Department of Psychology, Long Island University Brooklyn, and Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Psychiatry, University of Maryland-Sheppard Pratt Psychiatry Residency Program, Baltimore (Kimmel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Weitz).
Am J Psychother. 2024 Sep 1;77(3):119-128. doi: 10.1176/appi.psychotherapy.20230043. Epub 2024 Aug 6.
Established trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder (PTSD) have remission rates of approximately 30%-40%. Alternatively, interpersonal psychotherapy (IPT) and psychodynamic psychotherapy (PDT) focus on disrupted attachment, mentalization, and social connection in PTSD and may help some patients. The authors conducted a meta-analysis on these interpersonal and affect-oriented approaches to treating PTSD.
Building on a prior meta-analysis, the authors searched for randomized controlled trials (RCTs) comparing IPT or PDT with other established PTSD treatments or control conditions for adults diagnosed as having PTSD. Random-effects meta-analyses were conducted to assess outcome effect sizes and dropout rates. RCTs were rated via the Randomized Controlled Trial Psychotherapy Quality Rating Scale.
Ten RCTs (eight of IPT) comparing IPT or PDT with control (k=7) or active treatment (k=4) conditions were identified, nine of which were of adequate quality. IPT (k=5) and PDT (k=2), when analyzed together, were superior to control conditions overall (g=-1.14, p=0.011 [as was IPT alone: g=-0.88, p=0.034]) and to waitlist (g=-1.49) and treatment-as-usual (g=-0.70) groups. Effect sizes, however, may have been inflated by outliers or publication bias. IPT (k=3) and PDT (k=1), when analyzed together, were equally efficacious compared with other active PTSD treatments (primarily exposure-based psychotherapies), as was IPT alone, and had lower dropout rates (relative risk=0.63, p=0.049 for IPT and PDT analyzed together; relative risk0.61, p=0.098 for IPT alone).
Affect-focused therapies hold promise in the treatment of PTSD. IPT has demonstrated efficacy in multiple trials, whereas the evidence base for PDT is sparse.
创伤为中心的认知行为疗法治疗创伤后应激障碍（PTSD）的缓解率约为 30%-40%。另一种人际心理治疗（IPT）和心理动力学心理治疗（PDT）则关注 PTSD 中受损的依恋、心理化和社会联系，可能对一些患者有帮助。作者对这些治疗 PTSD 的人际和情感导向方法进行了荟萃分析。
基于先前的荟萃分析，作者搜索了比较 IPT 或 PDT 与其他针对 PTSD 的既定治疗或对照条件的随机对照试验（RCT）。采用随机效应荟萃分析评估结局效应大小和脱落率。RCT 通过随机对照试验心理治疗质量评分量表进行评分。
确定了 10 项 RCT（8 项为 IPT），比较了 IPT 或 PDT 与对照（k=7）或活性治疗（k=4）条件，其中 9 项为高质量。IPT（k=5）和 PDT（k=2）联合分析时，总体上优于对照条件（g=-1.14，p=0.011[IPT 单独分析时：g=-0.88，p=0.034]）和等待名单（g=-1.49）和常规治疗（g=-0.70）组。然而，效应大小可能因异常值或发表偏倚而被夸大。IPT（k=3）和 PDT（k=1）联合分析时，与其他活性 PTSD 治疗（主要是暴露为基础的心理治疗）同样有效，IPT 单独治疗也是如此，而且脱落率较低（IPT 和 PDT 联合分析时相对风险比=0.63，p=0.049；IPT 单独分析时相对风险比=0.61，p=0.098）。
情感导向疗法在 PTSD 治疗中有一定的前景。IPT 在多项试验中显示出疗效，而 PDT 的证据基础较少。
