A comparison of Narrative Exposure Therapy and Prolonged Exposure therapy for PTSD

The purpose of this review was to compare and contrast Prolonged Exposure (PE) and Narrative Exposure Therapy (NET). We examined the treatment manuals to describe the theoretical foundation, treatment components, and procedures, including the type, manner, and focus of exposure techniques and recording methods used. We examined extant clinical trials to investigate the range of treatment formats reported, populations studied, and clinical outcome data. Our search resulted in 32 studies on PE and 15 studies on NET. Consistent with prior reviews of PTSD treatment, it is evident that PE has a solid evidence base and its current status as a first line treatment for the populations studied to this date is warranted. We argue that NET may have advantages in treating complex traumatization seen in asylum seekers and refugees, and for this population NET should be considered a recommended treatment. NET and PE have several commonalities, and it is recommended that studies of these treatments include a broader range of populations and trauma types to expand the current knowledge on the treatment of PTSD.     

Post-traumatic stress disorder and suicidal behavior: A narrative review

There is a large literature investigating the underlying mechanisms, risk factors and demographics of suicidal thoughts and behaviors across a number of psychiatric disorders, such as, major depression, anxiety and schizophrenia. However, less research has focused on the relationship between Post-Traumatic Stress Disorder (PTSD) and suicide. There were two broad aims of this review. The first was to assess the extent to which PTSD is associated with suicide, and the second was to determine the effects of co-morbid disorders on this relationship. Overall, there was a clear relationship between PTSD and suicidal thoughts and behaviors irrespective of the type of trauma experienced. Very few studies directly examined whether depression was a mediating factor in the relationships reported. However, where this was investigated, the presence of co-morbid depression appeared to boost the effect of PTSD on suicidality. It was noteworthy that hardly any studies had investigated concepts thought to be key in other domains of research into suicidality, such as, feelings of entrapment, defeat and hopelessness.     

认知暴露疗法治疗门诊应激障碍病人和住院病人的疗效比较研究.

目的探讨门诊心理治疗和住院心理治疗在治疗应激障碍效果上的差异。方法连续病例33名随机分为两组,1组采取门诊心理治疗,另1组采取住院心理治疗,记录治疗时间,并且在治疗前后、治疗后3个月和1年4个时间点上测评汉密顿焦虑量表（HAMA）和汉密顿抑郁量表（HAMD）,在后两个时间点上测评创伤后应激障碍症状清单量表和创伤后应激障砰量表（PTSD）的发病率。结果HAMA和HAMD在两组间差异不明显,在纵向时间轴上差异显著（F=47．896,76．552,P〈0．01）,1年随访时门诊组焦虑症状较3个月随访时改善明显（P〈0．01）;住院治疗时间明显长于门诊治疗时间（t=2．149,P〈0．05）;门诊组创伤后应激障碍症状清单量表1年随访时明显低于3个月随访时（P〈0．05）;1年随访时住院组PTSD的患病率显著高于门诊组（x^2=5．543,P〈0．05）。结论规范的门诊认知暴露疗法对于缓解应激障碍的症状,降低从急性应激障碍到PTSD的转化有着艮好效果。     

A critical review of psychological treatments of posttraumatic stress disorder in refugees

Despite much research evidence that refugees suffer from elevated rates of posttraumatic stress disorder (PTSD), relatively few studies have examined the effectiveness of psychological treatments for PTSD in refugees. The field of refugee mental health intervention is dominated by two contrasting approaches, namely trauma-focused therapy and multimodal interventions. This article firstly defines these two approaches, then provides a critical review of 19 research studies that have been undertaken to investigate the efficacy of these treatments. Preliminary research evidence suggests that trauma-focused approaches may have some efficacy in treating PTSD in refugees, but limitations in the methodologies of studies caution against drawing definitive inferences. It is clear that research assessing the treatment of PTSD in refugees is lagging behind that available for other traumatized populations. The review examines important considerations in the treatment of refugees. A theoretical framework is offered that outlines contextual issues, maintaining factors, change mechanisms and the distinctive challenges to traditional trauma-focused treatments posed by the needs of refugees with PTSD.     

A meta-analytic review of prolonged exposure for posttraumatic stress disorder

Two decades of research demonstrate the efficacy of exposure therapy for posttraumatic stress disorder (PTSD). The efficacy of prolonged exposure (PE), a specific exposure therapy program for PTSD that has been disseminated throughout the world, has been established in many controlled studies using different trauma populations. However, a meta-analysis of the effectiveness of PE for PTSD has not been conducted to date. The purpose of the current paper is to estimate the overall efficacy of PE for PTSD relative to adequate controls. We included all published randomized controlled trials of PE vs. control (wait-list or psychological placebo) for the treatment of PTSD in adolescents or adults. Treatments were classified as PE if they included multiple sessions of imaginal and in vivo exposure and were based on the manualized treatment developed by Foa, Rothbaum, Riggs, and Murdock (1991). Thirteen studies with a total sample size of 675 participants met the final inclusion criteria. The primary analyses showed a large effect for PE versus control on both primary (Hedges's g = 1.08) and secondary (Hedges's g = 0.77) outcome measures. Analyses also revealed medium to large effect sizes for PE at follow-up, both for primary (Hedges's g = 0.68) and secondary (Hedges's g = 0.41) outcome measures. There was no significant difference between PE and other active treatments (CPT, EMDR, CT, and SIT). Effect sizes were not moderated by time since trauma, publication year, dose, study quality, or type of trauma. The average PE-treated patient fared better than 86% of patients in control conditions at post-treatment on PTSD measures. PE is a highly effective treatment for PTSD, resulting in substantial treatment gains that are maintained over time.     

Remission from post-traumatic stress disorder in adults: A systematic review and meta-analysis of long term outcome studies

Posttraumatic stress disorder (PTSD) is a frequent mental disorder associated with significant distress and high costs. We conducted the first systematic review and meta-analysis on spontaneous long-term remission rates, i. e., without specific treatment. Data sources were searches of databases, hand searches, and contact with authors. Remission estimates were obtained from observational prospective studies of PTSD without specific treatment. Remission was defined as the actual percentage of PTSD cases at baseline who are non-cases after a minimum of ten months. Forty-two studies with a total of 81,642 participants were included. The mean observation period was 40 months. Across all studies, an average of 44.0% of individuals with PTSD at baseline were non-cases at follow-up. Remission varied between 8 and 89%. In studies with the baseline within the first five months following trauma the remission rate was 51.7% as compared to 36.9% in studies with the baseline later than five months following trauma. Publications on PTSD related to natural disaster reported the highest mean of remission rate (60.0%), whereas those on PTSD related to physical disease reported the lowest mean of remission rate from PTSD (31.4%). When publications on natural disaster were used as a reference group, the only type of traumatic events to differ from natural disaster was physical disease. No other measured predictors were associated with remission from PTSD. Long-term remission from PTSD without specific treatment varies widely and is higher in studies with the baseline within five months following trauma.     

强迫障碍的暴露反应/仪式阻断治疗技术(综述)

强迫障碍是临床上较难治愈的一种神经症。暴露反应∕仪式阻断治疗技术(Exposure and Response/Ritual Prevention,本文简称ERP)目前被证实是一种针对强迫障碍的最为有效的心理治疗方法。本文从ERP心理治疗的定义出发,阐述了ERP治疗强迫障碍的理论基础、操作原则、疗效分析与其他心理治疗方法的比较等,最后对强迫障碍ERP心理治疗目前存在问题和未来研究方向进行了探讨。     

A meta-analytic review of exposure in group cognitive behavioral therapy for posttraumatic stress disorder

Although the efficacy of exposure is well established in individual cognitive behavioral treatments for posttraumatic stress disorder (PTSD), some clinicians and researchers have expressed concerns regarding the use of in-session disclosure of trauma details through imaginal exposure in group cognitive behavioral therapy (GCBT) for PTSD. Thus, the aim of the present study was to conduct a systematic review of the empirical support for GCBT in the treatment of PTSD and to compare GCBT protocols that encourage the disclosure of trauma details via in-session exposure to GCBT protocols that do not include in-session exposure. Randomized controlled trials that assessed the efficacy of GCBT for PTSD were included in the meta-analysis. A total of 651 participants with PTSD were included in the 12 eligible GCBT treatment conditions (5 conditions included in-group exposure, 7 conditions did not include in-group exposure). The overall pre–post effect size of GCBT for PTSD (ES = 1.13 [SE = 0.22, 95% CI: 0.69 to 1.56, p  .001]). suggests that GCBT is an effective intervention for individuals with PTSD. No significant differences in effect sizes were found between GCBT treatments that included in-group exposure and those that did not. Although the attrition rate was higher in treatments that included exposure in-group, this rate is comparable to attrition rates in individual CBT treatments and pharmacotherapy for PTSD. The results from this meta-analysis suggest that concerns about the potentially negative impact of group exposure may be unwarranted, and support the use of exposure-based GCBT as a promising treatment option for PTSD.     

The diagnostic accuracy of the PTSD Checklist: A critical review

The PTSD Checklist (PCL) is the most frequently used self-report measure of PTSD symptoms. Although the PCL has been in use for nearly 20 years and over a dozen validation studies have been conducted, this paper provides the first comprehensive review of its diagnostic utility. Eighteen diagnostic accuracy studies of the PCL are presented, followed by an examination of the potential roles of spectrum effects, bias, and prevalence in understanding the variation in sensitivity, specificity, and other operating characteristics across these studies. Two related issues as to the interchangeability of the PCL's three versions (civilian, military, and specific) and various scoring methods are also discussed. Findings indicate that the PCL has several strengths as a PTSD screening test and suggest that it can be a useful tool when followed by a second-tier diagnostic test such as a standardized interview. However, the PCL's operating characteristics demonstrate significant variation across populations, settings, and research methods and few studies have examined such factors that may moderate the PCL's utility. Recommendations and cautions regarding the use of the PCL as a clinical screening test, a diagnostic tool in research, and as an estimator of PTSD population prevalence are provided.     

Pretrauma risk factors for posttraumatic stress disorder: A systematic review of the literature

As it has become clear that most individuals exposed to trauma do not develop PTSD, it has become increasingly important to examine pretrauma risk factors. However, PTSD research has overwhelmingly relied on retrospective accounts of trauma, which is beleaguered by problems of recall bias. To further our understanding of PTSD's etiology, a systematic review of 54 prospective, longitudinal studies of PTSD published between 1991 and 2013 were examined. Inclusion criteria required that all individuals were assessed both before and after an index trauma. Results revealed six categories of pretrauma predictor variables: 1) cognitive abilities; 2) coping and response styles; 3) personality factors; 4) psychopathology; 5) psychophysiological factors; and 6) social ecological factors. The results indicated that many variables, previously considered outcomes of trauma, are pretrauma risk factors. The review considered these findings in the context of the extant retrospective PTSD literature in order to identify points of overlap and discrepancy. Pretrauma predictor categories were also used to conceptualize variable risk for PTSD. Limitations and directions for future research are discussed.     

Cognitive Behavioural Therapy for anorexia nervosa: A systematic review

Evidence for the effectiveness of psychological therapies for anorexia nervosa (AN) is inconsistent. There have been no systematic reviews solely on the effectiveness for Cognitive Behavioural Therapy (CBT) for AN. This review aimed to synthesise and appraise the recent evidence for CBT as a treatment for AN. Using specific search criteria, 16 relevant articles were identified which evaluated CBT alone or as part of a broader randomised/non-randomised trial. Various formats of CBT were utilised in the reviewed papers. Studies were evaluated using established quality criteria.     

放射性核素治疗的发展和现状

经过几十年的发展,放射性核素治疗已经成为临床重要的治疗手段之一,是核医学的主要组成部分。近年来,核素治疗越来越受到人们的重视。本文将放射性核素治疗的发展和目前常用的核素治疗方法进行了综述。     

治疗创伤后应激障碍的新靶点:内源性大麻素系统

正负面情绪,如焦虑和恐惧会使个体对潜在的危险和伤害刺激保持警觉,从而提高生存能力,但是当个体对这些潜在的危险过度应答时,便会对身心功能造成伤害。创伤后应激障碍(post-traumatic stress disorder,PTSD)是一种个体因为经历或目睹对生命具有威胁性的事件或严重的创伤,从而导致系列精神症状并出现长期持续的精神障碍,是对异乎寻常的威胁性、灾难性事件的延迟和持久的反应。PTSD     

The effects of glucocorticoids on the inhibition of emotional information: A dose-response study

There is evidence that cortisol influences cognitive and affective processes such as selective attention and memory for emotional events, yet the effects of glucocorticoids on attentional inhibition in humans remain unknown. Consequently, this double-blind study examined dose-dependent effects of exogenous glucocorticoids on the inhibition of emotional information. Sixty-three university students (14 male, 49 female) ingested either a placebo pill or hydrocortisone (10 mg or 40 mg), and completed a negative priming task assessing the inhibition of pictures depicting angry, sad, and happy faces. The 10 mg, but not the 40 mg hydrocortisone dose elicited increased inhibition for angry faces relative to placebo. Thus, moderate glucocorticoid elevations may have adaptive effects on emotional information processing, whereas high glucocorticoid elevations appear to attenuate this effect, consistent with the view that there are dose-dependent effects of glucocorticoids on cognition.     

Aspects of Exposure in Childhood Trauma: The Stressor Criterion

SUMMARY

Attention to posttraumatic stress disorder (PTSD) in children has lagged behind the understanding of this disorder in adults. This article provides a brief review related to the stressor criterion of PTSD in children. The stressor criterion for PTSD includes three elements-an event, exposure, and a subjective reaction-each of which is described in the diagnostic criteria for the disorder. A host of stressors, both natural and human-caused, have the potential to evoke symptoms. Exposure can be direct-through, for example, physical presence, direct victimization, and witnessing, or indirect-through, for example, an interpersonal relationship with a direct victim. Exposure to media coverage of an event as a stressor for PTSD has also been examined. The requirement of a subjective reaction to the event is supported by research. A number of factors limit the ability to investigate issues associated with the stressor criterion including difficulty obtaining reliable and valid measures. Future studies should focus on specific aspects of exposure and outcomes, indirect forms of exposure, the clinical significance of findings, and the various factors that influence a child's reaction to trauma.