慢性创伤后应激障碍延长暴露疗法中报告的身体健康症状和社会功能的变化。

Changes in reported physical health symptoms and social function with prolonged exposure therapy for chronic posttraumatic stress disorder.

作者信息

Rauch Sheila A M, Grunfeld Tania E E, Yadin Elna, Cahill Shawn P, Hembree Elizabeth, Foa Edna B

机构信息

Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan 48105, USA.

出版信息

Depress Anxiety. 2009;26(8):732-8. doi: 10.1002/da.20518.

Abstract

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with significant health risk, illness, and functional impairment, e.g., Green and Kimerling [2004: Physical Health Consequences of Exposure to Extreme Stress. Washington, DC: American Psychological Association] Kimerling et al. [2000: Trauma and Health: J Trauma Stress 13:115-128].

METHODS

These analyses examined whether negative health perceptions and general social functioning change with treatment of chronic PTSD among women from a randomized controlled study comparing prolonged exposure (PE; n=48) or PE combined with cognitive restructuring (PE/CR; n=40) to waitlist (n=19; Foa et al., 2005: J Consult Clin Psychol 73:953-964].

RESULTS

Self- reported physical health difficulties were significantly reduced in the PE and PE/CR conditions compared to the waitlist condition. These reductions did not demonstrate significant change during the 12 month follow-up period. Self-reported discomfort associated with physical health difficulties did not demonstrate significant change over treatment. No difference was detected between the active treatment and waitlist conditions. Both the PE and PE/CR groups reported improved social functioning at post treatment compared to the waitlist. Additional improvement in general social functioning was found between 3 and 12 month follow-up assessments. Changes in PTSD and depressive symptoms over treatment accounted for 29% of the variance in reduction of reported health problems and 30% of the variance in improvement of general social functioning. Importantly, only changes in PTSD symptoms significantly contribute to the model predicting change in physical health problems with depression associated only at a trend level. However, collinearity between PTSD and depression makes interpretation difficult.

CONCLUSIONS

Negative health perceptions and general social function improve with PE. Changes in depression and PTSD with treatment are related to these changes.

摘要

背景

创伤后应激障碍(PTSD)与重大健康风险、疾病及功能损害相关,例如,格林和基默林[2004年:《极端压力暴露对身体健康的影响》。华盛顿特区:美国心理学会];基默林等人[2000年:《创伤与健康:创伤应激杂志》13卷:第115 - 128页]。

方法

这些分析检验了在一项随机对照研究中,对于患有慢性创伤后应激障碍的女性,消极健康认知和一般社会功能在接受延长暴露疗法(PE;n = 48)或PE联合认知重建疗法(PE/CR;n = 40)与等待名单(n = 19;福阿等人,2005年:《咨询与临床心理学杂志》73卷:第953 - 964页)相比的治疗后是否发生变化。

结果

与等待名单组相比,PE组和PE/CR组自我报告的身体健康困难显著减少。这些减少在12个月的随访期内未显示出显著变化。与身体健康困难相关的自我报告不适在治疗过程中未显示出显著变化。在积极治疗组和等待名单组之间未检测到差异。与等待名单组相比,PE组和PE/CR组在治疗后均报告社会功能有所改善。在3至12个月的随访评估中发现一般社会功能有进一步改善。治疗过程中PTSD和抑郁症状的变化分别解释了报告的健康问题减少方差的29%和一般社会功能改善方差的30%。重要的是,只有PTSD症状的变化显著促成了预测身体健康问题变化的模型,抑郁仅在趋势水平上相关。然而,PTSD和抑郁之间的共线性使得解释困难。

结论

消极健康认知和一般社会功能通过PE得到改善。治疗中抑郁和PTSD的变化与这些改变相关。

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