边缘自我神经调节与心理治疗相结合治疗复杂创伤后应激障碍:治疗原理和案例研究。
Integration of limbic self-neuromodulation with psychotherapy for complex post-traumatic stress disorder: treatment rationale and case study.
机构信息
Faculty of Social Sciences, School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel.
Sagol Brain Institute Tel-Aviv, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
出版信息
Eur J Psychotraumatol. 2024;15(1):2256206. doi: 10.1080/20008066.2023.2256206. Epub 2024 Jan 3.
Exposure to repeated sexual trauma, particularly during childhood, often leads to protracted mental health problems. Childhood adversity is specifically associated with complex posttraumatic stress disorder (PTSD) presentation, which is particularly tenacious and treatment refractory, and features severe emotion dysregulation. Augmentation approaches have been suggested to enhance treatment efficacy in PTSD thus integrating first-line psychotherapy with mechanistically informed self-neuromodulation procedures (i.e. neurofeedback) may pave the way to enhanced clinical outcomes. A central neural mechanism of PTSD and emotion dysregulation involves amygdala hyperactivity that can be volitionally regulated by neurofeedback. We outline a treatment rationale that includes a detailed justification for the potential of combining psychotherapy and NF and delineate mechanisms of change. We illustrate key processes of reciprocal interactions between neurofeedback engagement and therapeutic goals. We describe a clinical case of a woman with complex PTSD due to early and repetitive childhood sexual abuse using adjunctive neurofeedback as an augmentation to an ongoing, stable, traditional treatment plan. The woman participated in (a) ten sessions of neurofeedback by the use of an fMRI-inspired EEG model of limbic related activity (Amygdala Electrical-Finger-Print; AmygEFP-NF), (b) traditional weekly individual psychotherapy, (c) skills group. Before and after NF training period patient was blindly assessed for PTSD symptoms, followed by a 1, 3- and 6-months self-report follow-up. We demonstrate mechanisms of change as well as the clinical effectiveness of adjunctive treatment as indicated by reduced PTSD symptoms and improved daily functioning within this single case. We outline an integrative neuropsychological framework for understanding the unique mechanisms of change conferring value to conjoining NF applications with trauma-focused psychotherapy in complex PTSD.
反复遭受性创伤,尤其是在童年时期,往往会导致长期的心理健康问题。童年逆境与复杂创伤后应激障碍(PTSD)的表现特别相关,这种表现特别顽固且难以治疗,且伴有严重的情绪失调。已经提出了增强治疗效果的方法,因此将一线心理治疗与基于机制的自我神经调节程序(即神经反馈)相结合,可能为增强临床疗效铺平道路。PTSD 和情绪失调的一个核心神经机制涉及杏仁核过度活跃,而神经反馈可以通过意志调节。我们概述了一种治疗原理,其中包括详细说明将心理治疗与 NF 结合的潜力,并阐明了变化的机制。我们说明了神经反馈参与和治疗目标之间的相互作用的关键过程。我们描述了一位患有复杂 PTSD 的女性的临床病例,她因早期和反复的儿童性虐待而患病,使用辅助神经反馈作为正在进行的、稳定的传统治疗计划的增强。该女性接受了以下治疗:(a)使用基于 fMRI 的边缘相关活动的 EEG 模型(杏仁核电指纹;AmygdEFP-NF)进行了十次神经反馈治疗,(b)传统的每周个体心理治疗,(c)技能小组。在 NF 训练期前后,对患者进行了 PTSD 症状的盲法评估,随后进行了 1、3 和 6 个月的自我报告随访。我们通过降低 PTSD 症状和改善日常生活功能来证明辅助治疗的有效性,以及变化的机制,这表明该单一病例具有临床效果。我们概述了一种综合神经心理学框架,用于理解将 NF 应用与创伤聚焦心理治疗相结合在复杂 PTSD 中赋予价值的独特变化机制。