School of Psychology, Queen's University Belfast, Belfast, Northern Ireland.
Southern Health & Social Care Trust, Support & Recovery Psychology, Bluestone Unit, Craigavon Area Hospital, Portadown, Northern Ireland.
J Trauma Stress. 2020 Oct;33(5):720-730. doi: 10.1002/jts.22530. Epub 2020 May 8.
Ehlers and Clark's (2000) cognitive model of posttraumatic stress disorder (PTSD) highlights the importance of negative appraisals in maintaining posttraumatic stress. Recent research suggests that alienation appraisals, defined as feeling disconnected from the self and others, mediate the association between traumatic experiences and subsequent PTSD symptoms. To our knowledge, no systematic review has yet explored the relation between alienation appraisals and PTSD symptoms in trauma-exposed adults, despite the important clinical implications posed by this association. A systematic search of the SCOPUS, Web of Science, PsycInfo, MEDLINE, CINAHL Plus, and PILOTS databases resulted in 470 studies, nine of which met full inclusion criteria. Studies were quality-assessed for risk of bias using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) quality assessment tool. A random-effects meta-analysis for the association between alienation appraisals and PTSD symptoms showed a large total effect size, r = .57, 95% CI [.46, .66], z = 8.41, p < .001. This large effect suggests that as alienation appraisals increase, PTSD symptoms increase. Although a strong positive association was found between alienation and PTSD symptoms, the mechanism of this association remains unclear. Limitations of the research included significant heterogeneity across studies and the fact that data were correlational. Future research to explore why alienation appraisals are significant in posttraumatic stress may further help to inform therapeutic approaches to targeting alienation appraisals in trauma survivors. Recommendations are made for the clinical assessment of alienation appraisals when exploring the impact of the traumatic experience on the survivor.
Ehlers 和 Clark（2000）提出的创伤后应激障碍（PTSD）认知模型强调了消极评价在维持创伤后应激中的重要性。最近的研究表明，疏离评价（定义为感觉与自我和他人脱节）在创伤经历与随后的 PTSD 症状之间起中介作用。据我们所知，尽管这种关联具有重要的临床意义，但尚未有系统评价探讨创伤后成年人的疏离评价与 PTSD 症状之间的关系。在 SCOPUS、Web of Science、PsycInfo、MEDLINE、CINAHL Plus 和 PILOTS 数据库中进行了系统搜索，共检索到 470 项研究，其中 9 项符合全部纳入标准。使用多元化设计研究质量评估工具（QATSDD）对研究进行质量评估，以评估偏倚风险。疏离评价与 PTSD 症状之间关联的随机效应荟萃分析显示，总效应大小较大，r =.57，95%CI [.46，.66]，z = 8.41，p <.001。这个大的效应表明，随着疏离评价的增加，PTSD 症状也会增加。虽然疏离和 PTSD 症状之间存在很强的正相关，但这种关联的机制尚不清楚。研究的局限性包括研究之间存在显著的异质性以及数据是相关的。未来的研究探索为什么疏离评价在创伤后应激中很重要，可能会进一步有助于为创伤幸存者的疏离评价目标提供治疗方法。建议在探索创伤经历对幸存者的影响时，对疏离评价进行临床评估。
