Thought Control Strategies and Rumination in Youth with Acute Stress Disorder and Posttraumatic Stress Disorder Following Single-Event Trauma
Thought Control Strategies and Rumination in Youth with Acute Stress Disorder and Posttraumatic Stress Disorder Following Single-Event Trauma
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DOI：
10.1089/cap.2013.0052
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发表时间：
2014-02-01
影响因子：
1.9
通讯作者：
Smith, Patrick
中科院分区：
文献类型：
--
作者：
Meiser-Stedman, Richard;Shepperd, Alicia;Smith, Patrick
目的：创伤后应激障碍(PTSD)侵袭性症状的思维控制策略被认为在PTSD的发生和维持中起着关键作用。虽然在成人中对这种思维控制策略进行实证评估的方法已经存在，但相对较少的研究探索了儿童和青少年如何管理创伤后侵扰现象。方法：对10-16岁的创伤后应激障碍儿童进行前瞻性纵向研究，他们是道路交通碰撞和袭击的幸存者，在急性期评估各种思维控制策略。这些包括被认为是保护性的策略(重新评估、社会支持)以及适应不良的策略(分心、惩罚、担忧)。在随访评估中评估对创伤的反省反应。结果：每次评估时创伤后应激症状(PTSS)与惩罚的使用和重新评估有关，而社会支持和反思与PTSS症状在随访时相关。在任何时间点，分心都与PTSS无关。即使考虑到基线的创伤后应激障碍，冥想也能解释创伤后应激障碍症状的差异，并被发现在基线的重新评估和惩罚与后续评估中的创伤后应激障碍之间的关系中起中介作用。结论：本研究没有发现任何证据支持倡导任何特定的思维控制策略来管理创伤后急性阶段青少年创伤后应激障碍的侵入性症状，并提出了对重新评估应对策略的使用的关注。这项研究强调了反省反应在创伤暴露青年创伤后应激障碍的发生和维持中的重要性。
Objective: Certain thought control strategies for managing the intrusive symptoms of posttraumatic stress disorder (PTSD) are thought to play a key role in its onset and maintenance. Whereas measures exist for the empirical assessment of such thought control strategies in adults, relatively few studies have explored how children and adolescents manage posttraumatic intrusive phenomena. Methods: In a prospective longitudinal study of 10-16-year-olds with PTSD, who were survivors of road traffic collisions and assaults, a variety of thought control strategies were assessed in the acute phase. These included strategies thought to be protective (reappraisal, social support) as well as maladaptive (distraction, punishment, worry). Ruminative responses to the trauma were assessed at the follow-up assessment. Results: Posttraumatic stress symptoms (PTSS) at each assessment were associated with the use of punishment and reappraisal, whereas social support and rumination were associated with PTSS symptoms at follow-up. Distraction was unrelated to PTSS at any time point. Rumination accounted for variance in PTSS symptoms at follow-up, even when accounting for baseline PTSS, and was found to mediate the relationships between reappraisal and punishment at baseline and PTSS at the follow-up assessment. Conclusions: The present study found no evidence to support advocating any particular thought control strategy for managing the intrusive symptoms of PTSD in youth in the acute posttrauma phase, and raised concerns over the use of reappraisal coping strategies. The study underscores the importance of ruminative responses in the onset and maintenance of PTSD in trauma-exposed youth.