University of Oxford, Oxford, UK.
Oxford Health NHS Foundation Trust, Oxford, UK.
Trauma Violence Abuse. 2024 Jan;25(1):577-592. doi: 10.1177/15248380231156198. Epub 2023 Mar 2.
Current views of psychological therapies for trauma typically assume the traumatic event to be in the past. Yet, individuals who live in contexts of ongoing organized violence or experience intimate partner violence (IPV) may continue to be (re)exposed to related traumatic events or have realistic fears of their recurrence. This systematic review considers the effectiveness, feasibility, and adaptations of psychological interventions for individuals living with ongoing threat. PsychINFO, MEDLINE, and EMBASE were searched for articles that examined psychological interventions in contexts of ongoing threat of either IPV or organized violence and used trauma-related outcome measures. The search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data on study population, ongoing threat setting and design, intervention components, evaluation methods, and outcomes were extracted, and study quality was assessed using the Mixed-Method Appraisal Tool. Eighteen papers featuring 15 trials were included (12 on organized violence and 3 on IPV). For organized violence, most studies showed moderate to large effects in reducing trauma-related symptoms when compared to waitlists. For IPV, findings were varied. Most studies made adaptations related to culture and ongoing threat and found that providing psychological interventions was feasible. The findings, albeit preliminary with mixed methodological quality, showed psychological treatments can be beneficial and should not be withheld in the context of ongoing organized violence and IPV. Clinical and research recommendations are discussed.
目前，创伤的心理治疗方法通常假设创伤事件已经过去。然而，生活在持续有组织暴力或经历亲密伴侣暴力（IPV）环境中的个体可能会继续（重新）接触到相关的创伤性事件，或者对其再次发生有现实的恐惧。本系统评价考虑了针对持续受到威胁的个体的心理干预措施的有效性、可行性和适应性。在持续受到 IPV 或有组织暴力威胁的情况下，使用与创伤相关的结果测量方法，在 PsychINFO、MEDLINE 和 EMBASE 中搜索了检查心理干预措施的文章。搜索是根据系统评价和荟萃分析的首选报告项目进行的。提取了关于研究人群、持续威胁背景和设计、干预措施组成部分、评估方法和结果的数据，并使用混合方法评估工具评估了研究质量。包括 15 项试验的 18 篇论文（12 项针对有组织暴力，3 项针对 IPV）。对于有组织暴力，与等候名单相比，大多数研究显示在减少与创伤相关的症状方面具有中等至较大的效果。对于 IPV，结果各不相同。大多数研究都针对文化和持续威胁进行了适应性调整，并发现提供心理干预是可行的。尽管这些发现的方法学质量参差不齐，但初步结果表明，心理治疗可能是有益的，在持续有组织暴力和 IPV 的情况下不应被拒绝。讨论了临床和研究建议。
