Do all psychological treatments really work the same in posttraumatic stress disorder?
Do all psychological treatments really work the same in posttraumatic stress disorder?
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DOI：
10.1016/j.cpr.2009.12.001
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发表时间：
2010-03
影响因子：
12.8
通讯作者：
Yule, William
中科院分区：
文献类型：
--
作者：
Ehlers, Anke;Bisson, Jonathan;Clark, David M.;Creamer, Mark;Pilling, Steven;Richards, David;Schnurr, Paula P.;Turner, Stuart;Yule, William
关键词：
Benish、Imel和Wampold最近的一项荟萃分析（2008，Clinical Psychology Review，28，746-758）得出结论，所有真正的治疗方法对创伤后应激障碍（PTSD）都同样有效。相比之下，其他7项荟萃分析或系统评价得出结论，有充分的证据表明以创伤为中心的心理治疗（以创伤为中心的认知行为疗法和眼动脱敏和再加工）对创伤后应激障碍有效;但不关注患者创伤记忆或其意义的治疗效果较差或尚未得到充分研究。因此，国际治疗指南推荐以创伤为中心的心理治疗作为PTSD的一线治疗。我们研究了可能的原因，不一致的结论，并认为，（1）现有的证据的选择程序中使用的Benish等人。（2008）的荟萃分析引入了偏见，（2）分析和结论没有考虑到需要证明创伤后应激障碍的治疗比自然恢复更有效。此外，在过去的二十年中，以创伤为中心的认知行为疗法的效果显著增加，这与治疗内容无关的结论相矛盾。为了进一步了解PTSD的最佳治疗方法，我们建议进一步研究治疗变化的积极机制，包括通常被认为是非特异性的治疗元素。我们还建议在荟萃分析中报告排除的透明度，并建议真正的治疗应根据经验和理论基础来定义，而不是通过对研究者意图的判断。
A recent meta-analysis by Benish, Imel, and Wampold (2008, Clinical Psychology Review, 28, 746–758) concluded that all bona fide treatments are equally effective in posttraumatic stress disorder (PTSD). In contrast, seven other meta-analyses or systematic reviews concluded that there is good evidence that trauma-focused psychological treatments (trauma-focused cognitive behavior therapy and eye movement desensitization and reprocessing) are effective in PTSD; but that treatments that do not focus on the patients' trauma memories or their meanings are either less effective or not yet sufficiently studied. International treatment guidelines therefore recommend trauma-focused psychological treatments as first-line treatments for PTSD. We examine possible reasons for the discrepant conclusions and argue that (1) the selection procedure of the available evidence used in Benish et al.'s (2008)meta-analysis introduces bias, and (2) the analysis and conclusions fail to take into account the need to demonstrate that treatments for PTSD are more effective than natural recovery. Furthermore, significant increases in effect sizes of trauma-focused cognitive behavior therapies over the past two decades contradict the conclusion that content of treatment does not matter. To advance understanding of the optimal treatment for PTSD, we recommend further research into the active mechanisms of therapeutic change, including treatment elements commonly considered to be non-specific. We also recommend transparency in reporting exclusions in meta-analyses and suggest that bona fide treatments should be defined on empirical and theoretical grounds rather than by judgments of the investigators' intent.
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影响因子：
5.9
作者：
FOA, EB;ROTHBAUM, BO;MURDOCK, TB
通讯作者：
MURDOCK, TB
影响因子：
4.1
作者：
Ehlers, A;Clark, DM;Fennell, M
通讯作者：
Fennell, M
影响因子：
10.6
作者：
Ehlers, A;Clark, DM
通讯作者：
Clark, DM
影响因子：
39.2
作者：
Greene, WL;Concato, J;Feinstein, AR
通讯作者：
Feinstein, AR
DOI：
10.1016/0197-2456(82)90024-1
发表时间：
1982-01-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
BLACKWELDER, WC
通讯作者：
BLACKWELDER, WC