McFarlane A C
Flinders University of South Australia, Bedford Park.
Br J Med Psychol. 1989 Mar;62(1):81-90. doi: 10.1111/j.2044-8341.1989.tb02813.x.
This report reviews treatment studies of post-traumatic stress disorder (PTSD). Much of the literature is descriptive and concentrates on particular treatment modalities without attempting to integrate these different approaches into the wider body of knowledge about PTSD. No study has randomly assigned patients to experimental and control groups. The treatment of 56 patients with PTSD is described, highlighting issues which influence the choice of approach and focus of therapy. These issues are seldom mentioned in the PTSD literature and include the unusual difficulties involved in developing a therapeutic alliance, the role of non-specific elements and the treatment of coexistent psychiatric disorders which are frequently present. The need to consider separately the degree of disturbed attention and arousal, the nature of the traumatic preoccupation and the patient's social and occupational functioning are stressed. The lack of knowledge about the natural history of PTSD and the different effectiveness of treatments in the acute and chronic stages are other uncertainties about the treatment of PTSD. Consideration of these points has led to a series of recommendations for future studies of the treatment of PTSD.
本报告回顾了创伤后应激障碍（PTSD）的治疗研究。大部分文献都是描述性的，专注于特定的治疗方式，而没有尝试将这些不同的方法整合到关于PTSD的更广泛知识体系中。没有研究将患者随机分配到实验组和对照组。本文描述了56例PTSD患者的治疗情况，突出了影响治疗方法选择和治疗重点的问题。这些问题在PTSD文献中很少被提及，包括建立治疗联盟所涉及的特殊困难、非特异性因素的作用以及经常出现的共病精神障碍的治疗。强调了需要分别考虑注意力和觉醒障碍的程度、创伤性专注的性质以及患者的社会和职业功能。关于PTSD自然病程的知识匮乏以及治疗在急性期和慢性期的不同效果，是PTSD治疗的其他不确定性因素。对这些要点的考虑导致了一系列关于PTSD未来治疗研究的建议。
