Buhmann Caecilie B, Mortensen Erik Lykke, Graebe Frida Lau, Larsen Sarah K, Harder Susanne, Arnfred Sidse, Austin Stephen F
Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.
Department of Psychology, Institute for Psychology, University of Copenhagen, Copenhagen, Denmark.
Front Psychiatry. 2024 Oct 24;15:1375972. doi: 10.3389/fpsyt.2024.1375972. eCollection 2024.
Studies have shown a high prevalence of trauma and PTSD among patients with severe mental illness, but relatively few studies have examined the outcomes of PTSD treatment for this patient group. The aim of this case-series was to assess the feasibility of a Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) intervention for PTSD in people with psychosis. The study examined the possibilities and obstacles when treating this population within clinical settings. Patients were selected from four community mental health centers and were screened for traumatic experiences and symptoms of PTSD. A small group of eligible participants (n=7) received manualized TF-CBT adapted for patients with psychosis. Experienced therapists received training and supervision in the intervention. Symptoms of PTSD and psychosis were assessed at baseline and post-treatment along with quality of life, level of functioning, alliance, life events, engagement, suicidal ideation and adverse events. Treatment fidelity and the different combinations of treatment modules were monitored in regard to implementation. Three cases were selected as illustrative of the different treatment courses when implementing the TF-CBT intervention within this population. Detailed case descriptions were based on quantitative ratings and the therapists' experiences with the therapy. Results from the case series highlighted issues regarding toleration of treatment, large variation in psychopathology and the task of matching treatment needs with appropriate therapeutic techniques. The complexity of the patient group may affect treatment and clinical research studies. Lessons learned from this case series can contribute to the future development implementation and evaluation of trauma treatment for patients with psychosis.
研究表明，严重精神疾病患者中创伤和创伤后应激障碍（PTSD）的患病率很高，但针对该患者群体的PTSD治疗效果的研究相对较少。本病例系列的目的是评估针对精神病患者PTSD的创伤聚焦认知行为疗法（TF-CBT）干预的可行性。该研究考察了在临床环境中治疗这一人群时的可能性和障碍。患者从四个社区心理健康中心选取，并接受了创伤经历和PTSD症状的筛查。一小部分符合条件的参与者（n = 7）接受了针对精神病患者改编的手册化TF-CBT。经验丰富的治疗师接受了该干预的培训和督导。在基线和治疗后评估了PTSD和精神病症状，同时还评估了生活质量、功能水平、治疗联盟、生活事件、参与度、自杀意念和不良事件。对治疗保真度和治疗模块的不同组合进行了实施方面的监测。选取了三个案例来说明在该人群中实施TF-CBT干预时不同的治疗过程。详细的案例描述基于定量评分和治疗师的治疗经验。该病例系列的结果突出了治疗耐受性、精神病理学的巨大差异以及将治疗需求与适当治疗技术相匹配的任务等问题。患者群体的复杂性可能会影响治疗和临床研究。从这个病例系列中学到的经验教训有助于未来针对精神病患者创伤治疗的发展、实施和评估。
