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

大屠杀是有史以来最具创伤的灾难之一。今天寻求心理治疗干预的幸存者，现在已经70多岁了，他们表明，由于潜在的创伤后应激障碍(PTSD)导致的抑郁或焦虑情绪，过去的负担变得难以忍受。已有的创伤后应激障碍的心理治疗方法(如认知行为疗法、心理动力疗法)主要针对中青年进行评估，很少有研究对老年患者进行研究。不存在将这些处理应用于大屠杀幸存者的特殊样本的对照研究。此外，有必要对创伤后应激障碍和其他与压力有关的精神障碍进行特定年龄的治疗。一种包括生活回顾和叙事曝光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，并且非常有效。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。在生活中经历创伤事件的老年人中，缺乏评估LRT对创伤后应激障碍症状影响的疗效研究。因此，这项研究的主要目的是评估大屠杀幸存者接受LRT治疗对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，并与支持性对照组进行比较。第二个目标是确定参与者的特征，特别是似乎从干预中受益的特征。这项拟议的研究是一项随机、对照的随访试验，包括患有一种或多种创伤相关疾病的大屠杀幸存者。LRT治疗为期6个月，共20个疗程。在治疗阶段之前和之后，都将对两种情况下的参与者进行评估。治疗后6个月进行随访。要求样本大小为80(包括辍学率)。以色列的项目合作伙伴是丹尼·布罗姆教授(耶路撒冷希伯来大学)，他是心理创伤治疗的先驱。这项研究是一个独特的机会，将丹尼·布罗姆在创伤后应激障碍治疗方面的专业知识与特定年龄的LRT治疗结合起来。他和他的团队与Amcha合作，Amcha是以色列国家大屠杀幸存者和第二代心理社会支持中心。目前约有7000名大屠杀幸存者得到Amcha的支持。这项研究的参与者将从全国六个AMCHA中心招募，并在接受LRT特殊培训后由经验丰富的心理治疗师进行治疗。对老年人的创伤相关疾病进行有效的干预非常重要，这也是因为创伤的可能性随着年龄的增加而增加。由于这项研究是在这群多次遭受创伤的人中进行的，我们相信结果可以很容易地转移到其他样本。

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.