Schumm Hannah, Krüger-Gottschalk Antje, Dyer Anne, Pittig Andre, Cludius Barbara, Takano Keisuke, Alpers Georg W, Ehring Thomas
Department of Psychology, LMU Munich, Leopoldstr. 13, Munich, Germany.
Institute of Psychology, WWU Münster, Fliednerstr. 21, 48149, Münster, Germany.
Behav Res Ther. 2022 Jan;148:104009. doi: 10.1016/j.brat.2021.104009. Epub 2021 Nov 19.
Cognitive behavioral therapy (CBT) has been well established in the treatment of posttraumatic stress disorder (PTSD). In recent years, researchers have begun to investigate its underlying mechanisms of change. Dysfunctional cognitive content, i.e. excessively negative appraisals of the trauma or its consequences, has been shown to predict changes in PTSD symptoms over the course of treatment. However, the role of change in cognitive processes, such as trauma-related rumination, needs to be addressed. The present study investigates whether changes in rumination intensity precede and predict changes in symptom severity. We also explored the extent to which symptom severity predicts rumination.
As part of a naturalistic effectiveness study evaluating CBT for PTSD in routine clinical care, eighty-eight patients with PTSD completed weekly measures of rumination and symptom severity. Lagged associations between rumination and symptoms in the following week were examined using linear mixed models.
Over the course of therapy, both ruminative thinking and PTSD symptoms decreased. Rumination was a significant predictor of PTSD symptoms in the following week, although this effect was at least partly explained by the time factor (e.g., natural recovery or inseparable treatment effects). Symptom severity predicted ruminative thinking in the following week even with time as an additional predictor.
The present study provides preliminary evidence that rumination in PTSD is reduced by CBT for PTSD but does not give conclusive evidence that rumination is a mechanism of change in trauma-focused treatment for PTSD.
认知行为疗法（CBT）在创伤后应激障碍（PTSD）的治疗中已得到充分确立。近年来，研究人员已开始探究其潜在的改变机制。功能失调的认知内容，即对创伤或其后果的过度负面评估，已被证明可预测治疗过程中PTSD症状的变化。然而，认知过程的改变，如与创伤相关的反复思考，其作用仍需探讨。本研究调查反复思考强度的变化是否先于并预测症状严重程度的变化。我们还探讨了症状严重程度对反复思考的预测程度。
作为一项在常规临床护理中评估CBT治疗PTSD的自然疗效研究的一部分，88名PTSD患者每周完成反复思考和症状严重程度的测量。使用线性混合模型检查反复思考与下一周症状之间的滞后关联。
在治疗过程中，反复思考和PTSD症状均有所减轻。反复思考是下一周PTSD症状的显著预测因素，尽管这种效应至少部分由时间因素（如自然恢复或不可分割的治疗效果）所解释。即使将时间作为额外的预测因素，症状严重程度仍可预测下一周的反复思考。
本研究提供了初步证据，表明PTSD的CBT可减少PTSD中的反复思考，但并未给出确凿证据证明反复思考是PTSD创伤聚焦治疗中的一种改变机制。
