Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.
VA Puget Sound Health Care System, Seattle, Washington, USA.
J Trauma Stress. 2020 Aug;33(4):610-616. doi: 10.1002/jts.22504. Epub 2020 Mar 26.
Research on psychotherapies for posttraumatic stress disorder (PTSD) is increasingly focused on understanding not only which treatments work but why and for whom they work. The present pilot study evaluated the temporal relations between five hypothesized change targets-posttraumatic cognitions, guilt, shame, general emotion dysregulation, and experiential avoidance-and PTSD severity among women with PTSD, borderline personality disorder, and recent suicidal and/or self-injurious behaviors. Participants (N = 26) were randomized to receive 1 year of dialectical behavior therapy (DBT) with or without the DBT prolonged exposure (DBT PE) protocol for PTSD. Potential change targets and PTSD were assessed at 4-month intervals during treatment and at 3-month posttreatment follow-up. Time-lagged mixed-effects models indicated that between-person differences in all change targets except guilt were associated with more severe PTSD, η s = .32-.55, and, except for general emotion dysregulation, slowed the rate of change in PTSD severity over time, η s = .20-.39. In DBT but not in DBT + DBT PE, individuals with higher levels of guilt and experiential avoidance relative to their own average had more severe PTSD at the next assessment point, η s = .12-.25. The associations between the proposed change targets and PTSD severity were not bidirectional, except for general emotion dysregulation, η = .50; and posttraumatic cognitions, η = .06. These preliminary findings suggest that trauma-related cognitions, shame, and guilt, as well as problems regulating them, may be important change targets for improving PTSD in this patient population.
创伤后应激障碍（PTSD）心理治疗的研究越来越关注不仅要了解哪些治疗有效，还要了解为什么以及对哪些人有效。本初步研究评估了五个假设的变化目标（创伤后认知、内疚、羞耻、一般情绪失调和体验回避）与 PTSD 严重程度之间的时间关系，对象为 PTSD、边缘型人格障碍以及近期自杀和/或自残行为的女性。参与者（N=26）随机分为接受 1 年的辩证行为疗法（DBT）加或不加 PTSD 的 DBT 延长暴露（DBT PE）方案。在治疗期间和治疗后 3 个月的随访中，每 4 个月评估一次潜在的变化目标和 PTSD。时滞混合效应模型表明，除内疚外，所有变化目标中的个体间差异与 PTSD 严重程度更严重相关，ηs=0.32-0.55，除一般情绪失调外，随着时间的推移，PTSD 严重程度的变化速度也会减慢，ηs=0.20-0.39。在 DBT 中，但不在 DBT+DBT PE 中，与自身平均水平相比，内疚和体验回避水平较高的个体在下次评估时 PTSD 更严重，ηs=0.12-0.25。除一般情绪失调，η=0.50；和创伤后认知，η=0.06 外，提议的变化目标与 PTSD 严重程度之间的关联不是双向的。这些初步发现表明，与创伤相关的认知、羞耻和内疚，以及调节这些认知的问题，可能是改善该患者群体 PTSD 的重要变化目标。
