Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Germany.
Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University, Frankfurt am Main, Germany.
J Trauma Stress. 2019 Oct;32(5):764-773. doi: 10.1002/jts.22440. Epub 2019 Sep 2.
Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) is a trauma-focused therapy shown to reduce core PTSD symptoms, such as intrusions, hyperarousal, and avoidance. Preliminary data indicate effects on elevated trauma-related emotions (e.g., guilt and shame) and possibly radical acceptance of the traumatic event. However, it is unclear if improvements in these variables are significant after controlling for changes in core PTSD symptoms and to what extent nonclinical levels are obtained. In the current study, 42 individuals who met criteria for PTSD after childhood abuse and were participating in a 3-month residential DBT-PTSD program were evaluated at the start of the exposure phase of DBT-PTSD and the end of treatment; a nonclinical sample with a history of childhood abuse was the reference group. Multivariate analyses of variance and multivariate analyses of covariance controlling for change in core PTSD symptoms were used to evaluate changes in several elevated trauma-related emotions (fear, anger, guilt, shame, disgust, sadness, and helplessness) and in radical acceptance. In a repeated measures multivariate analyses of variance, both elevated trauma-related emotions and radical acceptance significantly improved during DBT-PTSD, λ = 0.34, p < .001; η = .56; t(40) = -5.66, p < .001, SMD = 0.88, even after controlling for changes in PTSD symptoms, λ = 0.35, p < .001, η = .65; Λ = 0.86, p = .018, η = .14, respectively. Posttreatment, 31.0% (for acceptance) to 76.2% (for guilt) of participants showed nonclinical levels of the investigated outcomes, suggesting that both trauma-related emotions and radical acceptance changed after the 3-month residential DBT-PTSD program.
创伤后应激障碍的辩证行为疗法（DBT-PTSD）是一种以创伤为焦点的疗法，已被证明可减少核心 PTSD 症状，如闯入、过度警觉和回避。初步数据表明，它对升高的与创伤相关的情绪（例如，内疚和羞耻）有影响，并且可能对创伤事件有激进的接受。然而，尚不清楚在控制核心 PTSD 症状的变化后，这些变量的改善是否具有统计学意义，以及达到非临床水平的程度如何。在当前的研究中，42 名符合儿童期虐待后 PTSD 标准并参加为期 3 个月的 DBT-PTSD 住院治疗的个体在 DBT-PTSD 的暴露阶段开始时和治疗结束时进行了评估；具有儿童期虐待史的非临床样本作为参考组。使用多元方差分析和多元协方差分析，控制核心 PTSD 症状的变化，评估几种升高的与创伤相关的情绪（恐惧、愤怒、内疚、羞耻、厌恶、悲伤和无助）和激进接受的变化。在重复测量多元方差分析中，无论是升高的与创伤相关的情绪还是激进接受在 DBT-PTSD 期间都显著改善，λ=0.34，p<0.001；η=0.56；t(40)=-5.66，p<0.001，SMD=0.88，即使在控制 PTSD 症状的变化后，λ=0.35，p<0.001，η=0.65；Λ=0.86，p=0.018，η=0.14，分别。治疗后，31.0%（接受）到 76.2%（内疚）的参与者表现出研究结果的非临床水平，这表明在 3 个月的 DBT-PTSD 住院治疗后，与创伤相关的情绪和激进接受都发生了变化。
