Robertson Michael, Humphreys Leanne, Ray Rebecca
Mental Health Services, Mayo Healthcare Group, Taree NSW, Australia.
J Psychiatr Pract. 2004 Mar;10(2):106-18. doi: 10.1097/00131746-200403000-00005.
This article reviews available research data supporting the use of psychotherapy in the treatment of posttraumatic stress disorder (PTSD). The authors highlight how this evidence might inform clinical choices in treating PTSD, as well as demonstrating how assumptions based on gaps in the available literature may be misleading. The authors first discuss findings concerning a number of interventions that are commonly used in the treatment of trauma victims or patients with PTSD: critical incident stress debriefing, psychoeducation, exposure therapy, eye movement desensitization reprocessing, stress inoculation therapy, trauma management therapy, cognitive therapy, psychodynamic psychotherapy, and hypnotherapy. They also discuss a number of treatment strategies that have recently been studied in PTSD, including imagery rehearsal, memory structure intervention, interpersonal psychotherapy, and dialectical behavior therapy. PTSD is associated with significant symptomatic morbidity, although desired outcomes in clinical practice are typically related more to reduction in social, interpersonal, and occupational impairment. The most methodologically robust studies, which have typically examined cognitive or behavioral treatments, indicate that psychotherapy helps to relieve symptom severity; however, there is no consistent information about whether these interventions are helpful in improving other domains of impairment and associated disability, even though these problems are often the greatest concern to patients. Nor does the available evidence indicate when, and for whom, various psychotherapeutic interventions should be provided, or whether different modalities of treatment can and should be combined, or sequentially offered, as is often done in specialized treatment programs. Clinicians should keep these issues in mind in reviewing the literature on current (and future) clinical research. Unfortunately, the current evidence base on psychotherapy for PTSD gives only limited guidance concerning clinical choices in managing PTSD. The authors therefore provide some clinical guidelines based on the literature for clinicians treating patients with PTSD.
本文回顾了支持使用心理治疗来治疗创伤后应激障碍（PTSD）的现有研究数据。作者强调了这些证据如何为PTSD的临床治疗选择提供信息，同时也表明基于现有文献空白的假设可能具有误导性。作者首先讨论了一些常用于治疗创伤受害者或PTSD患者的干预措施的研究结果：关键事件应激晤谈、心理教育、暴露疗法、眼动脱敏再处理、压力接种疗法、创伤管理疗法、认知疗法、心理动力心理治疗和催眠疗法。他们还讨论了一些最近在PTSD研究中探讨的治疗策略，包括意象预演、记忆结构干预、人际心理治疗和辩证行为疗法。PTSD与显著的症状性发病率相关，尽管临床实践中的预期结果通常更多地与社会、人际和职业功能障碍的减轻有关。方法学上最严谨的研究，通常考察的是认知或行为治疗，表明心理治疗有助于减轻症状严重程度；然而，对于这些干预措施是否有助于改善其他功能障碍领域和相关残疾，并没有一致的信息，尽管这些问题往往是患者最关心的。现有证据也没有表明应该在何时、针对何人提供各种心理治疗干预措施，或者不同的治疗方式是否可以以及应该像在专门治疗项目中经常做的那样进行联合或序贯提供。临床医生在回顾关于当前（以及未来）临床研究的文献时应牢记这些问题。不幸的是，目前关于PTSD心理治疗的证据基础在指导PTSD的临床管理选择方面提供的指导有限。因此，作者根据文献为治疗PTSD患者的临床医生提供了一些临床指南。
