University of Washington, Department of Psychology, Box 351525, Seattle 98195-1525, USA.
J Behav Ther Exp Psychiatry. 2014 Mar;45(1):97-104. doi: 10.1016/j.jbtep.2013.09.003. Epub 2013 Sep 13.
Clinically, many individuals persist in prolonged exposure therapy (PE) for chronic PTSD despite continuing distress during recounting of the trauma memory (imaginal exposure). Theorists suggest that distress reduction is necessary for successful treatment outcome (e.g., Foa & Kozak, 1986), while others suggest otherwise (e.g., Craske et al., 2008). This study examined clinically reliable changes in distress, relations to broad clinical outcomes, and whether homework adherence affected this relationship.
In 116 patients with PTSD, first to last imaginal exposure sessions' peak and average distress was examined, calculating reliable change in distress. Homework adherence and helpfulness were examined. At post-treatment, PTSD symptoms (re-experiencing, avoidance, hyperarousal), depression, and functioning were examined.
Patients exhibited a lack of reliable change in distress (64.7%) more than a reliable change in distress (35.3%). Although no difference in post-treatment PTSD diagnostic status, individuals experiencing a reliable change in distress reported lower PTSD severity (re-experiencing, hyperarousal), depression, and better functioning. Further, perceived helpfulness of imaginal homework had an indirect effect on this relationship.
This study did not utilize a distress tolerance self-report measure; however, examined self-reported distress during imaginal exposure.
Results are encouraging for clinicians treating PTSD with PE, arguing that lack of reliable change in distress to the trauma memory does not result in treatment failure. Patient "buy in" to homework, rather than amount completed, was related to the process of distress reduction. Results suggest that distress reduction in imaginal exposure is not a key mechanism underlying therapeutic change in PE.
临床上，许多人在创伤记忆（想象暴露）回忆过程中持续感到痛苦，但仍坚持进行长时间暴露疗法（PE）治疗慢性 PTSD。理论家们认为，减少痛苦是治疗成功的必要条件（例如，Foa & Kozak，1986），而另一些人则认为并非如此（例如，Craske 等人，2008）。本研究检查了痛苦的临床可靠变化，与广泛的临床结果的关系，以及家庭作业依从性是否会影响这种关系。
在 116 名 PTSD 患者中，检查了首次到最后一次想象暴露治疗过程中高峰和平均痛苦，计算了痛苦的可靠变化。检查了家庭作业的依从性和有用性。在治疗后，检查了 PTSD 症状（再体验、回避、高度警觉）、抑郁和功能。
患者表现出痛苦的可靠变化不足（64.7%）而不是痛苦的可靠变化（35.3%）。尽管在治疗后 PTSD 诊断状态没有差异，但经历可靠变化的个体报告 PTSD 严重程度（再体验、高度警觉）、抑郁和功能更好。此外，想象家庭作业的感知有用性对这种关系有间接影响。
本研究没有使用痛苦耐受力自我报告测量；然而，在想象暴露期间检查了自我报告的痛苦。
对于使用 PE 治疗 PTSD 的临床医生来说，结果令人鼓舞，表明对创伤记忆的痛苦没有可靠变化不会导致治疗失败。患者对家庭作业的“投入”，而不是完成的数量，与痛苦减轻的过程有关。结果表明，想象暴露中的痛苦减轻不是 PE 中治疗变化的关键机制。
