Britvić Dolores, Radelić Natasa, Urlić Ivan
Department of Psychiatry, Split University Hospital and School of Medicine, Split, Croatia.
Croat Med J. 2006 Feb;47(1):76-84.
To assess the effectiveness of the long-term group psychotherapy in the treatment of posttraumatic stress disorder (PTSD) in war veterans on the basis of clinical picture of PTSD, associated neurotic symptoms, and adopted models of psychological defense mechanisms.
Prospective cohort study involved 59 war veterans who participated in dynamic-oriented supportive group psychotherapy for five years. The groups met once a week for 90 minutes. Forty-two veterans finished the program. The Clinician-Administered PTSD Scale structured interview was used to assess the intensity of PTSD. Crown-Crisp Index was used to evaluate other neurotic symptoms, and Life Style Questionnaire was used to assess the defense mechanisms. The assessments were done at the beginning of psychotherapy, after the second, and after the fifth year of treatment. Comorbid diagnoses, hospitalizations, and outpatient clinic treatments were also recorded.
Long-term group psychotherapy reduced the intensity of PTSD symptoms in our patients (the difference between Clinician-Administered PTSD Scale score at the beginning and the end of treatment, F=9.103, P=0.001). Other neurotic symptoms and the characteristic profile of defense mechanisms did not change significantly during the course of treatment. Predominant defense mechanisms were projection (M=82.0-/+14.4) and displacement (M=69.0-/+16.8). None of the symptoms or defense mechanisms present at the beginning of the treatment changed significantly after two or five years of treatment. The number of diagnosed major depressive episodes, which increased after the second year of psychotherapy, decreased by the end of treatment.
Psychotherapy can reduce the intensity of PTSD symptoms, but the changes in the personality of veterans with PTSD are deeply rooted. Traumatic experiences lead to the formation of rigid defense mechanisms, which cannot be significantly changed by long-term group psychotherapy.
基于创伤后应激障碍（PTSD）的临床表现、相关神经症症状以及所采用的心理防御机制模型，评估长期团体心理治疗对战时退伍军人创伤后应激障碍的治疗效果。
前瞻性队列研究纳入了59名参加了为期五年的以动力为导向的支持性团体心理治疗的战时退伍军人。这些团体每周会面一次，每次90分钟。42名退伍军人完成了该项目。使用临床医生管理的PTSD量表结构化访谈来评估PTSD的严重程度。使用皇冠-克里斯普指数来评估其他神经症症状，并使用生活方式问卷来评估防御机制。在心理治疗开始时、治疗的第二年和第五年后进行评估。还记录了共病诊断、住院情况和门诊治疗情况。
长期团体心理治疗降低了我们患者PTSD症状的严重程度（治疗开始和结束时临床医生管理的PTSD量表评分之间的差异，F = 9.103，P = 0.001）。在治疗过程中，其他神经症症状和防御机制的特征性概况没有显著变化。主要的防御机制是投射（M = 82.0±14.4）和转移（M = 69.0±16.8）。治疗开始时出现的症状或防御机制在治疗两年或五年后均无显著变化。在心理治疗第二年增加的诊断为重度抑郁发作的次数在治疗结束时减少了。
心理治疗可以降低PTSD症状的严重程度，但PTSD退伍军人的人格变化根深蒂固。创伤经历导致形成了僵化的防御机制，长期团体心理治疗无法使其发生显著改变。
