创伤认知与创伤后应激障碍认知行为治疗 10 年后的症状有关。
Trauma cognitions are related to symptoms up to 10 years after cognitive behavioral treatment for posttraumatic stress disorder.
机构信息
Department of Psychology, California State University.
National Center for PTSD, VA Boston Healthcare System.
出版信息
Psychol Trauma. 2017 Nov;9(6):750-757. doi: 10.1037/tra0000258. Epub 2017 Feb 9.
OBJECTIVES
This study examined (a) relationships between trauma-related cognitions and posttraumatic stress disorder (PTSD) symptoms from pretreatment through a long-term period after cognitive-behavioral therapy (CBT) for PTSD and (b) whether these relationships were impacted by treatment type.
METHOD
Participants were 171 women randomized into treatment for PTSD after rape. Measures of self-reported trauma-related cognitions and interviewer-assessed PTSD symptoms (i.e., Posttraumatic Maladaptive Beliefs Scale, Trauma-Related Guilt Inventory, and Clinician-Administered PTSD Scale) were obtained at pretreatment, posttreatment, and 3-month, 9-month, and 5-10 year follow-ups. Multilevel regression analyses were used to examine relationships between trauma-related cognitions and PTSD symptoms throughout the study period and whether these relationships differed as a function of treatment type (i.e., Cognitive Processing Therapy or Prolonged Exposure).
RESULTS
Initial multilevel regression analyses that examined mean within-participant associations suggested that beliefs regarding Reliability and Trustworthiness of Others, Self-Worth and Judgment, Threat of Harm, and Guilt were related to PTSD symptoms throughout follow-up. Growth curve modeling suggested that patterns of belief change throughout follow-up were similar to those previously observed in PTSD symptoms over the same time period. Finally, multilevel mediation analyses that incorporated time further suggested that change in beliefs was related to change in symptoms throughout follow-up. With 1 minor exception, relationships between beliefs and symptoms were not moderated by treatment type.
CONCLUSIONS
These data suggest that trauma-related cognitions are a potential mechanism for long-term maintenance of treatment gains after CBT for PTSD. Moreover, these cognitions may be a common, rather than specific, treatment maintenance mechanism. (PsycINFO Database Record
目的
本研究考察了（a）创伤相关认知与创伤后应激障碍（PTSD）症状之间的关系，这些关系从治疗前一直持续到认知行为疗法（CBT）治疗 PTSD 后的长期随访期，以及（b）这些关系是否受治疗类型的影响。
方法
171 名因强奸而接受 PTSD 治疗的女性被随机分为两组。在治疗前、治疗后以及 3 个月、9 个月和 5-10 年随访时，采用自我报告的创伤相关认知和访谈者评估的 PTSD 症状（即创伤后适应不良信念量表、创伤相关内疚量表和临床医生管理的 PTSD 量表）进行测量。采用多层回归分析来检验整个研究期间创伤相关认知与 PTSD 症状之间的关系，以及这些关系是否因治疗类型（即认知加工疗法或延长暴露疗法）而异。
结果
最初的多层回归分析检验了参与者内平均关联，结果表明，对他人的可靠性和可信度、自我价值和判断、伤害威胁和内疚的信念与随访期间的 PTSD 症状相关。增长曲线模型表明，随访期间信念变化的模式与 PTSD 症状在同一时期的变化模式相似。最后，纳入时间的多层中介分析进一步表明，信念的变化与整个随访期间症状的变化有关。只有 1 个小例外，信念与症状之间的关系不受治疗类型的调节。
结论
这些数据表明，创伤相关认知是 PTSD 认知行为治疗后长期维持治疗效果的潜在机制。此外，这些认知可能是一种共同的，而不是特定的，治疗维持机制。
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