GGZ Delfland, Delft, The Netherlands.
Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands.
Eur J Psychotraumatol. 2024;15(1):2407222. doi: 10.1080/20008066.2024.2407222. Epub 2024 Oct 15.
Clinicians are often hesitant to use trauma-focused therapy for patients with personality disorders (PDs) because of concerns that the pathology may worsen. Exploring trajectories of change and individual exacerbations in psychological distress and suicidal thoughts in patients with a PD without comorbid posttraumatic stress disorder (PTSD) during EMDR therapy or waiting time. In a randomized controlled trial, the effectiveness of five sessions of EMDR therapy was compared with a waitlist in 97 outpatients. Acute suicidal patients were not included in this study. Psychological distress and suicidality scores were measured on a weekly basis during the EMDR and waiting list (WL) periods and at 3-month follow-up. Data were analysed in a descriptive manner for individual patients, and hierarchical cluster analysis was used to identify patterns of change among clusters of patients. Mann-Whitney U and chi-squared tests were used to explore differences in specific patient characteristics between the found clusters of patients. Patients generally improved, and no clusters of patients deteriorated during the EMDR therapy. Session-to-session exacerbations occurred in both the EMDR (psychological distress: 10.0%; suicidal thoughts: 28.0%) and WL group (psychological distress: 28.0%; suicidal thoughts: 43.5%). Two percent of patients in the EMDR group and 8.7% of patients in the WL condition showed an increase in psychological distress, whereas 2.0% of patients in the EMDR group and 10.9% of patients in the WL condition showed an increase in suicidal thoughts posttreatment compared to baseline. These results show that although individual exacerbations in psychological distress and suicidal thoughts occur, these were less likely to occur in response to EMDR therapy compared with no therapy. Continuation of therapy following exacerbation led to a decrease in psychological distress and suicidal thoughts in most patients.
临床医生在为患有人格障碍 (PD) 的患者使用创伤焦点治疗时常常犹豫不决，因为他们担心病理学可能会恶化。在 EMDR 治疗或等待期间，探索无共患创伤后应激障碍 (PTSD) 的 PD 患者的心理困扰和自杀意念的变化轨迹和个体恶化情况。在一项随机对照试验中，将 97 名门诊患者的 5 次 EMDR 治疗与等待名单进行了比较。本研究未纳入急性自杀患者。在 EMDR 和等待名单 (WL) 期间以及 3 个月随访时，每周测量一次心理困扰和自杀得分。对个体患者进行描述性数据分析，并使用层次聚类分析来识别患者聚类之间的变化模式。使用 Mann-Whitney U 和卡方检验来探索发现的患者聚类之间特定患者特征的差异。患者总体上有所改善，在 EMDR 治疗期间没有患者群恶化。在 EMDR（心理困扰：10.0%；自杀意念：28.0%）和 WL 组（心理困扰：28.0%；自杀意念：43.5%）中都发生了治疗过程中的恶化。EMDR 组中有 2%的患者和 WL 组中有 8.7%的患者在治疗后出现心理困扰增加，而 EMDR 组中有 2.0%的患者和 WL 组中有 10.9%的患者在治疗后出现自杀意念增加。这些结果表明，尽管心理困扰和自杀意念会出现个体恶化，但与不治疗相比，EMDR 治疗更不可能引起这些恶化。在恶化后继续治疗会导致大多数患者的心理困扰和自杀意念减少。
