Echiverri Aileen M, Jaeger Jeff J, Chen Jessica A, Moore Sally A, Zoellner Lori A
University of Washington, Seattle.
Cogn Behav Pract. 2011 Aug;18(3):338-349. doi: 10.1016/j.cbpra.2010.05.008.
Prolonged exposure, a cognitive behavioral therapy including both in vivo and imaginal exposure to the traumatic memory, is one of several empirically supported treatments for chronic posttraumatic stress disorder (PTSD). In this article, we provide a case illustration in which this well-validated treatment did not yield expected clinical gains for a client with PTSD and co-occurring major depression. After providing an overview of the literature, theory, and treatment protocol, we discuss the clinical cascade effect that underlying ruminative processes had on the treatment of this case. Specifically, we highlight how ruminative processes, focusing on trying to understand why the traumatic event happened and why the client was still suffering, resulted in profound emotional distress in session and in a lack of an "optimal dose" of exposure during treatment.
延长暴露疗法是一种认知行为疗法，包括对创伤记忆进行现场暴露和想象暴露，是几种经实证支持的慢性创伤后应激障碍（PTSD）治疗方法之一。在本文中，我们提供了一个案例说明，在这个案例中，这种经过充分验证的治疗方法对一名患有PTSD并伴有重度抑郁症的患者并未产生预期的临床效果。在概述了相关文献、理论和治疗方案后，我们讨论了潜在的反刍过程对该病例治疗产生的临床级联效应。具体而言，我们强调了反刍过程如何聚焦于试图理解创伤事件为何发生以及患者为何仍在受苦，从而在治疗过程中导致了深刻的情绪困扰，并导致治疗期间缺乏“最佳剂量”的暴露。
