Applying learning principles to the treatment of post-trauma reactions
Applying learning principles to the treatment of post-trauma reactions
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DOI：
10.1196/annals.1301.012
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发表时间：
2003-01-01
期刊：
影响因子：
--
通讯作者：
Davis, M
中科院分区：
文献类型：
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作者：
Rothbaum, BO;Davis, M
创伤后应激障碍(PTSD)可以被描述为康复失败，部分原因是创伤后恐惧消退的失败。通过对物种灭绝过程的研究，我们可以了解创伤后应激障碍的病因和维持。人类对创伤的正常反应包括一系列可预见的反应，包括重复经历、回避和过度觉醒，这些反应通常在创伤后的几天和几周内消失。在大多数遭受创伤的人中，这些反应会随着时间的推移而消退。然而，在相当少数的人中，灭绝失败了，这些持续的反应成为创伤后应激障碍的症状。因此，我们的一个基本假设是，创伤后应激障碍是一种疾病，部分原因是创伤后可预测的生理和心理反应未能消退。最有经验验证的创伤后应激障碍的治疗方法包括让患者在没有危险的情况下暴露于与创伤相关的线索，然后导致这些再体验、回避和唤醒症状的消退。越来越多的证据表明，患有创伤后应激障碍的个体对灭绝的抵抗力更强。关于对遭受创伤的个人的早期干预，越来越多的证据表明，一些早期的一次性干预实际上可能会阻碍灭绝，而在创伤后至少几周在不止一次会议上向继续经历高于平均水平的反应的个人提供干预措施，通常在预防创伤后应激障碍的发展方面是有效的。因此，在确定干预是有益的、有害的还是中性的过程中，干预的时机、干预会话的次数以及觉醒水平和/或风险状态之间似乎存在交互作用。
Posttraumatic stress disorder (PTSD) can be characterized as a failure of recovery caused, in part, by a failure of fear extinction after trauma. By studying the process of extinction, we can be informed regarding the etiology and maintenance of PTSD. The normal response to trauma in humans includes a set of predictable reactions including reexperiencing, avoidance, and hyperarousal that typically extinguish in the days and weeks after the trauma. In the majority of people exposed to trauma, these responses extinguish over time. However, in a substantial minority, extinction fails and these persisting responses become the symptoms of PTSD. Therefore, one of our fundamental hypotheses is that PTSD is a disorder caused in part by the failure of extinction of predictable posttraumatic physiological and psychological reactions. The most empirically validated treatments for PTSD involve exposure of the patient to trauma-related cues in the absence of danger that then lead to the extinction of these reexperiencing, avoidance, and arousal symptoms. There is also mounting evidence that individuals with PTSD are more resistant to extinction. Regarding early interventions with traumatized individuals, there is mounting evidence that some early one-time interventions actually may impede extinction, whereas interventions delivered in more than one session, at least several weeks after the trauma, to individuals continuing to experience above average reactions, generally are effective in preventing the development of PTSD. Thus, there appears to be an interaction between timing of the intervention, number of intervention sessions, and either arousal level and/or risk status in determining whether the intervention will be helpful, harmful, or neutral.