有童年不良经历史的成年人创伤后应激障碍和物质使用障碍的治疗：心理干预的系统评价
Treatment of post-traumatic stress disorder and substance use disorder in adults with a history of adverse childhood experiences: A systematic review of psychological interventions.
作者信息
Molina Genevieve, Whittaker Anne
机构信息
CeGIDD, Pôle Santé Publique et Médecine Sociale, CHU Toulouse, Hôpital La Grave, TSA 60033, 31059 Toulouse Cedex 9, France.
NMAHP Research Unit, Faculty of Health Sciences and Sport, Pathfoot Building, University of Stirling, FK9 4LA, Stirling, Scotland, UK.
出版信息
Drug Alcohol Depend Rep. 2022 Jan 20;2:100028. doi: 10.1016/j.dadr.2022.100028. eCollection 2022 Mar.
BACKGROUND
Adverse childhood experiences (ACEs) have long-term effects on adult health, including unresolved trauma and substance use disorder (SUD). There are hypotheses of a mediating role of emotion regulation. This systematic literature review and narrative synthesis assessed the effectiveness of psychological interventions on emotion regulation, PTSD and SUD symptoms.
METHODS
Searches were conducted using the Cochrane Handbook for Systematic Reviews methodology. Eligible studies were randomised controlled trials (RCTs) and quasi-experimental psychological interventions published between 2009 and 2019. Study characteristics, results and methodological quality were systematically analysed.
RESULTS
Thirteen studies, including nine RCTs, were selected. Integrated SUD and PTSD treatments consisted of Seeking Safety, exposure-based treatment, Trauma Recovery and Empowerment Model, and integrated cognitive behavioural therapy. Two studies reported emotion regulation. Five studies found a small to medium positive effect size of psychological interventions on PTSD outcomes. Two studies had a small positive effect size on SUD outcomes and two a small negative effect size. Attrition was high across most studies. Characteristics likely to affect the applicability of the review were described.
CONCLUSION
The review found some evidence of a small inconsistent positive effect of psychological interventions on PTSD outcomes, and no evidence of effect on SUD outcomes. The range of theoretical models was narrow. Overall quality was low with high clinical heterogeneity and missing key information, particularly on emotion regulation, an important transdiagnostic feature. Further research is required to establish interventions that can treat these multiple conditions with a focus on effectiveness, acceptability, and implementation in real life clinical practice.
背景
儿童期不良经历（ACEs）对成人健康有长期影响，包括未解决的创伤和物质使用障碍（SUD）。存在情绪调节起中介作用的假说。本系统文献综述和叙述性综合分析评估了心理干预对情绪调节、创伤后应激障碍（PTSD）和SUD症状的有效性。
方法
使用Cochrane系统评价手册方法进行检索。符合条件的研究为2009年至2019年间发表的随机对照试验（RCT）和准实验性心理干预。对研究特征、结果和方法学质量进行系统分析。
结果
共纳入13项研究，其中包括9项RCT。综合SUD和PTSD治疗包括“寻求安全”、基于暴露的治疗、创伤恢复与赋权模型以及综合认知行为疗法。两项研究报告了情绪调节情况。五项研究发现心理干预对PTSD结局有小到中等程度的积极效应量。两项研究对SUD结局有小的积极效应量，两项有小的消极效应量。大多数研究的失访率较高。描述了可能影响本综述适用性的特征。
结论
该综述发现有一些证据表明心理干预对PTSD结局有小的、不一致的积极效应，但没有证据表明对SUD结局有影响。理论模型的范围较窄。总体质量较低，临床异质性高且关键信息缺失，尤其是关于情绪调节这一重要的跨诊断特征。需要进一步研究以建立能够治疗这些多种病症的干预措施，重点关注有效性、可接受性以及在现实生活临床实践中的实施情况。
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