Ehlers A, Clark D M, Dunmore E, Jaycox L, Meadows E, Foa E B
Department of Psychiatry, University of Oxford, U.K.
J Trauma Stress. 1998 Jul;11(3):457-71. doi: 10.1023/A:1024448511504.
Not all patients with posttraumatic stress disorder benefit from exposure treatment. The present paper describes two cognitive dimensions that are related to inferior response to exposure in rape victims. First, individuals whose memories during relieving of the trauma reflected mental defeat or the absence of mental planning showed little improvement. Second, inferior outcome was correlated with an overall feeling of alienation or permanent change following the trauma. These results are based on blind ratings of transcripts of exposure treatment sessions from 10 women with good outcome and 10 women with inferior outcome. Patients in the two groups were matched for initial symptom severity and were comparable in many aspects of the assault. Patients who experienced mental defeat, alienation, or permanent change may require cognitive restructuring in addition to exposure.
并非所有创伤后应激障碍患者都能从暴露疗法中获益。本文描述了与强奸受害者对暴露疗法反应较差相关的两个认知维度。首先，那些在创伤缓解过程中的记忆反映出精神挫败或缺乏心理规划的个体几乎没有改善。其次，较差的治疗结果与创伤后的疏离感或永久性改变的总体感受相关。这些结果基于对10名治疗效果良好的女性和10名治疗效果较差的女性的暴露治疗会话记录的盲评。两组患者在初始症状严重程度上相匹配，在袭击的许多方面也具有可比性。经历过精神挫败、疏离或永久性改变的患者除暴露疗法外可能还需要认知重构。
