多模式心理动力住院康复治疗后复杂性创伤后应激障碍（CPTSD）症状的长期改善——一项单中心观察性试点研究

Long-Term Improvements of Complex Post-Traumatic Stress Disorder (CPTSD) Symptoms After Multimodal Psychodynamic Inpatient Rehabilitation Treatment-An Observational Single Center Pilot Study.

作者信息

Riedl David, Thaler Jürgen, Kirchhoff Christina, Kampling Hanna, Kruse Johannes, Nolte Tobias, Campbell Chloe, Grote Vincent, Fischer Michael J, Lampe Astrid

机构信息

Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria.

University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria.

出版信息

J Clin Psychol. 2025 Aug;81(8):739-754. doi: 10.1002/jclp.23809. Epub 2025 May 12.

DOI:10.1002/jclp.23809

PMID:40353723

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12228083/

Abstract

BACKGROUND

Complex post-traumatic stress disorder (CPTSD) is a severely disabling mental health condition, frequently observed in survivors of prolonged, repeated or multiple traumatic stressors. While studies indicate that engaging in psychotherapy can reduce CPTSD symptom severity, data on long-term effectiveness of interventions is scarce. The aim of this study was to evaluate long-term CPTSD trajectories of affected individuals after a 6-week multimodal psychodynamic inpatient rehabilitation treatment.

METHODS

In this observational single center study participants completed questionnaires on CPTSD symptoms (ITQ), anxiety, depression, and somatization (BSI-18), functional impairment (WHODAS-12), mentalizing (MZQ-6) and epistemic trust, mistrust and credulity (ETMCQ) before (T1) and at the end of treatment (T2) as well as > 12 months after treatment. Repeated measures analyses of variance (ANOVAs) and reliable change index (RCIs) for the ITQ as primary outcome variable were calculated to evaluate mean symptom change. The influence of a range of potential factors affecting change was evaluated using correlation coefficients and ANOVAs.

RESULTS

A total of n = 38 individuals diagnosed with CPTSD completed the questionnaires 14-28 (median: 21.2) months after treatment. Participants reported a significant reduction of CPTSD symptoms with large effect sizes at follow-up (p < 0.001, d = 1.70) as well as reduced symptoms of depression (p = 0.009, d = 0.84) and anxiety (p = 0.009, d = 0.1.24) and improved social participation (p = 0.012, d = 1.06). At follow-up, 59% of participants no longer fulfilled CPTSD criteria. Improved epistemic trust (r = -0.43, p = 0.007), and reduced epistemic credulity (r = 0.44, p = 0.006) were associated with reduced CPTSD symptoms.

DISCUSSION

To the authors knowledge, this is the first study to report long-term CPTSD symptom trajectories after psychodynamic inpatient treatment. The results indicate lasting symptom change and identify improvements in epistemic trust as associated with symptom change. Due to the observational nature of the study, no causal attributions as to the effectiveness of the treatment can be drawn.

摘要

背景

复杂性创伤后应激障碍（CPTSD）是一种严重致残的心理健康状况，常见于经历长期、反复或多重创伤性应激源的幸存者。虽然研究表明，进行心理治疗可以减轻CPTSD症状的严重程度，但关于干预措施长期有效性的数据却很稀少。本研究的目的是评估受影响个体在接受为期6周的多模式心理动力住院康复治疗后的长期CPTSD轨迹。

方法

在这项观察性单中心研究中，参与者在治疗前（T1）、治疗结束时（T2）以及治疗后超过12个月完成了关于CPTSD症状（ITQ）、焦虑、抑郁和躯体化（BSI-18）、功能损害（WHODAS-12）、心理化（MZQ-6）以及认知信任、不信任和轻信（ETMCQ）的问卷调查。计算以ITQ作为主要结果变量的重复测量方差分析（ANOVA）和可靠变化指数（RCI），以评估平均症状变化。使用相关系数和方差分析评估一系列影响变化的潜在因素的影响。

结果

共有n = 38名被诊断为CPTSD的个体在治疗后14 - 28个月（中位数：21.2个月）完成了问卷调查。参与者报告称，随访时CPTSD症状显著减轻，效应量较大（p < 0.001，d = 1.70），抑郁症状（p = 0.009，d = 0.84）和焦虑症状（p = 0.009，d = 1.24）也有所减轻，社会参与度有所提高（p = 0.012，d = 1.06）。随访时，59%的参与者不再符合CPTSD标准。认知信任的改善（r = -0.43，p = 0.007）和认知轻信的降低（r = 0.44，p = 0.006）与CPTSD症状的减轻相关。