Parnassiagroep, Amsterdam, the Netherlands.
Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
Eur J Psychotraumatol. 2024;15(1):2332104. doi: 10.1080/20008066.2024.2332104. Epub 2024 Apr 17.
Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase. The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting. Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills. Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: = 0.81 to 1.29; PDS: = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: = 1.68 to 2.15), as well as on symptom levels of depression (BDI: = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome. PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase. ClinicalTrials.gov identifier: NCT01443182..
在接受心理健康服务的患者中，经历过儿童期虐待后患有 PTSD 的个体代表了一个很大的亚组。基于阶段的治疗旨在根据 PTSD 儿童期虐待幸存者的特定需求来调整治疗，包括情感调节和人际关系问题的技能培训阶段（STAIR）和以创伤为重点的阶段。本研究的目的是比较 STAIR+眼动脱敏再处理（EMDR）与 STAIR+叙事治疗（NT）作为在常规临床环境中治疗儿童期创伤后 PTSD 的方法。68 名成年人被随机分配到 STAIR/EMDR（8 个 STAIR 疗程后加 12 个 EMDR 疗程）或 STAIR/NT（8 个 STAIR 疗程后加 12 个 NT 疗程）。评估在治疗前、每个治疗阶段后以及干预后 3 个月和 12 个月的随访时进行。主要结局是评估者评定和自我报告的 PTSD 症状严重程度。次要结局包括抑郁症状严重程度和情绪调节及人际关系技能障碍。意向治疗样本的多层次分析表明，两种治疗方法的患者 PTSD 症状严重程度（CAPS：=0.81 至 1.29；PDS：=1.68 至 2.15）均显著改善，抑郁症状严重程度、焦虑症状严重程度、情绪调节、分离和人际关系技能障碍也均显著改善。这些效果一直持续到 12 个月的随访。在中期治疗后（即完成 STAIR 治疗后），两种治疗方法的患者 PTSD 症状严重程度（PDS：=1.68 至 2.15）和抑郁症状严重程度（BDI：=0.32 至 0.31）均有中度改善。STAIR 后，焦虑症状严重程度、情绪失调、人际关系问题和分离症状并未减轻。两种治疗方法在任何结局上均无显著差异。在以创伤为重点的阶段使用 EMDR 或 NT，对儿童期人际创伤后成年幸存者的 PTSD 可以进行有效的基于阶段的干预治疗。临床试验注册号：NCT01443182。
