Psychotherapist and Researcher,Foundation Centrum '45; and Arq Psychotrauma Expert Group,the Netherlands.
Psychotherapist,Foundation Centrum '45;Arq Psychotrauma Expert Group; andAssistant Professor,Department of Clinical Psychology,Utrecht University,the Netherlands.
Br J Psychiatry. 2019 Jun;214(6):369-377. doi: 10.1192/bjp.2019.59. Epub 2019 Apr 8.
Evidence-based treatment and age-specific services are required to address the needs of trauma-affected older populations. Narrative exposure therapy (NET) may present an appropriate treatment approach for this population since it provides prolonged exposure in a lifespan perspective. As yet, however, no trial on this intervention has been conducted with older adults from Western Europe.AimsExamining the efficacy of NET in a sample of older adults.
Out-patients with post-traumatic stress disorder (PTSD), aged 55 years and over, were randomly assigned to either 11 sessions of NET (n = 18) or 11 sessions of present-centred therapy (PCT) (n = 15) and assessed on the Clinician-Administered PTSD Scale (CAPS) pre-treatment, post-treatment and at follow-up. Total scores as well as symptom scores (re-experience, avoidance and hyperarousal) were evaluated.
Using a piecewise mixed-effects growth model, at post-treatment a medium between-treatment effect size for CAPS total score (Cohen's d = 0.44) was found, favouring PCT. At follow-up, however, the between-treatment differences were non-significant. Drop-out rates were low (NET 6.7%, PCT 14.3%) and no participant dropped out of the study because of increased distress.
Both NET and PCT appear to be safe and efficacious treatments with older adults: PCT is non-intrusive and NET allows for imaginal exposure in a lifespan perspective. By selectively providing these approaches in clinical practice, patient matching can be optimised.Declaration of interestNone.
为满足创伤后老年人群的需求，需要提供循证治疗和针对特定年龄的服务。叙事暴露疗法（NET）可能是一种适合该人群的治疗方法，因为它提供了从生命历程角度进行的延长暴露。然而，迄今为止，尚未针对来自西欧的老年人开展过该干预措施的试验。
在老年人样本中检验 NET 的疗效。
将患有创伤后应激障碍（PTSD）且年龄在 55 岁及以上的门诊患者随机分配至 NET（n=18）或以当下为中心疗法（PCT）（n=15）组，并在治疗前、治疗后和随访时使用临床医生管理 PTSD 量表（CAPS）进行评估。评估总分以及症状评分（再体验、回避和过度警觉）。
使用分段混合效应增长模型，在治疗后发现 CAPS 总分的中等治疗间效应大小（Cohen's d=0.44），有利于 PCT。然而，在随访时，治疗间差异不显著。脱落率较低（NET 为 6.7%，PCT 为 14.3%），且没有参与者因病情加重而退出研究。
NET 和 PCT 似乎对老年人都是安全且有效的治疗方法：PCT 是非侵入性的，而 NET 允许在生命历程角度进行想象暴露。通过在临床实践中选择性地提供这些方法，可以优化患者匹配。
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