Hayes Adele M, Yasinski Carly, Grasso Damion, Ready C Beth, Alpert Elizabeth, McCauley Thomas, Webb Charles, Deblinger Esther
University of Delaware.
University of Delaware.
Behav Ther. 2017 Mar;48(2):166-181. doi: 10.1016/j.beth.2016.06.004. Epub 2016 Jun 25.
Although there is substantial evidence to support the efficacy of cognitive-behavioral treatments (CBT) for posttraumatic stress disorder (PTSD), there is some debate about how these treatments have their effects. Modern learning theory and cognitive and emotional processing theories highlight the importance of reducing avoidance, facilitating the constructive processing of feared experiences, and strengthening new inhibitory learning. We examined variables thought to be associated with unproductive and constructive processing of traumatic experiences in a sample of 81 youth with elevated PTSD symptoms, who received Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for abuse or traumatic interpersonal loss. Sessions during the trauma narrative phase of TF-CBT were coded for indicators of unproductive processing (overgeneralization, rumination, avoidance) and constructive processing (decentering, accommodation of corrective information), as well as levels of negative emotion. In previous analyses of this trial (Ready et al., 2015), more overgeneralization during the narrative phase predicted less improvement in internalizing symptoms at posttreatment and a worsening of externalizing symptoms over the 12-month follow-up. In contrast, more accommodation predicted improvement in internalizing symptoms and also moderated the negative effects of overgeneralization on internalizing and externalizing symptoms. The current study examined correlates of overgeneralization and accommodation. Overgeneralization was associated with more rumination, less decentering, and more negative emotion, suggesting immersion in trauma-related material. Accommodation was associated with less avoidance and more decentering, suggesting a healthy distance from trauma-related material that might allow for processing and cognitive change. Decentering also predicted improvement in externalizing symptoms at posttreatment. Rumination and avoidance showed important associations with overgeneralization and accommodation, respectively, but did not predict treatment outcomes. This study identifies correlates of overgeneralization and accommodation that might shed light on how these variables relate to unproductive and constructive processing of traumatic experiences.
尽管有大量证据支持认知行为疗法（CBT）对创伤后应激障碍（PTSD）的疗效，但对于这些疗法如何产生效果仍存在一些争议。现代学习理论以及认知与情绪加工理论强调了减少回避、促进对恐惧经历的建设性加工以及加强新的抑制性学习的重要性。我们在81名PTSD症状严重的青少年样本中，研究了被认为与创伤经历的无效加工和建设性加工相关的变量，这些青少年因遭受虐待或人际创伤性丧失而接受了以创伤为焦点的认知行为疗法（TF-CBT）。对TF-CBT创伤叙事阶段的疗程进行编码，以确定无效加工（过度概括、反复思考、回避）和建设性加工（去中心化、接受纠正信息）的指标，以及负面情绪水平。在该试验之前的分析中（Ready等人，2015年），叙事阶段更多的过度概括预示着治疗后内化症状改善较少，且在12个月的随访期间外化症状会恶化。相比之下，更多的接受预示着内化症状的改善，并且还缓和了过度概括对内化和外化症状的负面影响。当前的研究考察了过度概括和接受的相关因素。过度概括与更多的反复思考、更少的去中心化以及更多的负面情绪相关，表明沉浸于与创伤相关的材料中。接受与更少的回避和更多的去中心化相关，表明与创伤相关材料保持健康的距离，这可能有助于进行加工和认知改变。去中心化还预示着治疗后外化症状的改善。反复思考和回避分别与过度概括和接受显示出重要关联，但并未预测治疗结果。本研究确定了过度概括和接受的相关因素，这可能有助于阐明这些变量与创伤经历的无效加工和建设性加工之间的关系。
