Rothbaum Barbara Olasov, Watkins Laura E
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta.
Am J Psychiatry. 2025 May 1;182(5):424-437. doi: 10.1176/appi.ajp.20250110.
Posttraumatic stress disorder (PTSD) symptoms are part of the normal response to trauma. Most trauma survivors will recover over time without intervention, but a significant minority will develop chronic PTSD, which is unlikely to remit without intervention. Currently, only two medications, sertraline and paroxetine, are approved by the U.S. Food and Drug Administration to treat PTSD, and the combination of brexpiprazole and sertraline and MDMA-assisted therapy have FDA applications pending. These medications, and the combination of pharmacotherapy and psychotherapy, are not recommended as first-line treatments in any published PTSD treatment guidelines. The only interventions recommended as first-line treatments are trauma-focused psychotherapies; the U.S. Department of Veterans Affairs/Department of Defense PTSD treatment guideline recommends prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing, and the American Psychological Association PTSD treatment guideline recommends PE, CPT, cognitive therapy, and trauma-focused cognitive-behavioral therapy. Although published clinical trials of psychedelic-assisted psychotherapy have not incorporated evidence-based PTSD psychotherapies, they have achieved greater response rates than other trials of combination treatment, and there is some enthusiasm about combining psychedelic medications with evidence-based psychotherapies. The state-of-the-art PTSD psychotherapies are briefly reviewed here, including their effects on clinical and neurobiological measures.
创伤后应激障碍（PTSD）症状是对创伤的正常反应的一部分。大多数创伤幸存者会随着时间推移自行康复，无需干预，但有相当少数人会发展为慢性PTSD，若无干预则不太可能缓解。目前，美国食品药品监督管理局仅批准了两种药物——舍曲林和帕罗西汀用于治疗PTSD，而布雷哌唑与舍曲林的联合用药以及MDMA辅助疗法的相关申请正在等待FDA审批。在任何已发布的PTSD治疗指南中，这些药物以及药物治疗与心理治疗的联合使用均不被推荐作为一线治疗方法。唯一被推荐作为一线治疗的干预措施是针对创伤的心理治疗；美国退伍军人事务部/国防部PTSD治疗指南推荐了延长暴露疗法（PE）、认知加工疗法（CPT）和眼动脱敏再处理疗法，而美国心理学会PTSD治疗指南推荐了PE、CPT、认知疗法和针对创伤的认知行为疗法。尽管已发表的迷幻剂辅助心理治疗临床试验未纳入基于证据的PTSD心理治疗方法，但它们取得的缓解率高于其他联合治疗试验，并且人们对将迷幻剂药物与基于证据的心理治疗方法相结合抱有一定热情。在此简要回顾一下最先进的PTSD心理治疗方法，包括它们对临床和神经生物学指标的影响。
