Life Review Therapy for Holocaust Survivors (LRT-HS): A randomised controlled trial

大屠杀是有史以来最具创伤性的灾难之一。今天，寻求心理治疗干预的幸存者，现在已经七十多岁了，他们表示，由于潜在的创伤后应激障碍（PTSD），过去的负担变得越来越难以忍受，他们的情绪变得沮丧或焦虑。已有的PTSD心理治疗方法（如认知行为疗法、心理动力疗法）主要在中青年中进行评估，只有很少的研究对老年人进行了调查。目前还没有对照研究将这些治疗方法应用于大屠杀幸存者的特殊样本。此外，有必要针对创伤后应激障碍和其他与压力相关的精神障碍进行年龄特异性治疗。包括生命回顾和叙事曝光在内的叙事方法似乎很好地满足了老年人回顾自己生活的自然需要，并且是非常有效的。然而，大多数关于生活回顾疗法（LRT）疗效的研究都集中在老年抑郁症上。目前缺乏评估LRT对生活中经历过创伤性事件的老年人PTSD症状影响的疗效研究。因此，本研究的主要目的是评估与支持性对照组相比，LRT对大屠杀幸存者创伤后应激障碍症状和相关心理健康问题（抑郁、焦虑、长期悲伤）的影响。第二个目标是确定参与者的特征，尤其是那些似乎从干预中受益的特征。拟议的研究是一项随机对照随访试验，包括患有一种或多种创伤相关疾病的大屠杀幸存者。LRT治疗包括20个疗程，为期6个月。在治疗阶段之前和之后，两种情况下的参与者都将被评估。随访将在治疗后6个月进行。需要80个样本量（包括退出率）。以色列的项目合作伙伴是耶路撒冷希伯来大学的Danny Brom教授，他是心理创伤治疗的先驱。目前的研究是将Danny Brom在PTSD治疗方面的专业知识与年龄特异性LRT治疗相结合的独特机会。他和他的团队与以色列国家大屠杀幸存者和第二代心理社会支持中心Amcha合作。目前约有7000名大屠杀幸存者得到Amcha的支持。本研究的参与者将从全国六个Amcha中心招募，并在经过LRT的特殊培训后由经验丰富的心理治疗师进行治疗。对老年人创伤相关疾病的有效干预非常重要，因为创伤的可能性随着年龄的增长而增加。因为这项研究是在一群受过多重创伤的人身上进行的，我们相信结果可以很容易地转移到其他样本上。

The Holocaust was one of the most traumatic catastrophes ever. Survivors seeking psychotherapeutic intervention today, now in their seventies and older, show the burden of the past becoming less endurable by a depressed or anxious mood as a result of an underlying posttraumatic stress disorder (PTSD). Established psychological treatments for PTSD (e.g., cognitive behavior therapy, psychodynamic therapies) have been evaluated mainly with young and middle-aged adults, only very few studies investigated them in old age. No controlled study exists applying those treatments to the special sample of Holocaust survivors. Moreover, there is a need for an age-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of live review therapy (LRT) focus on late-life depression. There is a lack of efficacy studies evaluating the effect of LRT on PTSD symptoms in older individuals that have experienced traumatic events during their lives. Thus, the main goal of this study is to evaluate the effect of LRT for Holocaust survivors on symptoms of PTSD and related mental health problems (depression, anxiety, prolonged grief), compared to a supportive control group. A secondary goal is to identify features of participants that especially seem to benefit from the intervention. The proposed study is a randomized, controlled follow-up trial including Holocaust survivors with one or more trauma-related disorders. The LRT treatment consists of 20 sessions over 6 months. Before and after the treatment phase, participants in both conditions will be assessed. Follow-up will take place at 6 months post-treatment. A sample size of 80 is required (drop-out rate included). The Israeli project partner is Prof. Dr. Danny Brom (Hebrew University of Jerusalem) who is a pioneer in psychological trauma treatment. The present study is a unique opportunity to combine the expertise of Danny Brom in PTSD treatment with the age-specific LRT treatment. He and his team cooperate with Amcha, the National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation. About 7000 Holocaust survivors are currently supported by Amcha. The participants of this study will be recruited from six Amcha centres across the country and treated by experienced psychotherapists after a special training in LRT. Efficacious interventions for trauma-related disorders in older people are of high importance, also because the probability of traumatization increases with age. Because of the fact that this study is conducted with this group of multiply traumatized people, we are convinced that the results can easily transferred to other samples.