创伤性应激障碍产妇心理护理体会

创伤性应激障碍系指在遇到暴力袭击、强奸、绑架和自然灾害等创伤性生活事件引发的精神障碍[1].人们在经历心理或身体创伤后,女性比男性更易患PTSD,其比例为2:1[2].     

运用心理技术治疗惧畸障碍的个案研究

目的通过介绍对1名惧畸障碍患者的诊断与干预，探讨用心理技术治疗惧畸障碍的方法及过程。方法依据医学鉴定结果，症状自评量表（SCL-90）测量结果以及典型行为表现诊断惧畸障碍。根据患者的实际情况采用观察法、谈话法、认知疗法以及放松训练等心理技术，制定详细的治疗划并对其进行心理咨询与治疗。结果治疗后患者的焦虑、抑郁等消极情绪有了显著改善（P〈0．01），惧畸障碍得到了有效控制，最终治愈。结论运用观察法、谈话法、认知疗法以及放松训练等心理技术对惧畸障碍进行治疗是有效的。     

1例大学生学习焦虑的认知行为干预

目的探讨大学生学习焦虑的心理机制及其干预办法,为学习焦虑的临床治疗提供参考。方法通过观察法、访谈法、贝克认知疗法、系统脱敏法和放松训练对1名具有学习焦虑症状的大学生进行个案实验研究。结果治疗前的焦虑自评量表(SAS)得分为62分,通过6次系统的咨询,焦虑自评量表(SAS)得分为50分,已恢复正常水平。结论通过认知疗法和系统脱敏法干预学习焦虑个案的临床效果显著,适合于普遍推广和使用。     

创伤后应激障碍患者创伤后应激症状与自传体记忆过度概括化的相关

目的:探讨伤后应激障碍患者的创伤后应激障碍症状与过度概括化自传体记忆的相互关系。方法:选取符合入组条件的创伤后应激障碍患者30人,正常对照组30人,所有被试均接受自传体记忆(AMT)、创伤后应激障碍症状自评量表(PTSD-SS)测验。结果:1与正常对照组比较,PTSD患者PTSD症状量表各症状及过度概括化自传体记忆总分上存在显著性的统计学意义(P0.05);2相关分析表明,创伤后应激障碍患者PTSD症状的重复体验、回避功能、社会功能与过度概括化自传体记忆呈高度的正相关性,分别为(r=0.59,0.53,0.71,0.59;P0.05)。结论:创伤后应激障碍患者PTSD症状及过度概括化的自传体记忆明显,且过度概括化的自传体记忆水平越高,PTSD患者的重复体验、回避功能、社会功能问题就越明显。     

事故后飞行人员的心理治疗与康复

飞行人员在其职业生涯中，不可避免地耳闻目睹或亲身经历飞行事故。对当事机组人员产生严重的心理问题应给予及时矫治。笔者采用音乐治疗、生物反馈放松训练、系统脱敏、成功表象飞行训练、空中特殊情况表象训练等一系列方法，分别对三位事故后产生创伤后应激障碍的空中乘务员、飞行驾驶员进行治疗，取得了较好的疗效。     

认知暴露疗法治疗创伤后应激障碍的研究

目的 探讨认知暴露疗法治疗创伤后应激障碍(PTSD)的效果.方法 连续病例20名被随机分成两组,一组采取药物干预,另一组采用认知暴露疗法结合药物干预.疗效采用创伤后应激障碍症状清单量表(PCLS)、症状自评量表(SCL-90)、贝克抑郁问卷(BDI)、状态-特质焦虑问卷(STAI-Form Y)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)进行盲法评定.结果 药物治疗和结合治疗都在一定程度上改善了PTSD的症状,但是在再经历方面,结合治疗组下降稳定.其余各量表纵向效应明显.随访时用创伤后应激障碍症状清单量表(PCLS)进行测量,发现结合治疗组有两名被试已经不再符合PTSD诊断阶段,但是统计检验显示两治疗组之间并无差异.结论 认知暴露疗法有助于PTSD患者的心理康复.     

舟曲泥石流5年后居民PTSD与社会支持、心理弹性关系

目的:了解舟曲泥石流5年后受灾居民创伤后应激障碍状况与社会支持、心理弹性的关系,为灾后的远期心理援助工作提供参考依据。方法:采用创伤后应激障碍检查量表平民版(PCL-C)、社会支持评定量、心理弹性量表对舟曲244名受灾居民进行调查。结果:泥石流5年后受灾居民创伤后应激障碍阳性者有82例(33.61%),女性显著高于男性(χ2=21.049,P0.001);PTSD阳性者社会支持与心理弹性得分均低于PTSD阴性者,且有显著性差异(P0.05)。PTSD与社会支持、心理弹性总分呈负相关(r=-0.423,P=0.000;r=-0.158,P=0.014)。结论:泥石流给受灾居民的心理健康造成持续影响,创伤后应激障碍与社会支持、心理弹性有着密切的联系,应重视居民远期心理援助。     

国外关于儿童和青少年创伤后应激障碍的理论研究进展

目前关于儿重和青少年PTSD的研究有了一定追展。但对其发生机制尚未明了。这必将影响我们对儿童和青少年PTSD症状的恰当解释、预防和治疗，客观上造成丁灾后干预不能满足儿童和青少年的需要。因此，迫切需要追一步完善儿童和青少年PTSD的理论，本文主要论述了国外儿童和青少年创伤后应激障碍的研究现状、理论进展及存在的问题，介绍了双重表征理论及其在儿童和青少年创伤后应激障碍研究中的应用和意义。     

运用心理技术治愈社交恐惧的个案研究

目的探讨用心理技术治疗社交恐惧障碍的方法及过程。方法依据医学鉴定结果,症状自评量表（SCL-90）测量结果以及来访者典型行为表现诊断为社交恐惧障碍;根据来访者的实际情况,采用观察法、谈话法、认知疗法、放松训练等心理技术,制定详细地干预计划并对其进行心理咨询与治疗。结果治疗后来访者的焦虑、人际敏感、抑郁等消极情绪有了显著改善（P〈0.01）,社交恐惧障碍得到了有效控制,最终治愈。结论运用认知疗法、放松训练等心理技术对社交恐惧障碍进行治疗是有效的。     

精神创伤后应激障碍与述情障碍的相关性分析

目的:研究旨在了解经历精神创伤后,创伤后应激障碍(PTSD)患者的症状特征与述情障碍的关系。方法:试验组为35名经历过精神创伤发生PTSD的患者,对照组为35名经历过精神创伤未发生PTSD的创伤暴露者,在不影响测验症状的情况下分别完成创伤后应激障碍临床筛查表平民版量表(PCL-C)及述情障碍20个条目量表(TAS-20)中文版。结果:PTSD患者述情障碍的发生率(57.14%)高于未发生PTSD的创伤幸存者(11.42%),PTSD患者的TAS-20总分(t=-5.271,P0.001)、因子1(F1:情感辩别不能)(t=-6.113,P0.001)及因子2(F2:情感描述不能)(t=-4.660,P0.001)得分高于对照组,差异有统计学意义。总分及因子分与PTSD症状的相关分析表明,PTSD患者的症状特征与TAS-20总分及F1、F2因子显著相关。结论:精神创伤暴露者中PTSD患者与未发生PTSD的创伤幸存者的述情障碍表现明显不同,TAS-20量表在临床具有较好的辅助诊断价值。     

Comparative efficacy,speed, and adverse effects of three PTSD treatments: exposure therapy,EMDR, and relaxation training

The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N = 60). Treaments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy.     

Do all psychological treatments really work the same in posttraumatic stress disorder?

A recent meta-analysis by Benish, Imel, and Wampold (2008, Clinical Psychology Review, 28, 746–758) concluded that all bona fide treatments are equally effective in posttraumatic stress disorder (PTSD). In contrast, seven other meta-analyses or systematic reviews concluded that there is good evidence that trauma-focused psychological treatments (trauma-focused cognitive behavior therapy and eye movement desensitization and reprocessing) are effective in PTSD; but that treatments that do not focus on the patients' trauma memories or their meanings are either less effective or not yet sufficiently studied. International treatment guidelines therefore recommend trauma-focused psychological treatments as first-line treatments for PTSD. We examine possible reasons for the discrepant conclusions and argue that (1) the selection procedure of the available evidence used in Benish et al.'s (2008)meta-analysis introduces bias, and (2) the analysis and conclusions fail to take into account the need to demonstrate that treatments for PTSD are more effective than natural recovery. Furthermore, significant increases in effect sizes of trauma-focused cognitive behavior therapies over the past two decades contradict the conclusion that content of treatment does not matter. To advance understanding of the optimal treatment for PTSD, we recommend further research into the active mechanisms of therapeutic change, including treatment elements commonly considered to be non-specific. We also recommend transparency in reporting exclusions in meta-analyses and suggest that bona fide treatments should be defined on empirical and theoretical grounds rather than by judgments of the investigators' intent.     

Relaxation therapy in asthma: a critical review

This review discusses the relationship between the psychological and physiological factors responsible for airways in asthma and indicates the mechanisms by which psychological methods of treatment may influence airway caliber. The effects of mental and muscular relaxation therapy, systematic desensitization, and biofeedback-assisted relaxation are evaluated in children and adults with asthma. The methodology and results of studies are analyzed critically to present a balanced opinion of the subjective and objective effects of these methods of treatment. Muscular relaxation therapy alone appears to have no effect. Certain mental relaxation techniques, such as autogenic training and transcendental mediation, systematic desensitization, and biofeedback-assisted relaxation, can produce subjective improvement as well as clinically significant improvement in respiratory function and other objective parameters. As with any therapy the response is variable and is influenced by factors such as age and severity of asthma.     

Cognitive trauma therapy for battered women with PTSD (CTT-BW)

This article describes a second treatment-outcome study of cognitive trauma therapy for battered women with posttraumatic stress disorder (PTSD; CTT-BW). CTT-BW includes trauma history exploration: PTSD education; stress management; exposure to abuse and abuser reminders; self-monitoring of negative self-talk; cognitive therapy for guilt; and modules on self-advocacy, assertiveness, and how to identify perpetrators. One hundred twenty-five ethnically diverse women were randomly assigned to immediate or delayed CTT-BW. PTSD remitted in 87% of women who completed CTT-BW, with large reductions in depression and guilt and substantial increases in self-esteem. White and ethnic minority women benefited equally from CTT-BW. Similar treatment outcomes were obtained by male and female therapists and by therapists with different levels of education and training. Gains were maintained at 3- and 6-month follow-ups.     

Cognitive-behavior therapy for PTSD in rape survivors

In recent years, new data have appeared, further suggesting the utility of cognitive-behavioral interventions for posttraumatic stress disorder (PTSD) subsequent to sexual assault. In this article, we present a model of cognitive-behavioral treatment (CBT) for PTSD in rape survivors. Emotional-processing theory, which proposes mechanisms that underlie the development of disturbances following rape, is reviewed. A CBT-based therapy (Prolonged Exposure) is presented that entails education about common reactions to trauma, relaxation training, imaginal reliving of the rape memory, exposure to trauma reminders, and cognitive restructuring. Current research regarding the use of prolonged exposure is discussed. The case example of a young female rape survivor is described in detail, and her prior substance dependence and intense shame are highlighted. The therapy was successful in reducing the client's symptoms of PTSD, as well as her depressive symptoms, and these gains were maintained at a one-year follow-up assessment.     

Relaxation training assisted by heart rate variability biofeedback: Implication for a military predeployment stress inoculation protocol

Decreased heart rate variability (HRV) is associated with posttraumatic stress disorder (PTSD) and depression symptoms, but PTSD's effects on the autonomic stress response and the potential influence of HRV biofeedback in stress relaxation training on improving PTSD symptoms are not well understood. The objective of this study was to examine the impact of a predeployment stress inoculation training (PRESTINT) protocol on physiologic measures of HRV in a large sample of the military population randomly assigned to experimental HRV biofeedback‐assisted relaxation training versus a control condition. PRESTINT altered the parasympathetic regulation of cardiac activity, with experimental subjects exhibiting greater HRV, that is, less arousal, during a posttraining combat simulation designed to heighten arousal. Autonomic reactivity was also found to be related to PTSD and self‐reported use of mental health services. Future PRESTINT training could be appropriate for efficiently teaching self‐help skills to reduce the psychological harm following trauma exposure by increasing the capacity for parasympathetically modulated reactions to stress and providing a coping tool (i.e., relaxation method) for use following a stressful situation.     

Cognitive behaviour therapy for posttraumatic stress disorder

Following considerable empirical scrutiny, cognitive behaviour therapy (CBT) has proven to be a safe and effective treatment for posttraumatic stress disorder (PTSD). This article overviews the general principles of treatment and describes the components that comprise CBT for PTSD. We then move on to review the efficacy of CBT for the treatment of PTSD caused by various traumas, including assault, road traffic accident (RTA), combat, and terrorism. Recent advances in early intervention and in the treatment of disorders that are comorbid with PTSD are reviewed. Finally, future directions are discussed. In particular, it is proposed that randomised controlled trials (RCT) of CBT for PTSD must be conducted with enhanced methodological rigour and public health relevance.     

The Relationship of Psychological Trauma and Dissociative and Posttraumatic Stress Disorders to Nonsuicidal Self-Injury and Suicidality: A Review

We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.     

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.     

1例大学生惊恐障碍的元认知心理干预

目的本研究运用元认知行为疗法对1名惊恐障碍的大学生做了临床诊断与技术干预,为惊恐障碍的治疗提供借鉴。方法采用观察法、访谈法、认知疗法及行为疗法中的放松训练,并结合元认知心理干预技术中情感组织者技术对1名患有惊恐障碍的来访者进行个案实验研究。结果治疗前来访者的SCL-90症状自评量表中某些因子分显示异常,如焦虑3.3、恐怖3.28、强迫2.7等。在没有使用任何辅助药物的情况下,通过4次放松训练共15天治疗后,SCL-90症状自评量表中各项因子分均达到正常水平,焦虑1.9、恐怖1.85、强迫2.2等。来访者在学校能够正常生活。结论此案例初步证明了元认知行为疗法治疗惊恐障碍疗程短,是很有希望的心理干预方法。