National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System Boston, Massachusetts 02130, USA.
Depress Anxiety. 2012 Aug;29(8):718-30. doi: 10.1002/da.21938. Epub 2012 Mar 30.
This secondary analysis of data from a randomized controlled trial of cognitive processing therapy (CPT) and its constituent components investigated whether dissociation decreased over the course of treatment primarily targeting symptoms of posttraumatic stress disorder (PTSD) and explored whether levels of dissociation predicted treatment outcome differentially by treatment condition.
An intention to treat sample of 150 women were randomized to CPT, cognitive therapy only (CPT-C) or written trauma accounts only (WA). Dissociation was measured by the dissociation subscale of the Traumatic Stress Inventory and the Multiscale Dissociation Inventory.
Multilevel regression analyses revealed significant decreases in dissociation that did not vary as a function of treatment condition. Growth curve modeling revealed significant treatment condition by dissociation interactions such that the impact of pretreatment levels of dissociation impacted the treatment conditions differently.
Women who endorsed low pretreatment levels of dissociation responded most efficiently to CPT-C, whereas women with the highest levels of dissociation, in particular high levels of depersonalization, responded better to CPT.
本研究对认知加工疗法（CPT）及其组成部分的随机对照试验数据进行了二次分析，旨在探讨在主要针对创伤后应激障碍（PTSD）症状的治疗过程中，是否会出现解离症状的减少，并探讨解离水平是否会通过治疗条件的不同而对治疗结果产生不同的预测作用。
本研究采用意向治疗样本，共有 150 名女性被随机分配到 CPT、仅认知疗法（CPT-C）或仅书面创伤报告组（WA）。采用创伤应激量表的解离分量表和多尺度解离量表来测量解离。
多水平回归分析显示，解离症状显著下降，且与治疗条件无关。增长曲线模型显示，治疗条件与解离的交互作用显著，即治疗前解离水平的高低对不同的治疗条件有不同的影响。
在治疗前解离水平较低的女性对 CPT-C 的反应最有效，而解离水平较高的女性，特别是人格解体水平较高的女性，对 CPT 的反应更好。
