The incorporation of emotion-regulation skills into couple- and family-based treatments for post-traumatic stress disorder.
The incorporation of emotion-regulation skills into couple- and family-based treatments for post-traumatic stress disorder.
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DOI：
10.1186/s40779-017-0130-9
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发表时间：
2017
影响因子：
21.1
通讯作者：
Glynn SM
中科院分区：
文献类型：
--
作者：
Perlick DA;Sautter FJ;Becker-Cretu JJ;Schultz D;Grier SC;Libin AV;Schladen MM;Glynn SM
创伤后应激障碍(PTSD)是一种以再体验和过度觉醒症状以及避免与创伤相关的刺激为特征的致残性、潜在的慢性障碍。越南战争的许多退伍军人和他们的伴侣所经历的痛苦，促使他们对开发联合干预措施产生了浓厚兴趣，这些干预措施既可以缓解创伤后应激障碍的核心症状，又可以加强家庭纽带。我们回顾了从越南时代到后911时代的创伤后应激障碍联合治疗的演变和证据基础。我们的审查特别侧重于治疗策略的使用，这些策略旨在解决由疾病的核心症状产生的情绪，以减少它们对退伍军人、他们的伴侣和关系的不利影响。我们提出了支持将情绪调节技能训练直接纳入创伤后应激障碍联合干预的理论基础和证据。我们首先回顾新出现的证据，这些证据表明，高水平的情绪失调是创伤后应激障碍症状的特征，并可以预测患有创伤后应激障碍的退伍军人及其家人报告的人际/婚姻困难水平。在这样做的过程中，我们提出了一个令人信服的理由，即在夫妇−/基于家庭的创伤后应激障碍治疗中，将正式技能培训包括在情绪调节中。我们进一步认为，在基于学习理论的治疗中，增加与创伤相关的记忆和情绪的暴露，要求退伍军人和他们的伴侣学会管理他们以前避免的不舒服的情绪。过去30多年开发的联合治疗方法都承认情绪在创伤后应激障碍中的重要性，但与其他治疗任务相比，它们在帮助参与者获得调整他们的策略方面存在很大差异，例如了解疾病或向所爱的人透露创伤。我们通过描述两种最近治疗创伤后应激障碍的创新疗法来结束我们的综述，这两种疗法特别强调在二元背景下的情绪调节技能训练：结构化方法疗法(SAT)和军人夫妇多家庭小组疗法(MFG-MC)。尽管将情绪调节技能结合到联合PTSD治疗中似乎很有希望，但需要复制和比较认知行为方法，以完善我们对哪些症状和退伍军人可能对一种方法比其他方法更敏感的理解。
Post-traumatic stress disorder (PTSD) is a disabling, potentially chronic disorder that is characterized by re-experience and hyperarousal symptoms as well as the avoidance of trauma-related stimuli. The distress experienced by many veterans of the Vietnam War and their partners prompted a strong interest in developing conjoint interventions that could both alleviate the core symptoms of PTSD and strengthen family bonds. We review the evolution of and evidence base for conjoint PTSD treatments from the Vietnam era through the post-911 era. Our review is particularly focused on the use of treatment strategies that are designed to address the emotions that are generated by the core symptoms of the disorder to reduce their adverse impact on veterans, their partners and the relationship. We present a rationale and evidence to support the direct incorporation of emotion-regulation skills training into conjoint interventions for PTSD. We begin by reviewing emerging evidence suggesting that high levels of emotion dysregulation are characteristic of and predict the severity of both PTSD symptoms and the level of interpersonal/marital difficulties reported by veterans with PTSD and their family members. In doing so, we present a compelling rationale for the inclusion of formal skills training in emotional regulation in couple−/family-based PTSD treatments. We further argue that increased exposure to trauma-related memories and emotions in treatments based on learning theory requires veterans and their partners to learn to manage the uncomfortable emotions that they previously avoided. Conjoint treatments that were developed in the last 30 years all acknowledge the importance of emotions in PTSD but vary widely in their relative emphasis on helping participants to acquire strategies to modulate them compared to other therapeutic tasks such as learning about the disorder or disclosing the trauma to a loved one. We conclude our review by describing two recent innovative treatments for PTSD that incorporate a special emphasis on emotion-regulation skills training in the dyadic context: structured approach therapy (SAT) and multi-family group for military couples (MFG-MC). Although the incorporation of emotion-regulation skills into conjoint PTSD therapies appears promising, replication and comparison to cognitive-behavioral approaches is needed to refine our understanding of which symptoms and veterans might be more responsive to one approach versus others.