Doron-LaMarca Susan, Niles Barbara L, King Daniel W, King Lynda A, Pless Kaiser Anica, Lyons Michael J
Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine, Boston, Massachusetts, USA.
National Center for PTSD, VA Boston Healthcare System, Department of Psychology, Boston University, and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.
J Trauma Stress. 2015 Oct;28(5):410-7. doi: 10.1002/jts.22039. Epub 2015 Sep 14.
The present study examined fluctuation over time in symptoms of posttraumatic stress disorder (PTSD) among 34 combat veterans (28 with diagnosed PTSD, 6 with subclinical symptoms) assessed every 2 weeks for up to 2 years (range of assessments = 13-52). Temporal relationships were examined among four PTSD symptom clusters (reexperiencing, avoidance, emotional numbing, and hyperarousal) with particular attention to the influence of hyperarousal. Multilevel cross-lagged random coefficients autoregression for intensive time series data analyses were used to model symptom fluctuation decades after combat experiences. As anticipated, hyperarousal predicted subsequent fluctuations in the 3 other PTSD symptom clusters (reexperiencing, avoidance, emotional numbing) at subsequent 2-week intervals (rs = .45, .36, and .40, respectively). Additionally, emotional numbing influenced later reexperiencing and avoidance, and reexperiencing influenced later hyperarousal (rs = .44, .40, and .34, respectively). These findings underscore the important influence of hyperarousal. Furthermore, results indicate a bidirectional relationship between hyperarousal and reexperiencing as well as a possible chaining of symptoms (hyperarousal → emotional numbing → reexperiencing → hyperarousal) and establish potential internal, intrapersonal mechanisms for the maintenance of persistent PTSD symptoms. Results suggested that clinical interventions targeting hyperarousal and emotional numbing symptoms may hold promise for PTSD of long duration.
本研究调查了34名退伍军人创伤后应激障碍（PTSD）症状随时间的波动情况。这些退伍军人每两周接受一次评估，为期两年（评估次数范围为13 - 52次），其中28人被诊断患有PTSD，6人有亚临床症状。研究考察了四个PTSD症状群（重新体验、回避、情感麻木和过度警觉）之间的时间关系，特别关注过度警觉的影响。采用多水平交叉滞后随机系数自回归模型对密集时间序列数据分析，以模拟战斗经历数十年后的症状波动。正如预期的那样，过度警觉预测了随后其他三个PTSD症状群（重新体验、回避、情感麻木）在随后两周间隔的波动（相关系数分别为0.45、0.36和0.40）。此外，情感麻木影响了后来的重新体验和回避，重新体验影响了后来的过度警觉（相关系数分别为0.44、0.40和0.34）。这些发现强调了过度警觉的重要影响。此外，结果表明过度警觉和重新体验之间存在双向关系，以及可能的症状连锁反应（过度警觉→情感麻木→重新体验→过度警觉），并确立了持续PTSD症状维持的潜在内部、个人内部机制。结果表明，针对过度警觉和情感麻木症状的临床干预可能对长期PTSD有前景。
