De Jongh Ad, Resick Patricia A, Zoellner Lori A, van Minnen Agnes, Lee Christopher W, Monson Candice M, Foa Edna B, Wheeler Kathleen, Broeke Erik ten, Feeny Norah, Rauch Sheila A M, Chard Kathleen M, Mueser Kim T, Sloan Denise M, van der Gaag Mark, Rothbaum Barbara Olasov, Neuner Frank, de Roos Carlijn, Hehenkamp Lieve M J, Rosner Rita, Bicanic Iva A E
Department of Social Dentistry (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
School of Health Sciences, Salford University, Manchester, United Kingdom.
Depress Anxiety. 2016 May;33(5):359-69. doi: 10.1002/da.22469. Epub 2016 Feb 3.
According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused treatment. The purpose of this paper is to critically evaluate the research underlying these treatment guidelines for cPTSD, and to specifically address the question as to whether a phase-based approach is needed. As reviewed in this paper, the research supporting the need for phase-based treatment for individuals with cPTSD is methodologically limited. Further, there is no rigorous research to support the views that: (1) a phase-based approach is necessary for positive treatment outcomes for adults with cPTSD, (2) front-line trauma-focused treatments have unacceptable risks or that adults with cPTSD do not respond to them, and (3) adults with cPTSD profit significantly more from trauma-focused treatments when preceded by a stabilization phase. The current treatment guidelines for cPTSD may therefore be too conservative, risking that patients are denied or delayed in receiving conventional evidence-based treatments from which they might profit.
根据当前复杂创伤后应激障碍（cPTSD）的治疗指南，针对患有cPTSD的成年人的心理治疗应从“稳定阶段”开始。该阶段着重于教授自我调节策略，旨在确保个体能够更好地耐受以创伤为重点的治疗。本文的目的是批判性地评估这些cPTSD治疗指南背后的研究，并具体探讨是否需要采用分阶段方法的问题。如本文所综述的，支持对患有cPTSD的个体采用分阶段治疗的研究在方法上存在局限性。此外，没有严格的研究支持以下观点：（1）分阶段方法对于患有cPTSD的成年人取得积极治疗效果是必要的；（2）一线以创伤为重点的治疗存在不可接受的风险，或者患有cPTSD的成年人对这些治疗没有反应；（3）患有cPTSD的成年人在经历稳定阶段后，从以创伤为重点的治疗中获益显著更多。因此，当前的cPTSD治疗指南可能过于保守，存在患者被拒绝或延迟接受他们可能从中获益的传统循证治疗的风险。
