Wokingham Community Mental Health Team, Berkshire Healthcare Foundation Trust, UK.
Horizon (Supporting Young People and Families Affected by Sexual Harm), Oxford Health NHS Foundation Trust, UK.
Psychol Psychother. 2021 Apr;94 Suppl 2:286-303. doi: 10.1111/papt.12275. Epub 2020 Apr 19.
Complex post-traumatic stress disorder (PTSD) is associated with severe difficulties in emotional regulation, interpersonal relationships, and shame. For individuals with these difficulties, exposure-based treatment for PTSD symptoms is less effective and can even be harmful. This study aimed to investigate the mechanisms of change at an individual and group level for individuals completing treatment for complex PTSD.
Constructivist grounded theory was used to develop an explanatory theoretical model of the change process.
Semi-structured interviews were conducted with 11 women with a diagnosis of complex PTSD who had completed the group treatment.
The theoretical model captured change as an ongoing journey, which continued after treatment finished. Participants identified three essential aspects of the group that brought about change. The first was the group itself, in which valued relationships were formed. Additionally, participants described two key mechanisms - developing a comprehensive understanding of themselves and their difficulties, and experiencing their emotions and compassion from others.
The key mechanisms of change were the relationships formed within the group and the need for a deeper understanding of the self in order to reduce shame and prepare for exposure-based treatment. Further support is provided for a phase-based approach to complex PTSD treatment. Psychoeducation alone, however, was not sufficient, and it was also crucial that participants could safely access their emotions and experience compassion from others in order for change to come about.
Important aspects of treatment for complex PTSD are emphasised to inform professional practice. In particular, the role of relationships is altering self-perceptions through group therapy. Other key elements included participants building an understanding of themselves and their difficulties through psychoeducation, developing compassion for others and themselves, and safely accessing their emotions. This study also builds upon the body of evidence for the benefits of phase-based treatment which addresses shame and emotional regulation prior to exposure therapy.
复杂创伤后应激障碍（PTSD）与情绪调节、人际关系和羞耻感方面的严重困难有关。对于有这些困难的个体，针对 PTSD 症状的暴露治疗效果较差，甚至可能有害。本研究旨在调查完成复杂 PTSD 治疗的个体在个体和群体层面上的变化机制。
采用建构主义扎根理论来制定一个关于变化过程的解释性理论模型。
对 11 名已完成团体治疗的被诊断为复杂 PTSD 的女性进行了半结构化访谈。
理论模型捕捉到了变化是一个持续的过程，在治疗结束后仍在继续。参与者确定了团体治疗带来变化的三个基本方面。第一个是团体本身，在其中形成了有价值的关系。此外，参与者描述了两个关键机制——对自己和自己的困难有一个全面的理解，以及从他人那里体验自己的情绪和同情。
变化的关键机制是团体内部形成的关系以及对自我的更深入理解，以减少羞耻感并为暴露治疗做好准备。这为复杂 PTSD 治疗的阶段性方法提供了进一步的支持。然而，仅进行心理教育是不够的，参与者还必须能够安全地体验自己的情绪并从他人那里体验到同情，以便实现变化。
强调了治疗复杂 PTSD 的重要方面，以指导专业实践。特别是，通过团体治疗，关系的作用改变了自我认知。其他关键要素包括参与者通过心理教育对自己和困难有了更深入的了解，对他人和自己产生了同情心，并安全地体验了自己的情绪。本研究还为基于阶段的治疗的益处提供了证据，该治疗方法在暴露治疗之前解决羞耻感和情绪调节问题。
