Gerger Heike, Werner Christoph Patrick, Gaab Jens, Cuijpers Pim
Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.
Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Psychol Med. 2021 Feb 26;52(15):1-13. doi: 10.1017/S0033291721000143.
Expressive writing about a traumatic event is promising in treating posttraumatic stress disorder (PTSD) symptoms in adult trauma survivors. To date, the comparative efficacy and acceptability of this approach is uncertain. Therefore, we aimed to examine the comparative efficacy and acceptability of expressive writing treatments.
We included 44 RCTs with 7724 participants contributing 54 direct comparisons between expressive writing (EW), enhanced writing (i.e. including additional therapist contact or individualized writing assignments; EW+), PTSD psychotherapies (PT), neutral writing (NW), and waiting-list control (WL).
EW, EW+, PT, and NW were statistically significantly more efficacious than WL at the longest available follow-up, with SMDs (95% CI) of -0.78 (-1.10 to -0.46) for PT, -0.81 (-1.02 to -0.61) for EW+ , -0.43 (-0.65 to -0.21) for EW, and -0.37 (-0.61 to -0.14) for NW. We found small to moderate differences between the active treatments. At baseline mean PTSD severity was significantly lower in EW+ compared with WL. We found considerable heterogeneity and inconsistency and we found elevated risk of bias in at least one of the bias dimensions in all studies. When EW+-WL comparisons were excluded from the analyses EW+ was no longer superior compared with EW.
The summarized evidence confirms that writing treatments may contribute to improving PTSD symptoms in medium to long-term. Methodological issues in the available evidence hamper definite conclusions regarding the comparative efficacy and acceptability of writing treatments. Adequately sized comparative randomized controlled trials preferably including all four active treatment approaches, reporting long-term data, and including researchers with balanced preferences are needed.
通过表达性写作来描述创伤事件，对于治疗成年创伤幸存者的创伤后应激障碍（PTSD）症状具有一定前景。迄今为止，这种方法的相对疗效和可接受性尚不确定。因此，我们旨在研究表达性写作治疗的相对疗效和可接受性。
我们纳入了44项随机对照试验，共7724名参与者，对表达性写作（EW）、强化写作（即包括额外的治疗师接触或个性化写作任务；EW+）、PTSD心理治疗（PT）、中性写作（NW）和等待列表对照（WL）进行了54次直接比较。
在最长可用随访期时，EW、EW+、PT和NW在统计学上均显著优于WL，PT的标准化均数差（SMD）（95%CI）为-0.78（-1.10至-0.46），EW+为-0.81（-1.02至-0.61），EW为-0.43（-0.65至-0.21），NW为-0.37（-0.61至-0.14）。我们发现积极治疗之间存在小到中等程度的差异。在基线时，EW+组的PTSD严重程度均值显著低于WL组。我们发现存在相当大的异质性和不一致性，并且在所有研究中至少有一个偏倚维度存在较高的偏倚风险。当将EW+-WL比较从分析中排除时，EW+与EW相比不再具有优势。
汇总的证据证实，写作治疗可能有助于在中长期改善PTSD症状。现有证据中的方法学问题妨碍了就写作治疗的相对疗效和可接受性得出明确结论。需要进行足够规模的比较随机对照试验，最好包括所有四种积极治疗方法，报告长期数据，并纳入偏好均衡的研究人员。
Zotero 插件
