California State University, Department of Advanced Studies in Education and Counseling, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840-2201, United States.
University of California, Santa Barbara, CA, United States.
J Affect Disord. 2019 Feb 15;245:617-625. doi: 10.1016/j.jad.2018.11.060. Epub 2018 Nov 5.
Although considerable research has tested evidence-based practices in clinical trials, research is needed on the use of trauma-focused treatments by victims of crime and violence in naturalistic settings. This study investigated four trauma-focused treatments, prolonged exposure therapy (PE), cognitive behavioral therapy (CBT), eclectic therapy, and person-centered therapy (PCT), and assessed treatment dropout and symptom improvement over five assessment time-points.
Descriptive comparisons and pattern mixture multigroup growth models were used to assess differences between treatments on time in treatment, rate of dropout, and improvement in posttraumatic stress (PTSD) and depression symptoms in an outpatient sample of 526 clients seeking routine clinical care.
PCT was significantly associated with the highest number of therapy sessions completed and the lowest rate of dropout (41.75%) compared to CBT and eclectic treatments. All treatment groups reported PTSD symptom improvement with no significant differences based on therapy type. For depression, the rate of improvement for clients in PCT who dropped out of treatment after session 3 was significantly steeper than the rate of improvement for clients in eclectic treatment who dropped out of treatment after session 3. Clients who stayed in treatment longer generally had larger decreases in symptoms compared to those who dropped out earlier.
The small sample size in each of the treatment groups may have limited power to detect change.
Several trauma-focused treatments offered in a community-based setting may result in significant symptomatic improvement.
尽管大量研究已经在临床试验中检验了基于证据的实践，但仍需要研究犯罪和暴力行为受害者在自然环境中使用创伤聚焦治疗的情况。本研究调查了四种创伤聚焦治疗方法，即延长暴露疗法（PE）、认知行为疗法（CBT）、折衷疗法和以人为中心疗法（PCT），并评估了在五个评估时间点上的治疗脱落率和症状改善情况。
采用描述性比较和模式混合多组增长模型，评估了在寻求常规临床护理的 526 名门诊患者中，不同治疗方法在治疗时间、脱落率以及创伤后应激障碍（PTSD）和抑郁症状改善方面的差异。
与 CBT 和折衷疗法相比，PCT 完成的治疗次数最多，脱落率最低（41.75%）。所有治疗组均报告 PTSD 症状有所改善，但基于治疗类型没有显著差异。对于抑郁，在第 3 次治疗后退出治疗的 PCT 患者的改善率明显高于在第 3 次治疗后退出治疗的折衷治疗患者的改善率。与早期脱落的患者相比，治疗时间较长的患者的症状通常会有较大幅度的下降。
每个治疗组的样本量都较小，可能会限制检测变化的能力。
在社区环境中提供的几种创伤聚焦治疗方法可能会导致显著的症状改善。
