Clinicians' perspectives on cognitive-behavioral treatment for PTSD among persons with severe mental illness.
Clinicians' perspectives on cognitive-behavioral treatment for PTSD among persons with severe mental illness.
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临床医生对严重精神疾病患者创伤后应激障碍（PTSD）认知行为治疗的看法。
DOI：
10.1176/ps.2006.57.7.1027
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
Wells,Christopher
中科院分区：
文献类型：
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作者：
Frueh,BChristopher;Cusack,KarenJ;Grubaugh,AnoukL;Sauvageot,JulieA;Wells,Christopher
目的作为严重精神疾病认知-行为创伤后应激障碍(PTSD)治疗方案的中间步骤，一个焦点小组收集了公共部门精神卫生系统中临床医生和临床主管的反馈。方法在一个国家资助的社区精神卫生中心系统内，与33名临床医生和临床主管进行了5次定性焦点小组讨论。结果临床医生认为创伤是其精神卫生服务消费者生活中的一个重要不利因素，不愿与他们一起处理创伤，但认为PTSD的认知-行为治疗可能是有效和适合他们的。临床医生还提供了实用的建议，以提高拟议的认知-行为治疗计划的可行性和可接受性。例如，建立针对性别的治疗小组；确保在讨论创伤经历之前与客户建立信任和融洽关系；为客户制定仔细的安全预防措施，特别是暴露治疗部分；为一些消费者缺乏理解治疗的认知能力的可能性做好准备；与其他护理提供者合作，确保与其他护理方面的最佳整合，并将临床干扰降至最低。结论这些发现为在公共部门接受治疗的严重精神疾病患者制定和实施创伤后应激障碍干预措施提供了相关信息。
ObjectiveAs an intermediate step in the development of a cognitive-be-havioral posttraumatic stress disorder (PTSD) treatment program for persons with severe mental illness, a focus group gathered feedback from clinicians and clinical supervisors within a public-sector mental health system.MethodsFive qualitative focus group discussions were held with 33 clinicians and clinical supervisors within a state-funded community mental health center system.ResultsClinicians perceived trauma to be a significant adverse factor in the lives of their mental health services consumers, were reluctant to address trauma with them, and yet believed that cognitive-behavioral treatments for PTSD may be effective and appropriate for them. Clinicians also offered practical suggestions to improve the feasibility and acceptability of the proposed cognitive-behavioral treatment program. Examples include creating gender-specific treatment groups; ensuring that trust and rapport with clients are established before the discussion of traumatic experiences; developing careful safety precautions for clients, especially for the exposure therapy component; preparing for the possibility that some consumers will lack the cognitive ability to understand treatment; and collaborating with other care providers to ensure optimal integration with other aspects of care and minimize clinic disruptions.ConclusionsThese findings provide information relevant to the development and implementation of PTSD interventions for patients with severe mental illness treated in public-sector settings.(Psychiatric Services 57: 1027–1031, 2006)