From Harvard Medical School; Massachusetts General Hospital (Drs. Charney, Bui, and Simon).
Harv Rev Psychiatry. 2018 May/Jun;26(3):99-115. doi: 10.1097/HRP.0000000000000186.
After participating in this activity, learners should be better able to:• Evaluate psychotherapeutic and pharmacologic approaches to treating patients with posttraumatic stress disorder.
A strong evidence base exists for psychological and pharmacological interventions for the treatment of posttraumatic stress disorder (PTSD). The published literature investigating the effectiveness of these treatments in reducing the symptoms and impairments associated with PTSD has expanded substantially in recent years. This review provides a concise overview of the empirical literature examining these treatment approaches. Evidence-based, trauma-focused therapies are recommended as first-line interventions, with the most support for cognitive- and exposure-based approaches. Prolonged exposure and cognitive processing therapy are the two most cited and rigorously investigated. Various other evidence-supported protocols are discussed. Pharmacotherapies can be used when evidence-based psychotherapies are not available or are ineffective, or on the basis of patient preference. Pharmacotherapy with the most support for PTSD includes selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Evidence supports the implementation of these interventions across genders, populations, and settings. Given that little research directly compares the effectiveness of different PTSD interventions and their mechanisms of action, it remains uncertain how to best select and tailor treatments to optimize individual outcomes. Future directions and novel, ongoing research are discussed.
在参与此活动后,学习者应能够更好地:
有大量证据表明心理和药物干预措施可有效治疗创伤后应激障碍(PTSD)。近年来,大量研究调查了这些治疗方法在减轻 PTSD 相关症状和损害方面的有效性。本综述简要概述了考察这些治疗方法的实证文献。推荐以循证为基础、以创伤为重点的疗法作为一线干预措施,最支持认知和暴露疗法。其中,暴露疗法和认知加工疗法是最常被引用和严格研究的两种疗法。还讨论了其他几种有证据支持的方案。当循证心理疗法不可用或无效时,或基于患者的偏好,可使用药物疗法。最支持 PTSD 治疗的药物疗法包括选择性 5-羟色胺再摄取抑制剂和 5-羟色胺-去甲肾上腺素再摄取抑制剂。有证据表明,这些干预措施可以在不同性别、人群和环境中实施。鉴于很少有研究直接比较不同 PTSD 干预措施的有效性及其作用机制,因此仍不确定如何最好地选择和定制治疗方案以优化个体结果。讨论了未来的方向和正在进行的新研究。