Weinhold Sara Lena, Göder Robert, Pabst Astrid, Scharff Anna-Lena, Schauer Maggie, Baier Paul Christian, Aldenhoff Josef, Elbert Thomas, Seeck-Hirschner Mareen
Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany.
Department of Psychology, University of Konstanz, Constance, Germany.
J Neural Transm (Vienna). 2017 Feb;124(Suppl 1):99-107. doi: 10.1007/s00702-016-1536-3. Epub 2016 Mar 12.
Most individuals diagnosed with borderline personality disorder (BPD) have been exposed to severe and traumatic stressors and thus frequently present with symptoms of a posttraumatic stress disorder (PTSD). Severe sleep disturbances often accompany these complex cases, but changes of sleep parameters during therapy and the impact of sleep on treatment response have barely been studied. Narrative Exposure Therapy (NET) is an evidence-based approach for the treatment of trauma-related psychological disorders. To investigate the effect of NET on sleep in patients with BPD and comorbid PTSD, we screened 45 inpatients and outpatients who met the inclusion criteria of both diagnoses according to DSM-IV and who had a minimum of 2 weeks' stable medication. Patients were allocated to NET (N = 13) or treatment as usual (TAU; N = 8) in blocks. Polysomnographies and psychological questionares were performed before, directly and 6 months after the last therapy session. The aim of this pilot study was to investigate the effectiveness of trauma therapy by NET on sleep quantity (total sleep time) and sleep continuity (sleep efficiency and awakenings) in patients with comorbid BPD and PTSD. Participants of the NET group compared with those who received TAU showed an increased reduction in sleep latency from baseline to the end of therapy and a reduction in arousals over time. Patients with longer pre-treatment total sleep time and pre-treatment REM sleep duration showed a better outcome of NET with respect to PTSD symptoms. NET seems not lead to a change in sleep for the worse during therapy and seems to improve sleep as good as treatment as usual. Furthermore, our results provide evidence of an influence of sleep structure at baseline on treatment success later on.
大多数被诊断为边缘性人格障碍（BPD）的个体都曾遭受过严重的创伤性应激源，因此经常出现创伤后应激障碍（PTSD）的症状。这些复杂病例常伴有严重的睡眠障碍，但治疗期间睡眠参数的变化以及睡眠对治疗反应的影响几乎未被研究过。叙事暴露疗法（NET）是一种基于证据的治疗创伤相关心理障碍的方法。为了研究NET对BPD合并PTSD患者睡眠的影响，我们筛选了45名住院和门诊患者，他们符合DSM-IV中两种诊断的纳入标准，且至少有2周的稳定用药情况。患者被分组分配到NET组（N = 13）或常规治疗组（TAU；N = 8）。在最后一次治疗前、治疗刚结束时和治疗6个月后进行多导睡眠图检查和心理问卷调查。这项初步研究的目的是调查NET创伤治疗对BPD合并PTSD患者的睡眠量（总睡眠时间）和睡眠连续性（睡眠效率和觉醒次数）的有效性。与接受TAU治疗的患者相比，NET组患者从基线到治疗结束时睡眠潜伏期的缩短幅度更大，且随着时间推移觉醒次数减少。治疗前总睡眠时间较长和治疗前快速眼动睡眠时间较长的患者，在PTSD症状方面NET治疗效果更好。NET在治疗期间似乎不会导致睡眠变差，而且似乎与常规治疗一样能改善睡眠。此外，我们的结果提供了基线睡眠结构对后期治疗成功有影响的证据。
