Department of Psychology, University of Konstanz, Konstanz, Germany.
Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada.
BMC Psychiatry. 2020 Jun 17;20(1):312. doi: 10.1186/s12888-020-02720-y.
Trauma-focused therapy approaches are recommended as treatment for posttraumatic stress disorder (PTSD). This includes the treatment of trauma-related suffering in refugee populations. However, there is a lack of knowledge about symptom trajectories in refugees living in volatile conditions. This has led to fear of "retraumatisation" and general skepticism in clinicians concerning the use of exposure therapy.
To test the relevance of this concern, we investigated PTSD symptom trajectories and potentially influencing factors during the course of Narrative Exposure Therapy (NET) in a refugee sample living in Germany. Refugees filled out the PTSD Checklist prior to each treatment session and also during follow-up interviews. Therapists continuously documented positive and negative life events as well as the content of the treatment sessions. Additionally, structured clinical interviews were conducted pre-treatment and at follow-up time points.
On average, clients presented with substantial decreases in PTSD symptoms already during and after NET. However, symptom trajectories differed and ranged from fast responders to slow responders to no immediate response during treatment. Importantly, a persistent worsening of symptoms was not observed, also not after exposure to the most distressing events. In contrast, stressful life experiences seemed to aggravate PTSD symptoms.
Consistent with earlier studies, NET leads to clinically and behaviorally relevant reductions in PTSD symptoms both throughout and following treatment in refugees living in volatile conditions. Concerns about imaginal exposure in refugees were not substantiated. While stressful life events contributed to transient symptom increases, they weren't found to prevent the overall effectiveness of NET.
NCT02852616.
创伤焦点疗法方法被推荐作为创伤后应激障碍（PTSD）的治疗方法。这包括治疗难民群体中与创伤相关的痛苦。然而，对于生活在不稳定环境中的难民的症状轨迹知之甚少。这导致了临床医生对使用暴露疗法的“再创伤化”的恐惧和普遍怀疑。
为了检验这种担忧的相关性，我们在德国的难民样本中调查了叙事暴露疗法（NET）过程中 PTSD 症状轨迹和潜在的影响因素。难民在每次治疗前和治疗后访谈中填写 PTSD 检查表。治疗师持续记录积极和消极的生活事件以及治疗内容。此外，在治疗前和随访时间点进行了结构化的临床访谈。
平均而言，患者在 NET 过程中和结束后 PTSD 症状已经显著减轻。然而，症状轨迹不同，从快速反应者到缓慢反应者到治疗期间没有立即反应者不等。重要的是，没有观察到症状持续恶化，即使在接触最痛苦的事件后也没有。相比之下，生活压力事件似乎加剧了 PTSD 症状。
与早期研究一致，NET 导致生活在不稳定环境中的难民在治疗过程中和治疗结束后 PTSD 症状都有临床和行为相关的显著减轻。对难民想象暴露的担忧没有得到证实。虽然生活压力事件导致症状短暂增加，但它们并未阻止 NET 的总体有效性。
NCT02852616。
