What works for whom and why: A narrative systematic review of interventions for reducing post-traumatic stress disorder and problematic substance use among women with experiences of interpersonal violence
What works for whom and why: A narrative systematic review of interventions for reducing post-traumatic stress disorder and problematic substance use among women with experiences of interpersonal violence
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DOI：
10.1016/j.jsat.2018.12.007
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发表时间：
2019-04-01
影响因子：
3.9
通讯作者：
Gilchrist, Gail
中科院分区：
文献类型：
--
作者：
Bailey, Karen;Trevillion, Kylee;Gilchrist, Gail
背景和目的：有人际暴力（IPV）史的女性会经历高水平的创伤后应激障碍（PTSD）、有问题的物质使用和重复受害。以前的系统综述考虑综合创伤特异性治疗解决创伤后应激障碍和物质使用的有效性，缺乏按性别或创伤类型的亚组分析。此外，以正念为基础的干预措施来同时治疗这两个问题的研究还不足。目前尚不清楚影响实施的治疗成分和背景因素对有IPV经历的妇女最有效。这篇叙述性综述审查了一系列定量和定性数据，以探讨：综合干预措施对哪些妇女群体有效（亚群体）？如何（作用机制），和/或在什么背景下（干预的外部因素）？方法学：两阶段搜索策略确定符合条件的研究。这一过程确定了20个对照试验，报告了心理或正念干预对创伤后应激障碍和物质使用的有效性，以及39个与试验相关的相关补充信息。利用主题分析对两个阶段确定的手稿进行叙事综合。研究结果：安全的社会支持和持续的暴力风险被确定为可能影响治疗结果的背景因素，需要研究人员和治疗提供者的关注。虽然有证据表明PTSD的减少与物质使用的减少有关，但可能有不止一种途径可以减少PTSD女性的物质使用，这需要关注情绪调节。其他“主动机制”包括不同形式的应对技能和支持，以重建与自我和他人的联系。由于缺乏针对既往治疗的补充研究，因此无法对这些模型进行详细讨论。结论：创伤后应激障碍和药物使用的综合治疗，教授广泛的应对技能，以促进外部安全、症状稳定和情绪调节，结合获得安全的社会支持和外部倡导，可能对患有更严重的创伤后应激障碍的妇女，或对那些正在经历的受害者来说，过去的治疗是禁忌。还应促进物质使用治疗服务的长期支持和有组织的创伤知情实践。
Background and aims: Women with histories of interpersonal violence (IPV) experience high levels of post traumatic stress disorder (PTSD), problematic substance use, and repeat victimization. Previous systematic reviews considering the effectiveness of integrated trauma-specific treatments to address PTSD and substance use have lacked sub-group analysis by gender or trauma type. Furthermore, mindfulness-based interventions for treating both issues together are under-researched. It is unclear what treatment components and contextual factors impacting implementation work best for women with IPV experiences. This narrative review examines a range of quantitative and qualitative data to explore: for which groups of women do integrated interventions work (subgroups)? How (mechanisms of action), and/or under what contexts (factors external to the intervention)?Methodology: A two-staged search strategy identified eligible studies. This process identified 20 controlled trials reporting on the effectiveness of psychological or mindfulness-based interventions for PTSD and substance use and 39 relevant supplementary information related to the trials. Narrative synthesis using thematic analysis was conducted on manuscripts identified in both stages.Findings: Safe social support and ongoing risks of violence were identified as contextual factors which may affect treatment outcomes, requiring attention by researchers and treatment providers. Whilst there was some evidence that reduced PTSD correlates with substance use decrease, there may be more than one pathway to substance use reduction among women with PTSD, requiring a focus on emotional regulation. Other 'active mechanisms' included different modalities of coping skills and support to rebuild connection with self and others. Lack of supplementary studies for trials involving past-focused treatment precluded detailed discussion of these models.Conclusions: Integrated PTSD and substance use treatment which teaches extensive coping skills to promote external safety, symptom stabilisation, and emotional regulation, combined with access to safe social support and external advocacy, may be particularly useful for women with more severe PTSD, or for those experiencing ongoing victimization for whom past-focused treatments are contraindicated. Long-term support and organisational trauma-informed practice in substance use treatment services should also be promoted.