Harpviken Anna Naterstad, Jensen Tine Kristin, Johnson Sverre Urnes, Ormhaug Silje Mørup, Birkeland Marianne Skogbrott
Section for Implementation and Treatment Research, Norwegian Center for Violence and Traumatic Stress Studies Oslo, Norway.
Department of Psychology, University of Oslo, Oslo, Norway.
Eur J Psychotraumatol. 2025 Dec;16(1):2515683. doi: 10.1080/20008066.2025.2515683. Epub 2025 Jul 9.
Even though evidence-based treatments are generally effective in reducing post-traumatic stress disorder (PTSD) in youth, many still experience elevated symptoms after treatment. A better understanding of how PTSD develops throughout treatment can increase efficiency and reduce residual symptoms. This study investigated which PTSD symptom clusters and symptoms within these clusters changed the most and least through trauma-focused cognitive behavioural therapy (TF-CBT), and identified common residual symptoms after treatment. Latent growth curve modelling was used to identify differences in intercepts and slopes of symptoms, and residual symptoms were identified with McNemar tests in a sample of 517 youth (aged 6-19 years, 75.6% girls) receiving TF-CBT. We found small but statistically significant differences in slopes across clusters. Avoidance both reduced the most and demonstrated most residual symptoms. Also, within clusters, many of the symptoms that reduced the most, such as psychological cue reactivity, persistent negative emotional state, and difficulties sleeping and concentrating, had the highest symptom levels before treatment and the most residual symptoms after treatment. Overall, symptoms of PTSD were reduced throughout TF-CBT. Symptoms rated highest at treatment start decreased the most but also tended to persist as common residual symptoms. Symptoms such as psychological cue reactivity, persistent negative emotional state, and negative beliefs that were common residual symptoms and are known to be central in the development and maintenance of PTSD are of particular clinical relevance. Research based on frequent symptom measurements during treatment could capture subtler changes, increasing understanding of the mechanisms of effective trauma treatment.
尽管循证治疗通常在减轻青少年创伤后应激障碍（PTSD）方面有效，但许多人在治疗后仍有症状加重的情况。更好地了解PTSD在整个治疗过程中的发展情况可以提高治疗效率并减少残留症状。本研究调查了哪些PTSD症状群以及这些症状群中的哪些症状在以创伤为重点的认知行为疗法（TF-CBT）中变化最大和最小，并确定了治疗后的常见残留症状。潜在增长曲线模型用于识别症状截距和斜率的差异，在接受TF-CBT的517名青少年（6-19岁，75.6%为女孩）样本中，通过McNemar检验确定残留症状。我们发现各症状群在斜率上存在微小但具有统计学意义的差异。回避症状减少最多且残留症状也最多。此外，在各症状群中，许多减少最多的症状，如心理线索反应性、持续的负性情绪状态以及睡眠和注意力集中困难，在治疗前症状水平最高，治疗后残留症状也最多。总体而言，PTSD症状在整个TF-CBT过程中有所减轻。治疗开始时评分最高的症状减少最多，但也往往作为常见残留症状持续存在。诸如心理线索反应性、持续的负性情绪状态以及负性信念等作为常见残留症状且已知在PTSD的发生和维持中起核心作用的症状具有特别的临床相关性。基于治疗期间频繁症状测量的研究可以捕捉到更细微的变化，增进对有效创伤治疗机制的理解。
