Vogel Anna, Comtesse Hannah, Nocon Agnes, Kersting Anette, Rief Winfried, Steil Regina, Rosner Rita
Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.
Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Deggendorf, Germany.
Front Psychiatry. 2021 Apr 15;12:534664. doi: 10.3389/fpsyt.2021.534664. eCollection 2021.
Present-centered therapy (PCT) was originally developed as a strong comparator for the non-specific effects of psychotherapy in the treatment of posttraumatic stress disorder. PCT qualifies as a not strictly supportive treatment as it is structured and homework is assigned between sessions. It does not focus on cognitive restructuring or exposure. A growing body of literature supports its beneficial effects. For example, it demonstrated only slightly inferior effect sizes and lower dropout rates compared to that of trauma-focused cognitive behavioral therapy in several trials with patients suffering from posttraumatic stress disorder. The current study is the first to evaluate the feasibility and the treatment effects of PCT in adults with prolonged grief disorder (PGD). Meta-analyses on psychotherapy for PGD have yielded moderate effect sizes. = 20 individuals suffering from PGD were treated with PCT by novice therapists as part of a preparation phase for an upcoming RCT in an outpatient setting. Treatment consisted of 20-24 sessions á 50 min. All outcomes were assessed before treatment, at post-treatment, and at the 3-month follow-up. The primary outcome, PGD symptom severity, was assessed using the Interview for Prolonged Grief-13. Secondary outcomes were self-reported PGD severity, depression, general psychological distress, and somatic symptom severity. Furthermore, therapists evaluated their experiences with their first PCT patient and the treatment manual. In intent-to-treat analyses of all patients we found a significant decrease in interview-based PGD symptom severity at post-treatment ( = 1.26). Decreases were maintained up to the 3-month follow-up assessment ( = 1.25). There were also significant decreases in self-reported PGD symptoms, depression, and general psychological distress. No changes were observed for somatic symptoms. The completion rate was 85%. Therapists deemed PCT to be a learnable treatment program that can be adapted to the patient's individual needs. The preliminary results of PCT as a treatment for PGD demonstrate large effects and indicate good feasibility in outpatient settings. The treatment effects were larger than those reported in meta-analyses. Thus, PCT is a promising treatment for PGD. Possible future research directions are discussed.
以当前为中心的疗法（PCT）最初是作为心理治疗在创伤后应激障碍治疗中的非特异性效应的有力对照疗法而开发的。PCT可被视为一种并非严格意义上的支持性治疗，因为它具有结构化特点且在各次治疗之间布置了家庭作业。它不专注于认知重构或暴露疗法。越来越多的文献支持其有益效果。例如，在几项针对创伤后应激障碍患者的试验中，与以创伤为重点的认知行为疗法相比，它显示出的效应量仅略低，且脱落率更低。当前的研究是首次评估PCT在患有持续性悲伤障碍（PGD）的成年人中的可行性和治疗效果。关于PGD心理治疗的荟萃分析得出了中等效应量。作为即将在门诊环境中进行的一项随机对照试验准备阶段的一部分，20名患有PGD的个体由新手治疗师采用PCT进行治疗。治疗包括20至24次，每次50分钟。所有结果在治疗前、治疗后以及3个月随访时进行评估。主要结果，即PGD症状严重程度，使用《持续性悲伤访谈 - 13》进行评估。次要结果包括自我报告的PGD严重程度、抑郁、一般心理困扰和躯体症状严重程度。此外，治疗师评估了他们对首位接受PCT治疗患者的体验以及治疗手册。在对所有患者的意向性分析中，我们发现治疗后基于访谈的PGD症状严重程度显著降低（ = 1.26）。这种降低在3个月随访评估时仍得以维持（ = 1.25）。自我报告的PGD症状、抑郁和一般心理困扰也有显著降低。躯体症状未观察到变化。完成率为85%。治疗师认为PCT是一个可学习的治疗方案，可以根据患者的个体需求进行调整。PCT作为PGD治疗方法的初步结果显示出显著效果，并表明在门诊环境中有良好的可行性。治疗效果大于荟萃分析中报告的效果。因此，PCT是一种有前景的PGD治疗方法。文中讨论了可能的未来研究方向。
