Institute of Psychology, University of Münster, Münster, Germany ; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
Institute of Psychology, University of Münster, Münster, Germany.
Eur J Psychotraumatol. 2014 Sep 17;5. doi: 10.3402/ejpt.v5.24470. eCollection 2014.
Exposure-based treatment approaches are first-line interventions for patients suffering from posttraumatic stress disorder (PTSD). However, the dissemination of exposure-based treatments for PTSD is challenging, as a large proportion of clinicians report being concerned about symptoms worsening as a result of this type of intervention and are therefore reluctant to offer it to patients with PTSD. However, there is only little empirical evidence to date on the pattern of symptom worsening during exposure-based treatment for PTSD.
The goal of the present study was to explore the frequency of sudden losses and sudden gains in the course of an exposure-based treatment programme for female patients suffering from PTSD related to childhood sexual abuse who also show severe comorbidity. In addition, the relationship between sudden changes and treatment outcome was examined.
Female participants (N=74) were randomised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list. The pattern of symptom change was assessed via weekly assessments using the Posttraumatic Diagnostic Scale (PDS). Sudden changes were computed as suggested by the literature on sudden gains.
During treatment, only one participant (3%) experienced a sudden loss, whereas 25% of participants experienced sudden gains. In the waiting condition, 8% of the participants experienced sudden losses and 5% experienced sudden gains during the same time period. No symptom worsening was observed in response to exposure sessions. However, sudden gains occurred during exposure and non-exposure treatment weeks. Patients with sudden gains showed better treatment outcome in the post-treatment and follow-up assessments.
Exposure-based treatment did not lead to PTSD symptom worsening in the study sample. Results show that sudden gains occur frequently during PTSD treatment and have a prognostic value for treatment outcome.
暴露疗法是治疗创伤后应激障碍（PTSD）患者的一线干预措施。然而，暴露疗法在 PTSD 中的推广具有挑战性，因为很大一部分临床医生报告担心这种类型的干预会导致症状恶化，因此不愿意将其提供给 PTSD 患者。然而，迄今为止，关于 PTSD 暴露治疗过程中症状恶化的模式，仅有很少的经验证据。
本研究的目的是探讨在针对与儿童期性虐待相关的 PTSD 的女性患者的暴露治疗计划中，突然失去和突然获得的频率，这些患者也表现出严重的共病。此外，还研究了突然变化与治疗结果之间的关系。
将 74 名女性参与者随机分配到 12 周的 DBT-PTSD 住院治疗计划或常规治疗等待名单中。使用创伤后诊断量表（PDS）每周评估一次来评估症状变化模式。突然变化是按照关于突然获得的文献建议进行计算的。
在治疗期间，只有一名参与者（3%）经历了突然失去，而 25%的参与者经历了突然获得。在等待治疗期间，同一时期有 8%的参与者经历了突然失去，5%的参与者经历了突然获得。暴露治疗并没有导致 PTSD 症状恶化。然而，在暴露和非暴露治疗周期间，会出现突然获得。突然获得的患者在治疗后和随访评估中表现出更好的治疗结果。
暴露疗法在研究样本中未导致 PTSD 症状恶化。结果表明，在 PTSD 治疗中经常出现突然获得，并且对治疗结果具有预后价值。
