Kaysen Debra, Stappenbeck Cynthia A, Carroll Haley, Fukunaga Rena, Robinette Katie, Dworkin Emily R, Murray Sarah M, Tol Wietse A, Annan Jeannie, Bolton Paul, Bass Judith
Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
Eur J Psychotraumatol. 2020 Mar 17;11(1):1735162. doi: 10.1080/20008198.2020.1735162. eCollection 2020.
: While evidence is growing for the efficacy of trauma-focused mental health interventions in low- and middle-income countries, concerns have been raised about whether these types of interventions can be effectively delivered in contexts with ongoing conflict and violence. Cognitive Processing Therapy (CPT) has been shown to be effective in reducing sexual violence survivors' psychological symptoms in eastern Democratic Republic of the Congo (DRC), a region with a history of chronic conflict. : The purpose of the present study is to assess the degree to which exposure to different levels of ongoing insecurity impacts effectiveness of an evidence-based trauma-focused psychotherapy for sexual violence survivors. : Participants were 158 female sexual violence survivors receiving CPT in seven communities in South Kivu. Participants completed weekly assessments of their symptoms of PTSD and depression as part of CPT. Degree of site insecurity was categorized as high or low levels of ongoing insecurity based on information collected from supervisors and clinicians. Hierarchical linear modelling was used to examine change over time moderated by level of insecurity at the site. : Overall, women reported a significant reduction in psychological symptoms over time ( = -2.04, <.001). Residing in a site of greater insecurity was associated with higher initial symptoms ( = 5.91, <.01), but similar improvement over time ( = -0.30, =.10) compared to women living in relatively more secure sites. High rates of attendance and treatment completion were observed. : These results support the effectiveness of trauma-focused therapies when provided in a well-structured and well-supervised program even in contexts of ongoing conflict and violence.
虽然有越来越多的证据表明创伤聚焦型心理健康干预措施在低收入和中等收入国家具有疗效，但人们对这类干预措施能否在持续冲突和暴力的环境中有效实施提出了担忧。认知加工疗法（CPT）已被证明在减少刚果民主共和国东部性暴力幸存者的心理症状方面有效，该地区有着长期冲突的历史。本研究的目的是评估接触不同程度的持续不安全因素对一项针对性暴力幸存者的循证创伤聚焦心理治疗效果的影响程度。参与者是在南基伍七个社区接受CPT治疗的158名女性性暴力幸存者。作为CPT的一部分，参与者每周完成对其创伤后应激障碍（PTSD）和抑郁症状的评估。根据从主管人员和临床医生收集的信息，将地点不安全程度分为持续不安全的高或低水平。采用分层线性模型来检验由地点不安全程度所调节的随时间的变化。总体而言，女性报告随着时间推移心理症状有显著减轻（β = -2.04，p <.001）。居住在不安全程度更高的地点与初始症状较高相关（β = 5.91，p <.01），但与生活在相对更安全地点的女性相比，随时间的改善情况相似（β = -0.30，p =.10）。观察到高出席率和治疗完成率。这些结果支持了在结构良好且监督完善的项目中提供创伤聚焦疗法的有效性，即使是在持续冲突和暴力的环境中。
