Identifying Change Targets for Posttraumatic Stress Disorder Among Suicidal and Self-Injuring Women With Borderline Personality Disorder.
Identifying Change Targets for Posttraumatic Stress Disorder Among Suicidal and Self-Injuring Women With Borderline Personality Disorder.
复制标题
确定患有边缘性人格障碍的自杀和自残女性的创伤后应激障碍的改变目标。
DOI：
10.1002/jts.22504
复制
发表时间：
2020
影响因子：
3.3
通讯作者：
Schmidt,SaraC
中科院分区：
文献类型：
--
作者：
Harned,MelanieS;Fitzpatrick,Skye;Schmidt,SaraC
对创伤后应激障碍（PTSD）心理疗法的研究越来越多地集中在了解哪些治疗方法有效，以及为什么和为谁工作。本试点研究评估了患有创伤后应激障碍、边缘性人格障碍和最近自杀的女性中五个假设的变化目标（创伤后认知、内疚、羞耻、一般情绪失调和经验性回避）与创伤后应激障碍严重程度之间的时间关系和/或自残行为。参与者（N= 26）随机接受1年的辩证行为疗法（DBT）与或不DBT延长暴露（DBT PE）的PTSD协议。在治疗期间和治疗后3个月随访时，每隔4个月评估一次潜在变化目标和PTSD。时滞混合效应模型表明，除内疚外，所有变化目标的人与人之间差异与更严重的PTSD相关，η2s = 0.32 - 0.55，除一般情绪失调外，PTSD严重程度随时间的变化率减慢，η2s = 0.20 - 0.39。在DBT中，而不是在DBT + DBT PE中，相对于他们自己的平均水平，内疚和经验回避水平较高的个体在下一个评估点时具有更严重的PTSD，η2s = 0.12 - 0.25。除了一般情绪失调（η2= 0.50）和创伤后认知（η2= 0.06）之外，所提出的改变目标和创伤后应激障碍严重程度之间的关联不是双向的。这些初步研究结果表明，创伤相关的认知，羞耻和内疚，以及调节它们的问题，可能是改善这一患者人群PTSD的重要变化目标。
Research on psychotherapies for posttraumatic stress disorder (PTSD) is increasingly focused on understanding not only which treatments work but why and for whom they work. The present pilot study evaluated the temporal relations between five hypothesized change targets—posttraumatic cognitions, guilt, shame, general emotion dysregulation, and experiential avoidance—and PTSD severity among women with PTSD, borderline personality disorder, and recent suicidal and/or self‐injurious behaviors. Participants (N= 26) were randomized to receive 1 year of dialectical behavior therapy (DBT) with or without the DBT prolonged exposure (DBT PE) protocol for PTSD. Potential change targets and PTSD were assessed at 4‐month intervals during treatment and at 3‐month posttreatment follow‐up. Time‐lagged mixed‐effects models indicated that between‐person differences in all change targets except guilt were associated with more severe PTSD, η2s = .32–.55, and, except for general emotion dysregulation, slowed the rate of change in PTSD severity over time, η2s = .20–.39. In DBT but not in DBT + DBT PE, individuals with higher levels of guilt and experiential avoidance relative to their own average had more severe PTSD at the next assessment point, η2s = .12–.25. The associations between the proposed change targets and PTSD severity were not bidirectional, except for general emotion dysregulation, η2= .50; and posttraumatic cognitions, η2= .06. These preliminary findings suggest that trauma‐related cognitions, shame, and guilt, as well as problems regulating them, may be important change targets for improving PTSD in this patient population.