Yehuda Rachel, Spiegel David, Southwick Steven, Davis Lori L, Neylan Thomas C, Krystal John H
James J. Peters Veterans Affairs, New York, NY, USA.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA;
Eur J Psychotraumatol. 2016 Nov 8;7:33768. doi: 10.3402/ejpt.v7.33768. eCollection 2016.
This paper is based upon a panel discussion held on 5 November in New Orleans, Louisiana (USA), as part of the ISTSS 2015 annual meeting The panel was chaired by Professor Dr. Rachel Yehuda of the Icahn School of Medicine at Mount Sinai and the James J. Peters Veterans Affairs, and included five clinician-scholars who exchanged thoughts about what they have changed their minds about over the years: Dr. David Spiegel, Dr. Steven Southwick, Dr. Lori Davis, Dr. Thomas Neylan, and Dr. John Krystal. This paper provides a summary of the salient points made by each expert and the questions and discussion that ensured. Major issues raised included the increasingly clear limitations to the fear-based model that has advanced the field. While treatments for PTSD have improved, there are some aspects of trauma exposure that cannot be entirely repaired. Research providing an evidence base to treatment has led to overly specific treatment guidelines that may obscure more general principles of effective treatment. Treatment might be viewed as a way to increase the plasticity of the brain in the context of processing social cues. A variety of novel and integrative therapies include comprehensive holistic care, exercise, returning to competitive work, logotherapy, mindfulness, enhancing well-being and resilience, and medications with novel mechanisms, such as ketamine.
本文基于11月5日在美国路易斯安那州新奥尔良市举行的一场小组讨论,该讨论是国际创伤应激研究学会(ISTSS)2015年年会的一部分。该小组由西奈山伊坎医学院及詹姆斯·J·彼得斯退伍军人事务部的瑞秋·耶胡达教授主持,成员包括五位临床医生兼学者,他们就多年来改变想法的事情交流了看法,这五位分别是大卫·斯皮格尔博士、史蒂文·索思威克博士、洛里·戴维斯博士、托马斯·内兰博士和约翰·克里斯托博士。本文总结了每位专家提出的要点以及随之而来的问题和讨论。提出的主要问题包括,推动该领域发展的基于恐惧的模型存在越来越明显的局限性。虽然创伤后应激障碍(PTSD)的治疗方法有所改进,但创伤暴露的某些方面无法完全修复。为治疗提供证据基础的研究导致了过于具体的治疗指南,可能会模糊有效治疗的更一般原则。治疗可被视为在处理社会线索的背景下增加大脑可塑性的一种方式。各种新颖的综合疗法包括全面的整体护理、运动、重返竞争性工作、存在主义心理治疗、正念、增强幸福感和恢复力,以及具有新机制的药物,如氯胺酮。