Burback Lisa, Winkler Olga, Jetly Rakesh, Swainson Jennifer, Zhang Yanbo, Bhat Venkat, Vermetten Eric
Department of Psychiatry, University of Alberta Faculty of Medicine and Dentistry, Alberta, Canada.
The Institute of Mental Health Research, University of Ottawa, Royal Ottawa Hospital, Ottawa, Canada.
Psychiatry Clin Psychopharmacol. 2025 Aug 11;35(Suppl 1):S152-S167. doi: 10.5152/pcp.2025.241019.
Traditional trauma-focused psychotherapies (TFPs) were developed based on an anxiety disorder model of posttraumatic stress disorder (PTSD). However, PTSD is a more complex disorder with heterogeneous onset, presentation, trajectory, and treatment responsivity. As half of treated patients do not respond to first-line treatments, innovative therapies are emerging to improve outcomes. This narrative review of therapist-delivered psychotherapies for PTSD focuses on interventions not yet endorsed by clinical guidelines. A systematic search of MEDLINE and American Psychological Association PsycINFO was conducted for English-language human clinical studies, guidelines, and reviews related to PTSD psychotherapy through June 29, 2024. Data were thematically analyzed, focusing on how emerging interventions modify or diverge from current guideline-recommended treatments. The review identified 4 key themes for improving trauma therapy: (1) optimizing existing TFPs, (2) adapting psychotherapies used for other conditions, (3) reimagining exposure therapies, and (4) new therapeutic modalities. New exposure treatments include those capitalizing on memory reconsolidation science, combination with pharmacotherapies, neuromodulation, or virtual reality technologies, and mind-body and somatic psychotherapies. Moral injury, identity, and spirituality-focused therapies aim to resolve intense internal conflicts, guilt and shame, and issues of meaning and purpose. Finally, multi-modal treatments like 3MDR and psychedelic-assisted psychotherapies have multiple synergistic mechanisms. Ongoing research will be crucial to validating emerging approaches and optimizing their combined potential. A PTSD staging model may provide a structured framework for rigorous empirical evaluation and clinical implementation. Future research should prioritize randomized controlled trials with diverse patient populations and long-term follow-up to ensure their safety, efficacy, and scalability.
传统的创伤聚焦心理疗法（TFPs）是基于创伤后应激障碍（PTSD）的焦虑症模型发展而来的。然而，PTSD是一种更为复杂的疾病，其发病、表现、病程和治疗反应性具有异质性。由于一半接受治疗的患者对一线治疗无反应，创新疗法正在涌现以改善治疗效果。这篇关于治疗师提供的PTSD心理疗法的叙述性综述聚焦于尚未得到临床指南认可的干预措施。通过对MEDLINE和美国心理学会PsycINFO进行系统检索，查找截至2024年6月29日与PTSD心理治疗相关的英文人类临床研究、指南和综述。对数据进行了主题分析，重点关注新兴干预措施如何修改或偏离当前指南推荐的治疗方法。该综述确定了改善创伤治疗的4个关键主题：（1）优化现有的TFPs，（2）改编用于其他病症的心理疗法，（3）重新构想暴露疗法，以及（4）新的治疗模式。新的暴露疗法包括利用记忆巩固科学、与药物疗法、神经调节或虚拟现实技术相结合的疗法，以及身心和躯体心理疗法。以道德伤害、身份认同和精神性为重点的疗法旨在解决强烈的内心冲突、内疚和羞耻感以及意义和目的问题。最后，像3MDR和迷幻剂辅助心理疗法这样的多模式治疗具有多种协同机制。正在进行的研究对于验证新兴方法并优化其综合潜力至关重要。一个PTSD分期模型可能为严格的实证评估和临床实施提供一个结构化框架。未来的研究应优先开展针对不同患者群体的随机对照试验并进行长期随访，以确保其安全性、有效性和可扩展性。
