The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD
The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD
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DOI：
10.1016/j.brat.2009.09.001
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发表时间：
2010-01-01
影响因子：
4.1
通讯作者：
Hoogduin, Kees A. L.
中科院分区：
文献类型：
--
作者：
Hagenaars, Muriel A.;van Minnen, Agnes;Hoogduin, Kees A. L.
本研究调查了 71 名患有创伤后应激障碍 (PTSD) 的患者分离现象和抑郁对长期暴露治疗效果的影响。在治疗前使用半结构化访谈和问卷来评估诊断、合并症、治疗前抑郁症状、创伤后应激障碍症状严重程度和分离现象（特质分离、麻木和人格解体）。在治疗前的行为暴露测试中，患者被想象地暴露在（部分）创伤记忆中9分钟，在此期间评估主观恐惧。在治疗后和 6 个月的随访 PTSD 中，再次评估完成者的抑郁和分离症状 (n = 60)。治疗前，辍学者和完成者的分离和抑郁症状水平相似，分离现象和抑郁都没有预示着改善。与预期相反，在行为暴露测试中，分离现象和抑郁与增强而不是阻碍的恐惧激活有关。然而，在控制了最初的 PTSD 严重程度后，这些影响消失了。因此，目前的结果并不支持禁忌症，而是暗示即使是具有严重分离或抑郁症状的患者也可能像具有轻微分离或抑郁症状的患者一样从暴露治疗中获益。 (C) 2009 Elsevier Ltd. 保留所有权利。
This study investigates the impact of dissociative phenomena and depression on the efficacy of prolonged exposure treatment in 71 patients with posttraumatic stress disorder (PTSD). Diagnoses, comorbidity, pretreatment depressive symptoms, PTSD symptom severity, and dissociative phenomena (trait dissociation, numbing, and depersonalization) were assessed at pretreatment using semi-structured interviews and questionnaires. In a pretreatment behavioral exposure test, patients were imaginally exposed to (part of) their trauma memory for 9 min, during which subjective fear was assessed. At posttreatment and 6 months follow-up PTSD, depressive and dissociative symptoms were again assessed in the completers (n = 60). Pretreatment levels of dissociative and depressive symptoms were similar in dropouts and completers and none of the dissociative phenomena nor depression predicted improvement. Against expectations, dissociative phenomena and depression were associated with enhanced rather than impeded fear activation during the behavioral exposure test. However, these effects disappeared after controlling for initial PTSD severity. Hence, rather than supporting contraindication, the current results imply that patients presenting with even severe dissociative or depressive symptoms may profit similarly from exposure treatment as do patients with minimal dissociative or depressive symptoms. (C) 2009 Elsevier Ltd. All rights reserved.