Bachem Rahel, Maercker Andreas
a Department of Psychology , University of Zurich , Zurich , Switzerland.
Cogn Behav Ther. 2016 Sep;45(5):397-413. doi: 10.1080/16506073.2016.1191083. Epub 2016 Jun 14.
Adjustment disorders (AjD) are among the most frequent mental disorders yet often remain untreated. The high prevalence, comparatively mild symptom impairment, and transient nature make AjD a promising target for low-threshold self-help interventions. Bibliotherapy represents a potential treatment for AjD problems. This study investigates the effectiveness of a cognitive behavioral self-help manual specifically directed at alleviating AjD symptoms in a homogenous sample of burglary victims. Participants with clinical or subclinical AjD symptoms following experience of burglary were randomized to an intervention group (n = 30) or waiting-list control group (n = 24). The new explicit stress response syndrome model for diagnosing AjD was applied. Participants received no therapist support and assessments took place at baseline, after the one-month intervention, and at three-month follow-up. Based on completer analyses, group by time interactions indicated that the intervention group showed more improvement in AjD symptoms of preoccupation and in post-traumatic stress symptoms. Post-intervention between-group effect sizes ranged from Cohen's d = .17 to .67 and the proportion of participants showing reliable change was consistently higher in the intervention group than in the control group. Engagement with the self-help manual was high: 87% of participants had worked through at least half the manual. This is the first published RCT of a bibliotherapeutic self-help intervention for AjD problems. The findings provide evidence that a low-threshold self-help intervention without therapist contact is a feasible and effective treatment for symptoms of AjD.
适应障碍(AjD)是最常见的精神障碍之一,但往往未得到治疗。其高患病率、相对较轻的症状损害以及短暂性,使AjD成为低门槛自助干预的一个有前景的目标。阅读疗法是治疗AjD问题的一种潜在方法。本研究调查了一本认知行为自助手册在减轻入室盗窃受害者同质样本中AjD症状方面的有效性。经历入室盗窃后出现临床或亚临床AjD症状的参与者被随机分为干预组(n = 30)或等待名单对照组(n = 24)。应用了用于诊断AjD的新的明确应激反应综合征模型。参与者未接受治疗师支持,评估在基线、为期一个月的干预后以及三个月随访时进行。基于完整分析,组间与时间的交互作用表明,干预组在专注的AjD症状和创伤后应激症状方面有更大改善。干预后组间效应量范围为Cohen's d = 0.17至0.67,且干预组中显示出可靠变化的参与者比例始终高于对照组。对手册的参与度很高:87%的参与者完成了至少一半的手册内容。这是首次发表的关于针对AjD问题的阅读疗法自助干预的随机对照试验。研究结果提供了证据,表明一种无需治疗师接触的低门槛自助干预对于AjD症状是一种可行且有效的治疗方法。