紧急事件应激晤谈在心理危机干预中的应用

尽管经历了重大创伤后，许多人会出现与创伤相关的症状，但只有极少数发展出急性应激障碍、创伤后应激障碍（PTSD），或两者兼有。多数人会在没有专业人士的帮助下自然康复，但仍有少数人会出现持久的心理问题，因此各种心理危机干预技术逐渐发展出来，紧急事件应激晤谈（Critical Incident Stress Debriefing，CISD）作为一种早期心理危机干预技术至今已有50余年的历史。本文就CISD的起源、组成以及应用进行综述。     

PTSD及其危机干预

创伤后应激障碍 (posttraumaticstressdisorder ,PTSD)是指个体经历威胁生命事件之后出现的一组有特征性和持续存在的症状群 ,并且导致一定社会功能的丧失。本文复习有关PTSD的人群终生患病率、共病问题、以及危机干预及其影响因素。创伤后应激障碍 (PosttraumaticStressDisorder ,PTSD )是指突发性、威胁性或灾难性生活事件导致个体延迟出现和长期持续存在的精神障碍[1] ,其临床表现以再度体验创伤为特征 ,并伴有情绪的易激惹和回避行为[2 ] 。简而言之 ,PTSD是一种创伤后心理失平衡状态。人的心理活动包括感知、情感和意志行为等…     

Ⅰ型糖尿病患儿母亲创伤后应激障碍发病率及影响因素

目的：调查Ⅰ型糖尿病患儿母亲创伤后应激障碍（ PTSD）的发生率及影响因素,识别相关的创伤性压力源。方法：采用自制一般情况调查表、压力源访谈提纲、PTSD平民版筛查问卷（ PCL－C ）、临床用创伤后应激障碍诊断量表（CAPS）,对56例已诊断Ⅰ型糖尿病患儿母亲进行调查评估,依据DSM－IV中PTSD的诊断标准调查PTSD发生率并分析影响因素及压力源情况。结果：用PCL－C筛查PTSD症状阳性率14．29％,CAPS诊断PTSD发病率8．93％。单因素分析显示,母亲婚姻情况、教育程度、患儿性别、病程长短、治疗方式、居住地与PTSD症状发生无关,发现孩子诊断为糖尿病是主要创伤性压力源。结论：Ⅰ型糖尿病患儿母亲存在较高的PTSD发病率,需要早期识别和干预。     

烟台海难援救军人PTSD发生的影响因素分析

目的：了解影响海难援救军人的创伤后应激障碍（PTSD）发生的相关因素,探讨影响其发生的危险因素及其作用。方法：采用PTSD自评量表,症状自评量表（SCL－90）,生活事件理表（LES）,艾森克问卷（EPQ）和自行编制的涉及应激事件强度和人口学等因素的调查表,在海难事件后1个月对参与善后援救军人进行调查,并分析统计其影响PTSD发生的相关因素。结果：PTSD的得分高低与能否获取经济帮助,对上级领导工作方法和善后处理的满意程度,善后处理中打捞和目睹的尸体量呈显著负相关;与生活事件评分,善后处理中抢救幸存者的数量和EPQ的N得分呈显著正相关;PTSD得分与SCL－90总分,总均分,阳性项目数,阳性症状均分,身体化,强迫症状,人际敏感,抑郁,焦虑,敌对,恐怖,偏执,精神病性和附加因子量表分均呈显著正相关,而与阴性症状项目数呈负相关。结论：该海难事件是一强烈的应激事件,PTSD发生率高,LES量表分和EPQ的N量表得分与PTSD严重程度密切相关,可望通过改善上级领导工作方法和善后处理方法,积极争取支持,以降低其发生或减轻其严重程度。     

大学新生领悟社会支持与创伤后应激障碍的关系研究

目的 探讨领悟社会支持与创伤后应激障碍的关系,为心理危机的预防与干预提供依据.方法 用领悟社会支持量表(PSSS)和创伤后应激障碍自评量表(PTSD-SS)对来自5.12地震灾区的237名大学新生进行调查.结果 ①性别、专业在领悟社会支持和PTSD上均无显著差异,②领悟社会支持及其各雏度与PTSD呈显著负相关;③领悟家庭外支持比领悟家庭内支持对PTSD的预测作用更明显.结论 领悟社会支持是PTSD状况的重要影响因素.     

灾难后的心理应激反应和危机干预

本文主要综述了灾难的形成与影响、心理应激反应、心理危机干预和创伤后应激障的干预。     

5·12地震后一般灾区大学生创伤后应激障碍症状调查

目的调查＂5·12＂汶川地震后,一般灾区大学生创伤后应激障碍（post-traumatic stress disorder,PTSD）症状的发生率及其相关因素,为进一步开展大学生的心理咨询与救助提供参考依据。方法以成都某医学院校300名学生为调查对象,采用一般情况调查问卷（自编）、事件影响量表（IES）进行集体施测。结果 PTSD症状的发生率为8.52%（23/270）。经单因素分析与创伤后应激障碍症状相关的影响因素有：震后家人情况（2χ=44.502,P=0.00）、震后亲戚/朋友情况（χ2=44.690,P=0.00）、家乡受灾情况（χ2=47.192,P=0.00）、震后房屋受损状况（χ2=31.193,P=0.00）、震后财产受损状况（χ2=26.433,P=0.00）5个因素。经非条件逐步Log istic回归筛选出创伤后应激障碍症状的影响因素有：震后家人情况（t=4.326,P=0.00）、震后亲戚/朋友情况（t=5.240,P=0.00）、家乡受灾情况（t=-5.805,P=0.00）。结论在灾后重建过程中,一般灾区大学生心理健康状况值得关注,特别是家在重灾区,有家人或亲戚、朋友伤亡的学生更值得关注。     

地震后17个月受灾青少年PTSD及其相关因素

目的：研究地震后17个月受灾青少年创伤后应激障碍（PTSD）的发生率,症状分布及其相关因素。方法：在张北地震震中一所中学随机抽取205名中学生,进行DSM－IV PTSD诊断检查及相关量表的调查。结果：灾后17个月PTSD发生率为9．4％,女性明显高于男性,PTSD症状出现频率较高的有：似乎事件重现的动作或感受（74．5％）,警觉性过高（68．8％）,强烈的生理反应（66．7％）,强烈的心理痛苦和烦恼（63．0％）,及反复闯入的痛苦加忆（60．9％）,出现较少的症状是情感范围有所限制（10．4％）,脱离或觉得他人陌生的感觉（13．5％）。与PTSD发生相关的因素有心理痛苦水平,感受到生命危险程度,受伤程度及女性。结论：地震后青少年PTSD的发生率是9．4％（17个月）,而且PTSD的发生具有可预测性。     

宜宾震后青少年身心状况

目的:考察宜宾震后青少年创伤后应激障碍、抑郁与情绪调节策略等状况及其在性别、年级上的差异,探讨PTSD、抑郁与情绪调节策略三者之间的关系,为创伤后心理危机干预提供依据.方法:采用创伤后应激障碍量表、抑郁量表、情绪调节策略量表,对宜宾震中长宁县321名青少年进行测量.结果:①震后2周,6.50％的青少年有PTSD倾向,4...     

30年后唐山地震所致孤儿创伤后应激障碍现患率调查

目的：调查30年后唐山大地震孤儿创伤后应激障碍（PTSD）的现患率并探讨PTSD的危险因素。方法：应用中国精神障碍分类方案与诊断标准第3版中PTSD诊断标准对260例地震所致孤儿进行诊断;按照有无PTSD分为PTSD组和正常组,比较两组社会人口学资料、地震后急性应激反应、地震后生活状况和目前心理健康状况。用logistic回归分析筛选PTSD的危险因素。结果：260例孤儿中有32例为现患PTSD（12%）。患PTSD的孤儿组SAS（47.8±14.5/40.3±10.3）、SDS（53.0±12.0/45.2±11.7）、SCL-90总分（156.6±65.5/127.9±41.0）高于非PTSD孤儿组（均P〈0.05）。Logistic回归分析筛选出6个PTSD的预测因素,分别为经历地震时的年龄、神经质、内外向、地震发生后强烈的精神痛苦、反复出现噩梦和消极应对方式（OR值分别为4.5、0.2、5.5、3.5、5.4、3.9）。结论：灾难后孤儿幸存者30年后仍有较高PTSD现患率,青少年阶段、地震创伤的严重程度、人格倾向性及应对方式与现患PTSD相关。     

Early predictors of chronic post-traumatic stress disorder in assault survivors

BACKGROUND: Some studies suggest that early psychological treatment is effective in preventing chronic post-traumatic stress disorder (PTSD), but it is as yet unclear how best to identify trauma survivors who need such intervention. This prospective longitudinal study investigated the prognostic validity of acute stress disorder (ASD), of variables derived from a meta-analysis of risk factors for PTSD, and of candidate cognitive and biological variables in predicting chronic PTSD following assault. METHOD: Assault survivors who had been treated for their injuries at a metropolitan Accident and Emergency (A&E) Department were assessed with structured clinical interviews to establish diagnoses of ASD at 2 weeks (n=222) and PTSD at 6 months (n=205) after the assault. Candidate predictors were assessed at 2 weeks. RESULTS: Most predictors significantly predicted PTSD status at follow-up. Multivariate logistic regressions showed that a set of four theory-derived cognitive variables predicted PTSD best (Nagelkerke R2=0.50), followed by the variables from the meta-analysis (Nagelkerke R2=0.37) and ASD (Nagelkerke R2=0.25). When all predictors were considered simultaneously, mental defeat, rumination and prior problems with anxiety or depression were chosen as the best combination of predictors (Nagelkerke R2=0.47). CONCLUSION: Questionnaires measuring mental defeat, rumination and pre-trauma psychological problems may help to identify assault survivors at risk of chronic PTSD.     

Symptoms of posttraumatic stress disorder in patients who have had a myocardial infarction

Symptoms of posttraumatic stress disorder (PTSD) and risk factors for recurrent ischemia were evaluated in 65 survivors of a myocardial infarction (MI) at baseline and 6 months afterward. PTSD patients had more uncontrolled cardiovascular risk factors at baseline. Patients with PTSD (N=14) were offered trauma-focused cognitive-behavior treatment (CBT) plus a nonspecific intervention to improve adherence to medical recommendations. Adherence to aspirin improved in recipients of the nonspecific intervention (N=8); PTSD symptoms and cardiovascular risk improved in patients who received CBT (N=6). PTSD may be a treatable risk factor for poor post-MI outcome. Further research is needed to evaluate treatment options.     

PTSD symptoms associated with the experiences of psychosis and hospitalisation: A review of the literature

There is evidence of high rates of PTSD in people with psychosis, but the influence that symptoms or hospitalisation have on PTSD in individuals with psychosis is less clear. This paper reviewed studies investigating the prevalence of PTSD induced as a result of the experience of psychosis and hospitalisation and factors that might influence its development. The review included 24 studies, published between 1980 and 2011. Studies showed high levels of PTSD resulting from the trauma of symptoms and/or hospitalisation, with prevalence rates for actual PTSD resulting from these traumas varying from 11% to 67%. In line with studies of PTSD related to other traumatic events, there were inconsistent associations between PTSD and severity of positive and negative symptoms, but there were consistent associations between affective symptoms and PTSD. There were also inconsistent associations between hospital experiences and PTSD. Consistent with the general PTSD literature, there was some evidence that psychosis-related PTSD was associated with trauma history. There was also some emerging evidence that psychological variables, such as appraisals and coping style may influence psychosis-related PTSD. The review highlights the need for further research into psychological mechanisms that could increase vulnerability to psychosis-related PTSD and treatment approaches.     

Two subjective factors as moderators between critical incidents and the occurrence of post traumatic stress disorders: Adult attachment and perception of social support

This paper presents the result of a research which investigated the influence of the subjective factors ‘adult attachment style’ and ‘perception of social support’ in the occurrence of post traumatic stress disorders (PTSD) in a population of 544 subjects working for a security company and the Belgian Red Cross. The analysis of the results suggests that ‘adult attachment style’ and ‘perception of social support’ moderate between a critical incident and the occurrence of a PTSD. In other words, these independent variables differentiate between individuals who are more, and who are less prone, to suffer from a PTSD after having experienced a critical incident. The results of this research shed light on subjective risk factors related to PTSD. The findings can also suggest guidelines for the treatment of individuals suffering from a PTSD.     

The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review

This review provides a comprehensive and critical summary of the literature as to the development and maintenance of post-traumatic stress disorder (PTSD) following civilian war trauma and torture. Prevalence rates are reviewed and predictors are discussed in terms of risk factors, protective factors, and factors that maintain PTSD. Most epidemiologically sound studies found relatively low rates of PTSD. There is good evidence of a dose-response relationship between cumulative war trauma and torture and development and maintenance of PTSD. There is also some evidence that female gender and older age are risk factors in development of PTSD. Some refugee variables may exacerbate symptoms of PTSD and contribute to their maintenance. Preparedness for torture, social and family support, and religious beliefs may all be protective against PTSD following war trauma and torture. Applicability of the concept of PTSD to non-western populations and areas for much needed further study are discussed.     

A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents

Post-traumatic stress disorder (PTSD) is a complex and chronic disorder that causes substantial distress and interferes with social and educational functioning. Consequently, identifying the risk factors that make a child more likely to experience traumatic distress is of academic, clinical and social importance. This meta-analysis estimated the population effect sizes of 25 potential risk factors for PTSD in children and adolescents aged 6-18 years across 64 studies (N=32,238). Medium to large effect sizes were shown for many factors relating to subjective experience of the event and post-trauma variables (low social support, peri-trauma fear, perceived life threat, social withdrawal, comorbid psychological problem, poor family functioning, distraction, PTSD at time 1, and thought suppression); whereas pre-trauma variables and more objective measures of the assumed severity of the event generated small to medium effect sizes. This indicates that subjective peri-trauma factors and post-event factors are likely to have a major role in determining whether a child develops PTSD following exposure to a traumatic event. Such factors could potentially be assessed following a potentially traumatic event in order to screen for those most vulnerable to developing PTSD and target treatment efforts accordingly. The findings support the cognitive model of PTSD as a way of understanding its development and guiding interventions to reduce symptoms.     

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.     

Posttraumatic stress in children following acute physical injury.

OBJECTIVE: To prospectively assess the presence of posttraumatic stress disorder (PTSD) in children hospitalized following acute physical injury. The focus was identification of the incidence of PTSD, PTSD symptoms, and exploration of factors associated with development of PTSD symptoms and disorder. METHOD: Forty children ages 8-17 were interviewed approximately 1 month following a serious injury and assessed for PTSD, pretrauma behavior problems, levels of peritraumatic fear, and posttraumatic thought suppression. RESULTS: Twenty-two and a half percent of participants met DSM-IV diagnostic criteria for PTSD; 47.5% met criteria for at least two of the three PTSD symptom clusters. Greater thought suppression was associated with increased symptoms of PTSD, as were the child's peritraumatic fear response and pretrauma internalizing behaviors. CONCLUSIONS: Results suggest that many children who have been hospitalized for physical trauma may be experiencing clinically significant PTSD symptomatology and may benefit from psychological as well as medical intervention.     

A consideration of select pre-trauma factors as key vulnerabilities in PTSD

Posttraumatic stress disorder (PTSD) is a pathological response to a traumatic event. A number of risk and vulnerability factors predicting PTSD development have been identified in the literature. Many of these variables are specific factors occurring during and after exposure to a traumatic event or are not measured prospectively to assess temporal sequence. Recent research, however, has begun to focus on pre-trauma individual differences that could contribute to risk for developing PTSD. The present review proposes that a number of biological and cognitive vulnerability factors place individuals at risk for PTSD development prior to the actual experience of trauma. Accordingly, this review provides a summary of evidence for a select number of these factors as pre-trauma vulnerabilities to PTSD. Included is a discussion of biological factors, including molecular genetic studies of systems regulating serotonin, catecholamines, and glucocorticoids as well as aspects of the neuroendocrine system. Specific cognitive factors are also considered, including intelligence, neuropsychological functioning and cognitive biases such as negative attributional style and appraisals. For each factor, the present review summarizes evidence to date regarding PTSD vulnerability and highlights directions for future research in this area.     

Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia, and depression after motor vehicle accidents? A prospective longitudinal study

The study investigated the power of theoretically derived cognitive variables to predict posttraumatic stress disorder (PTSD), travel phobia, and depression following injury in a motor vehicle accident (MVA). MVA survivors (N = 147) were assessed at the emergency department on the day of their accident and 2 weeks, 1 month, 3 months, and 6 months later. Diagnoses were established with the Structured Clinical Interview for DSM-IV. Predictors included initial symptom severities; variables established as predictors of PTSD in E. J. Ozer, S. R. Best, T. L. Lipsey, and D. S. Weiss's (2003) meta-analysis; and variables derived from cognitive models of PTSD, phobia, and depression. Results of nonparametric multiple regression analyses showed that the cognitive variables predicted subsequent PTSD and depression severities over and above what could be predicted from initial symptom levels. They also showed greater predictive power than the established predictors, although the latter showed similar effect sizes as in the meta-analysis. In addition, the predictors derived from cognitive models of PTSD and depression were disorder-specific. The results support the role of cognitive factors in the maintenance of emotional disorders following trauma.