, & Middleton, 2002). The current study used single digit stimuli in the flanker task and tested cognitive inhibitory ability in samples with DID, depression, posttraumatic stress disorder and psychosis. The DID, depressed and PTSD groups displayed no evidence of weakened cognitive inhibitory functioning. Consistent with previous research, however, the psychosis sample displayed a reduced capacity to engage in cognitive inhibition. Cognitive inhibitory ability was not related to measures of dissociation, childhood traumatic experience or schizotypy. Results are discussed in terms of the positive symptoms of schizophrenia and the nature of stimuli used in the flanker task.     

Culturally Competent Treatment of Posttraumatic Stress Disorder in Clinical Practice: An Ideographic, Transcultural Approach

Cultural context is a relevant factor in understanding the development, maintenance, and treatment of posttraumatic stress disorder (PTSD). Evidence suggests that the reexperiencing and arousal symptoms of PTSD represent a universal response to trauma observable across many ethnocultural groups. Variation in the expression of this response may be related to the influence of culture on the avoidance and numbing reactions to trauma. Thus, a central challenge for culturally competent treatment of PTSD does not appear to be whether to utilize empirically supported treatments for PTSD, but rather how to effectively engage individuals of various cultures in these interventions and how to address ethnocultural sources of avoidance in the maintenance of PTSD. The enormity of cultural diversity, however, presents a challenge to the task of adapting and empirically testing empirically supported treatments. An ideographic transcultural approach to cultural competency is proposed.     

眼动脱敏与再加工治疗现状

眼动脱敏与再加工 (Eyemovementdesensitizationandrepro cessing,以下简称EMDR)由FrancineShapiro于 1987年创立 ,最初仅为眼动脱敏 (EMD) ,1991年发展为眼动脱敏与再加工 ,其中眼动脱敏仅是EMDR中双侧刺激的一种 ,而双侧刺激是EMDR操作中众多组分的一部分。EMDR是一种整合的心理疗法 ,它借鉴了控制论 (cybernetics)、精神分析、行为、认知、生理学等多种学派的精华 ,建构了加速信息处理的模式 ,帮助患者迅速降低焦虑 ,并且诱导积极情感、唤起患者对内的洞察、观念转变和行为改变以及加强内部资源 ,使患者能够达到理想的行为和人…