创伤后应激障碍的心理治疗:近5年RCT回顾

Psychotherapy of posttraumatic stress disorder: a review of randomized controlled trials in 5 years

创伤后应激障碍(PTSD)是继发于创伤事件的一类精神障碍,其核心症状表现为创伤记忆侵入、躲避创伤相关刺激、认知消极改变、唤醒增强和行为过激等。PTSD与战争密切相关,经历战争的退伍老兵PTSD患病率为10%~13%。PTSD对个体的工作、家庭、亲密关系和社会生活方面的功能损害很大,且持续时间长,其终生患病率为1.3%-12.2%。该文对近5年来PTSD心理治疗的随机对照试验(RCT)研究进行全面综述和归纳,发现与其他传统暴露和非暴露疗法相比,采用延长暴露(PE)疗法治疗PTSD具有一定优势,调整后的PE疗法仍有较好疗效;在与传统治疗PTSD药物的对比试验中,PE表现出不逊于药物的疗效;在与空白对照组的比较中,PE对PTSD症状的缓解具有良好效果。PE是一种有循证依据且疗效显著的PTSD心理治疗方法,可从创新和改善实施方法、治疗前对患者进行评估、开展个性化治疗等方面进一步提高PE的疗效并降低脱落率。

Posttraumatic stress disorder(PTSD) is a mental disorder that occurs after a traumatic event. The core symptoms of PTSD are intrusiveness of traumatic event, avoidance of trauma-related stimulus, negative change of cognition, hypervigilance, and extreme behavior, et al. PTSD is highly relevant to war: The prevalence of PTSD ranged from 10%-13% among veterans who had combat experience. PTSD can severely impair individual function of work, family, intimacy and social life in a long time. The lifetime prevalence of PTSD varies from 1.3% to 12.2%. Therefore, finding effective treatment of PTSD has always been an important field in research. This article has a comprehensive review and summary of randomized control trials focused on PTSD psychotherapies in recent 5 years. The results indicate that: 1) Compared with traditional exposure therapy and non-exposure therapy, prolonged exposure had some advantages in treating PTSD. Modified prolonged exposure(PE) is also effective to PTSD. 2) In trials comparing PE with traditional PTSD drugs, PE was non-inferior to drugs in treatment effect. 3) W hen compared with control group, PE demonstrated considerable outcomes in alleviating PTSD symptoms. In conclusion, PE is an evidently effective psychotherapy for PTSD. Efforts should be made in enhancing therapeutic effect and decrease dropout rate by innovating and improving implements, assessing patients before treatment, and carrying out personalized treatment, et al.