Treating Adults With Complex Posttraumatic Stress Disorder Using a Modular Approach to Treatment: Rationale, Evidence, and Directions for Future Research
Treating Adults With Complex Posttraumatic Stress Disorder Using a Modular Approach to Treatment: Rationale, Evidence, and Directions for Future Research
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DOI：
10.1002/jts.22457
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发表时间：
2019-12-01
影响因子：
3.3
通讯作者：
Cloitre, Marylene
中科院分区：
文献类型：
--
作者：
Karatzias, Thanos;Cloitre, Marylene
ICD-11复合型PTSD（CPTSD）是一种新的疾病，因此，目前还没有临床试验评估其治疗干预措施。在本文中，我们提供了一个灵活的多模块的方法来治疗CPTSD，其可行性，并提出了一些证据表明其潜在的好处的基本原理。该方法强调了在选择经验支持的干预措施（或一组干预措施）和基于损害、严重和与患者相关的症状的交付顺序方面的灵活性。这种方法有许多潜在的好处。它可以包括使用已经有证据表明有效的干预措施，从而可以利用过去的科学努力。它也与以病人为中心的护理相一致，强调病人选择在确定目标问题、选择干预措施和监测结果方面的重要性。其他疾病的模块化治疗研究人员发现，与疾病特异性手动协议相比，灵活的多模块治疗程序在解决已确定的问题方面具有上级优势，并且与更高的治疗师满意度和减轻患者负担相关。我们简要地确定类型的干预措施，已成功地治疗创伤暴露人群以及新兴的干预措施，是相关的特定问题与暴露于复杂的创伤。最后，我们以如何组织和测试这种治疗方法的例子作为结论。现在迫切需要研究现有和新的干预方法对ICD-11 CPTSD治疗的有效性。
ICD-11 complex PTSD (CPTSD) is a new condition, and, therefore, there are as yet no clinical trials evaluating interventions for its treatment. In this paper, we provide the rationale for a flexible multimodular approach to the treatment of CPTSD, its feasibility, and some evidence suggesting its potential benefits. The approach highlights flexibility in the selection of empirically supported interventions (or a set of interventions) and the order of delivery based on symptoms that are impairing, severe, and of relevance to the patient. The approach has many potential benefits. It can incorporate the use of interventions for which there is already evidence of efficacy allowing the leveraging of past scientific efforts. It is also consistent with patient-centered care, which highlights the importance of patient choice in identification of the problems to target, interventions to select, and outcomes to monitor. Researchers on modular treatments of other disorders have found that, compared to disorder-specific manualized protocols, flexible multimodular treatment programs are superior in resolving identified problems and are associated with greater therapist satisfaction and reduced patient burden. We briefly identify types of interventions that have been successful in treating trauma-exposed populations as well as emerging interventions that are relevant to the particular problems associated with exposure to complex trauma. We conclude with examples of how such treatments can be organized and tested. Research is now urgently needed on the effectiveness of existing and new intervention approaches to ICD-11 CPTSD treatment.