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一种基于日间诊所小组的多模式创伤相关障碍治疗方案的有效性:复杂性创伤后应激障碍与非复杂性创伤相关障碍的差异治疗结果。

Effectiveness of a Multimodal, Day Clinic Group-Based Treatment Program for Trauma-Related Disorders: Differential Therapy Outcome for Complex PTSD vs. Non-Complex Trauma-Related Disorders.

作者信息

Philipps Anke, Silbermann Andrea, Morawa Eva, Stemmler Mark, Erim Yesim

机构信息

Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.

Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.

出版信息

Front Psychiatry. 2019 Nov 7;10:800. doi: 10.3389/fpsyt.2019.00800. eCollection 2019.

Abstract

The effectiveness of the psychotherapeutic treatment of posttraumatic stress disorder is evidence-based and generally considered proven. However, the effectiveness of multimodal, group-based day clinic treatment programs has rarely been investigated. Moreover, there is no consensus in the literature concerning the question whether psychotherapeutic approaches for trauma-related disorders are also applicable for patients with complex PTSD (cPTSD). The aim of the study was to evaluate our multimodal group-based treatment program regarding a change of psychiatric burden, a change of protective factors, and possible differences in therapy outcome for patients with or without cPTSD. The group-based treatment for patients with trauma-related disorders was examined in 66 patients who filled out the following questionnaires in the first and in the last week of treatment: Essen Trauma Inventory (ETI), Screening for complex PTSD (SkPTBS), Patient Health Questionnaire-somatization module (PHQ-15), Beck Depression Inventory-Revised (BDI-II), Posttraumatic Growth Inventory (PTGI), and Questionnaire on social support (F-SozU). The treatment was shown to significantly reduce depressive symptoms (p < 0.001, d = -0.536) and increase posttraumatic growth (New Possibilities: p = 0.004, d = 0.405; Personal Strength: p = 0.005, d = 0.414). For patients with cPTSD, depressive (p = 0.010, d = -0.63) as well as cPTSD symptoms (p = 0.020, d = -0.796) were significantly reduced; perceived social support was increased after day clinic treatment (p = 0.003, d = 0.61). Contrary to our expectations, somatoform symptoms were increased after therapy. The present work expands previous research by demonstrating that multimodal group-based, day clinic treatment is effective in the treatment of trauma-related disorders, also in their complex form.

摘要

创伤后应激障碍心理治疗的有效性有循证依据,且普遍被认为已得到证实。然而,多模式、基于团体的日间门诊治疗项目的有效性鲜有研究。此外,关于创伤相关障碍的心理治疗方法是否也适用于复杂性创伤后应激障碍(cPTSD)患者这一问题,文献中尚无共识。本研究的目的是评估我们基于团体的多模式治疗项目在减轻精神负担、改变保护因素以及有无cPTSD患者治疗效果的可能差异方面的情况。对66名患有创伤相关障碍的患者进行了基于团体的治疗,这些患者在治疗的第一周和最后一周填写了以下问卷:埃森创伤量表(ETI)、复杂性创伤后应激障碍筛查量表(SkPTBS)、患者健康问卷躯体化模块(PHQ - 15)、贝克抑郁量表修订版(BDI - II)、创伤后成长量表(PTGI)以及社会支持问卷(F - SozU)。结果显示,该治疗显著减轻了抑郁症状(p < 0.001,d = -0.536),并促进了创伤后成长(新的可能性:p = 0.004,d = 0.405;个人力量:p = 0.005,d = 0.414)。对于cPTSD患者,抑郁症状(p = 0.010,d = -0.63)以及cPTSD症状(p = 0.020,d = -0.796)均显著减轻;日间门诊治疗后,感知到的社会支持有所增加(p = 0.003,d = 0.61)。与我们的预期相反,治疗后躯体形式症状有所增加。本研究通过证明基于团体的多模式日间门诊治疗对创伤相关障碍有效,包括其复杂形式,扩展了先前的研究。

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