Salcioğlu Ebru, Başoğlu Metin, Livanou Maria
Section of Trauma Studies, Division of Psychological Medicine, Institute of Psychiatry, King's College London, University of London, London SE5 8AF, UK.
Behav Res Ther. 2007 Oct;45(10):2268-79. doi: 10.1016/j.brat.2007.04.012. Epub 2007 May 3.
Although the effectiveness of cognitive-behavioral treatment in posttraumatic stress disorder (PTSD) is well established, few studies examined its effects on individual PTSD symptoms and possible mechanisms of improvement in symptoms. In a previous randomized controlled study [Başog lu, M., Salciog lu, E., Livanou, M., Kalender, D., & Acar, G. (2005). Single-session behavioral treatment of earthquake-related posttraumatic stress disorder: A randomized waitlist controlled trial. Journal of Traumatic Stress, 18, 1-11] a single session of behavioral treatment involving self-exposure instructions was highly effective in reducing earthquake-related PTSD. In the present study we examined the effects of treatment on each PTSD symptom and which symptoms improved early in treatment. Because the intervention focused solely on behavioral avoidance, we hypothesized that avoidance would be the first symptom to change and that reduction in avoidance would generalize to all other symptoms. The results showed significant between-groups treatment effect on only behavioral avoidance early in treatment (week 6). At 6 months post-treatment recovery rates ranged from 60% to 89% for 15 PTSD symptoms, including the numbing symptoms. Lack of improvement in avoidance was associated with lack of improvement in 12 symptoms. The critical process in recovery thus appeared to be increased sense of control associated with reduction in avoidance. These findings imply that live exposure to fear cues designed to enhance sense of control might be sufficient for recovery from PTSD.
尽管认知行为疗法在创伤后应激障碍（PTSD）中的有效性已得到充分证实，但很少有研究考察其对个体PTSD症状的影响以及症状改善的可能机制。在之前的一项随机对照研究中[Başog lu, M., Salciog lu, E., Livanou, M., Kalender, D., & Acar, G.（2005年）。单次行为疗法治疗与地震相关的创伤后应激障碍：一项随机等待名单对照试验。《创伤应激杂志》，18，1 - 11]，包含自我暴露指导的单次行为疗法在减轻与地震相关的PTSD方面非常有效。在本研究中，我们考察了治疗对每种PTSD症状的影响以及哪些症状在治疗早期得到改善。由于干预仅专注于行为回避，我们假设回避将是首先改变的症状，并且回避的减少将推广到所有其他症状。结果显示，在治疗早期（第6周），组间治疗效果仅在行为回避方面显著。治疗后6个月，15种PTSD症状（包括麻木症状）的恢复率在60%至89%之间。回避没有改善与12种症状没有改善相关。因此，恢复的关键过程似乎是与回避减少相关的控制感增强。这些发现意味着，旨在增强控制感的现场暴露于恐惧线索可能足以使PTSD患者康复。
