创伤后应激障碍和认知加工疗法治疗结束后 9 个月的辩证行为疗法的长期效果。

Long-term effects of dialectical behaviour therapy for posttraumatic stress disorder and cognitive processing therapy 9 months after treatment termination.

机构信息

Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.

Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.

出版信息

Eur J Psychotraumatol. 2024;15(1):2393061. doi: 10.1080/20008066.2024.2393061. Epub 2024 Sep 2.

Abstract

The complexity of posttraumatic stress disorder (PTSD) symptoms related to childhood abuse (CA) present challenges for effective psychotherapeutic treatment. Consequently, there is great interest in the long-term effectiveness of psychological treatments for this population. This study aims to investigate the long-term outcomes of Dialectical Behaviour Therapy for PTSD (DBT-PTSD) and Cognitive Processing Therapy (CPT) 9 months after treatment termination. This is a long-term analysis from a randomised-controlled trial of DBT-PTSD versus CPT (registration number DRKS00005578). Initially, 193 individuals with CA-related PTSD were randomly allocated to receive either DBT-PTSD ( = 98) or CPT ( = 95). The primary outcome the Clinician-administered PTSD-Scale for DSM-5 (CAPS-5) was administred at baseline, treatment completion (15 months post-randomization) and at the 9-month follow-up. Secondary outcomes included self-reported PTSD severity (PCL-5), dissociation (DSS), severity of borderline symptoms (BSL-23), and psychosocial functioning (GAF). No significant changes were observed in the primary (CAPS) and all other outcomes from post-intervention to 9-months follow-up in both the DBT-PTSD (CAPS:  = 15.60, = 14.93) and CPT group (CAPS:  = 18.80,  = 17.41). Between-group analyses at 9-months follow-up were significantly in favour of DBT-PTSD compared to CPT with small to medium effect sizes on all outcomes ranging from = 0.35 on the CAPS to = 0.57 on the BSL-23 and GAF. Our results indicate that treatment effects of psychotherapy addressing complex presentations of PTSD persist 9 months after treatment termination. In addition, the superiority of DBT-PTSD as compared to CPT found at treatment termination, was confirmed at 9-months follow-up. German Clinical Trials Register identifier: DRKS00005578..

摘要

创伤后应激障碍(PTSD)症状的复杂性与儿童期虐待(CA)有关,这给有效的心理治疗带来了挑战。因此,人们对针对这一人群的心理治疗的长期效果非常感兴趣。本研究旨在调查创伤后应激障碍的辩证行为疗法(DBT-PTSD)和认知加工疗法(CPT)在治疗结束后 9 个月的长期效果。这是一项针对 DBT-PTSD 与 CPT 的随机对照试验的长期分析(注册号 DRKS00005578)。最初,193 名患有 CA 相关 PTSD 的个体被随机分配接受 DBT-PTSD(n=98)或 CPT(n=95)治疗。主要结局是临床管理 PTSD 量表第五版(CAPS-5),在基线、治疗结束(随机分组后 15 个月)和 9 个月随访时进行评估。次要结局包括自我报告的 PTSD 严重程度(PCL-5)、分离(DSS)、边缘症状严重程度(BSL-23)和心理社会功能(GAF)。在 DBT-PTSD 组(CAPS:=15.60,=14.93)和 CPT 组(CAPS:=18.80,=17.41)中,从干预后到 9 个月随访时,主要结局(CAPS)和所有其他结局均无显著变化。在 9 个月随访时,与 CPT 相比,DBT-PTSD 在所有结局上均具有显著优势,从 CAPS 的效应大小为 0.35 到 BSL-23 和 GAF 的 0.57。我们的研究结果表明,针对 PTSD 复杂表现的心理治疗的治疗效果在治疗结束后 9 个月仍然存在。此外,在治疗结束时发现的 DBT-PTSD 优于 CPT 的优势在 9 个月随访时得到了确认。德国临床试验注册中心标识符:DRKS00005578。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b81/11370672/1cb3b2d3e062/ZEPT_A_2393061_F0001_OB.jpg

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