Neuner Frank, Onyut Patience Lamaro, Ertl Verena, Odenwald Michael, Schauer Elisabeth, Elbert Thomas
Department of Clinical Psychology, University of Konstanz, Konstanz, Germany.
J Consult Clin Psychol. 2008 Aug;76(4):686-94. doi: 10.1037/0022-006X.76.4.686.
Traumatic stress due to conflict and war causes major mental health problems in many resource-poor countries. The objective of this study was to examine whether trained lay counselors can carry out effective treatment of posttraumatic stress disorder (PTSD) in a refugee settlement. In a randomized controlled dissemination trial in Uganda with 277 Rwandan and Somalian refugees who were diagnosed with PTSD the authors investigated the effectiveness of psychotherapy administered by lay counselors. Strictly manualized narrative exposure therapy (NET) was compared with more flexible trauma counseling (TC) and a no-treatment monitoring group (MG). Fewer participants (4%) dropped out of NET treatment than TC (21%). Both active treatment groups were statistically and clinically superior to MG on PTSD symptoms and physical health but did not differ from each other. At follow-up, a PTSD diagnosis could not be established anymore in 70% of NET and 65% TC participants, whereas only 37% in MG did not meet PTSD criteria anymore. Short-term psychotherapy carried out by lay counselors with limited training can be effective to treat war-related PTSD in a refugee settlement.
冲突和战争造成的创伤性应激在许多资源匮乏国家引发了严重的心理健康问题。本研究的目的是检验经过培训的非专业咨询师能否在难民安置点对创伤后应激障碍（PTSD）进行有效治疗。在乌干达开展的一项随机对照推广试验中，作者对277名被诊断患有PTSD的卢旺达和索马里难民进行研究，调查了非专业咨询师实施心理治疗的有效性。将严格按照手册进行的叙事暴露疗法（NET）与更灵活的创伤咨询（TC）以及无治疗监测组（MG）进行比较。退出NET治疗的参与者（4%）比退出TC治疗（21%）的更少。两个积极治疗组在PTSD症状和身体健康方面在统计学和临床上均优于MG组，但两组之间没有差异。在随访时，70%接受NET治疗和65%接受TC治疗的参与者不再符合PTSD诊断标准，而在MG组中只有37%不再符合PTSD标准。由训练有限的非专业咨询师开展的短期心理治疗对于治疗难民安置点与战争相关的PTSD是有效的。
