Hoeboer C M, De Kleine R A, Molendijk M L, Schoorl M, Oprel D A C, Mouthaan J, Van der Does W, Van Minnen A
Leiden University, Institute of Psychology; and Parnassiagroep, PsyQ, The Hague, the Netherlands.
Leiden University, Institute of Psychology, the Netherlands.
BJPsych Open. 2020 May 19;6(3):e53. doi: 10.1192/bjo.2020.30.
Many patients with post-traumatic stress disorder (PTSD) experience dissociative symptoms. The question of whether these dissociative symptoms negatively influence the effectiveness of psychotherapy for PTSD is unresolved.
To determine the influence of dissociative symptoms on psychotherapy outcome in PTSD.
We conducted a systematic search in Cochrane, Embase, PILOTS, PsycINFO, PubMed and Web of Science for relevant clinical trials. A random-effects meta-analysis examined the impact of dissociation on psychotherapy outcome in PTSD (pre-registered at Prospero CRD42018086575).
Twenty-one trials (of which nine were randomised controlled trials) with 1714 patients were included. Pre-treatment dissociation was not related to treatment effectiveness in patients with PTSD (Pearson's correlation coefficient 0.04, 95% CI -0.04 to 0.13). Between-study heterogeneity was high but was not explained by moderators such as trauma focus of the psychotherapy or risk of bias score. There was no indication for publication bias.
We found no evidence that dissociation moderates the effectiveness of psychotherapy for PTSD. The quality of some of the included studies was relatively low, emphasising the need for high-quality clinical trials in patients with PTSD. The results suggest that pre-treatment dissociation does not determine psychotherapy outcome in PTSD.
许多创伤后应激障碍（PTSD）患者会出现分离症状。这些分离症状是否会对PTSD心理治疗的效果产生负面影响，这一问题尚无定论。
确定分离症状对PTSD心理治疗结果的影响。
我们在考克兰图书馆、Embase、PILOTS、心理学文摘数据库、医学期刊数据库和科学网中系统检索了相关临床试验。一项随机效应荟萃分析考察了分离对PTSD心理治疗结果的影响（在国际前瞻性注册系统中预先注册，注册号为CRD42018086575）。
纳入了21项试验（其中9项为随机对照试验），共1714名患者。PTSD患者治疗前的分离症状与治疗效果无关（皮尔逊相关系数为0.04，95%置信区间为-0.04至0.13）。研究间异质性较高，但未被心理治疗的创伤焦点或偏倚风险评分等调节因素所解释。没有证据表明存在发表偏倚。
我们没有发现证据表明分离症状会影响PTSD心理治疗的效果。部分纳入研究的质量相对较低，这凸显了开展PTSD患者高质量临床试验的必要性。结果表明，PTSD患者治疗前的分离症状并不能决定心理治疗的结果。
