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治疗性按摩与家庭护理以减轻创伤后应激障碍中的分离症状:一例报告

Therapeutic Massage and Homecare to Reduce Dissociation in Post-traumatic Stress Disorder: A Case Report.

作者信息

Fraser Alison

机构信息

West Coast College of Massage Therapy, Victoria, British Columbia, Canada.

出版信息

Int J Ther Massage Bodywork. 2025 Sep 11;18(3):5-13. doi: 10.3822/ijtmb.v18i3.1183. eCollection 2025 Sep.


DOI:10.3822/ijtmb.v18i3.1183
PMID:40881720
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12370312/
Abstract

INTRODUCTION: Dissociation is a transdiagnostic phenomenon common among trauma survivors. Key characteristics include depersonalization, derealization, absorption, and amnesia. Chronic dissociation is correlated with autonomic nervous system hypoarousal and other neurophysiological adaptations that impact survivors' ability to make gains in conventional psychotherapy. Therapeutic massage has demonstrated stimulatory effects on cortical regions that exhibit functional dysregulation in dissociation and post-traumatic stress disorder (PTSD). This case study explored whether therapeutic massage and homecare could reduce persistent dissociation in a client with PTSD. CASE PRESENTATION: The study participant was a 35-year-old Indigenous female who was diagnosed with PTSD at age 18. Intake assessment via the Dissociative Experiences Scale-II (DES-II) confirmed pathological levels of dissociation consistent with PTSD. Intervention comprised 10 sessions conducted by a massage therapy student over a period of 12 weeks. Each session included an initial interview, therapeutic massage, homecare prescription, and closing interview. Manual techniques were selected to promote parasympathetic tone while providing tactile stimuli; homecare techniques were selected to promote conscious proprioception. Dissociative progress was evaluated using four discrete DES-II samples, while somatic awareness was assessed during structured, 15-min massage periods in each session. Both tracked indicators showed improvement with intervention, with DES-II scores decreasing by 53.7% from initial baseline, and real-time awareness of somatic stimuli improving by 78%. These improvements were consistent with the participant's subjective reports of increased somatosensory awareness. DISCUSSION: As a low-risk intervention, therapeutic massage shows promise as an adjunct therapy in PTSD recovery. While the participant demonstrated improvements in tracked indicators, further research is needed to isolate the effects of massage from those of homecare exercises and the data collection process itself. Collaboration with psychiatry would enhance future study rigor by incorporating diagnostic assessments beyond the scope of massage therapy.

摘要

引言:分离是创伤幸存者中常见的一种跨诊断现象。其关键特征包括人格解体、现实解体、专注和失忆。慢性分离与自主神经系统唤醒不足及其他神经生理适应有关,这些会影响幸存者在传统心理治疗中取得进展的能力。治疗性按摩已被证明对在分离和创伤后应激障碍(PTSD)中表现出功能失调的皮质区域有刺激作用。本案例研究探讨了治疗性按摩和家庭护理是否能减少一名PTSD患者的持续性分离。 病例介绍:研究参与者是一名35岁的原住民女性,她在18岁时被诊断患有PTSD。通过分离体验量表-II(DES-II)进行的入院评估证实了与PTSD一致的病理性分离水平。干预措施包括一名按摩治疗专业学生在12周内进行的10次治疗。每次治疗包括一次初始访谈、治疗性按摩、家庭护理处方和结束访谈。选择手法技术来促进副交感神经张力,同时提供触觉刺激;选择家庭护理技术来促进有意识的本体感觉。使用四个独立的DES-II样本评估分离进展,同时在每次治疗中15分钟的结构化按摩期间评估躯体意识。两个追踪指标在干预后均显示出改善,DES-II分数较初始基线下降了53.7%,对躯体刺激的实时意识提高了78%。这些改善与参与者关于躯体感觉意识增强的主观报告一致。 讨论:作为一种低风险干预措施,治疗性按摩有望成为PTSD康复中的辅助治疗方法。虽然参与者在追踪指标上有所改善,但需要进一步研究以区分按摩与家庭护理练习以及数据收集过程本身的影响。与精神病学合作将通过纳入按摩治疗范围之外的诊断评估来提高未来研究的严谨性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6801/12370312/7c804736bd33/ijtmb-18-5f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6801/12370312/cc93964410bd/ijtmb-18-5f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6801/12370312/26b8960223a5/ijtmb-18-5f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6801/12370312/7c804736bd33/ijtmb-18-5f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6801/12370312/cc93964410bd/ijtmb-18-5f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6801/12370312/26b8960223a5/ijtmb-18-5f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6801/12370312/7c804736bd33/ijtmb-18-5f3.jpg

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本文引用的文献

[1]
Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients.

Eur J Psychotraumatol. 2022

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Psychol Med. 2022-7

[3]
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Exp Neurol. 2020-8

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BMC Psychiatry. 2020-1-7

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J Psychiatry Neurosci. 2017-10-2

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Am J Psychiatry. 2017-9-26

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