A systematic review and meta-analysis of predictors of response to trauma-focused psychotherapy for posttraumatic stress disorder.

IF 17.3 1区 心理学 Q1 PSYCHOLOGY
Psychological bulletin Pub Date : 2024-07-01 Epub Date: 2024-06-17 DOI:10.1037/bul0000438
Dharani Keyan, Nadine Garland, Jasmine Choi-Christou, Jenny Tran, Meaghan O'Donnell, Richard A Bryant
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Abstract

Although trauma-focused psychotherapy (T-F psychotherapy) is the treatment of choice for posttraumatic stress disorder (PTSD), up to one half of patients do not respond to this treatment. Attempts to improve response to T-F psychotherapy have focused on augmenting fear extinction-based factors. Here, a systematic and meta-analytic review of predictors of T-F psychotherapy outcome was conducted with the goal of using an aggregate data-driven approach to elucidate baseline factors associated with treatment outcome. There were 114 studies that met inclusion criteria (N = 61, 970; Mage = 40.1 years; 40.1% female). There were 237 effect sizes across 24 meta-analytic categories. Poorer treatment response is associated with lower pretreatment levels of activation of fear-related brain regions, psychophysiological reactivity to fear provocation, trauma-related cognitions, anger, depression, high-risk alleles of genes linked to fear, lower levels of executive control, and social support. A range of other factors also predicted poorer responses including being male, non-Caucasian, older in age, early trauma occurrence, more trauma experience, history of combat trauma, as well as comorbid sleep, pain, poor quality life, and alcohol abuse difficulties. This review provides one potential explanation for the limited success of T-F psychotherapy augmentation strategies that have focused only on fear circuity mechanisms at the exclusion of other factors. Here, poor response relating to predictors of early trauma onset and comorbidity are consistent with clinical presentations of complex PTSD, which may suggest T-F psychotherapy is less effective for this condition. This collective evidence suggests that clinicians should consider a tailored approach that targets potential barriers to successful treatment response. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

针对创伤后应激障碍的创伤焦点心理疗法反应预测因素的系统回顾和荟萃分析。
尽管创伤心理疗法(T-F 心理疗法)是治疗创伤后应激障碍(PTSD)的首选疗法,但多达一半的患者对这种疗法没有反应。改善创伤后应激障碍心理疗法反应的尝试主要集中在增强基于恐惧消退的因素上。在此,我们对T-F心理疗法疗效的预测因素进行了系统性的荟萃分析回顾,目的是采用综合数据驱动法来阐明与疗效相关的基线因素。共有 114 项研究符合纳入标准(N = 61,970;年龄 = 40.1 岁;40.1% 为女性)。在 24 个元分析类别中有 237 个效应大小。较差的治疗反应与治疗前较低水平的恐惧相关脑区激活、对恐惧激起的心理生理反应、创伤相关认知、愤怒、抑郁、与恐惧相关基因的高风险等位基因、较低水平的执行控制和社会支持有关。一系列其他因素也预示着较差的反应,包括男性、非白种人、年龄较大、创伤发生较早、创伤经历较多、战斗创伤史,以及合并睡眠、疼痛、生活质量差和酗酒等困难。这篇综述提供了一个潜在的解释,说明为什么 T-F 心理治疗增强策略的成功率有限,因为这些策略只关注恐惧循环机制,而忽略了其他因素。在这里,与早期创伤发作的预测因素和合并症有关的不良反应与复杂创伤后应激障碍的临床表现一致,这可能表明 T-F 心理治疗对这种情况的效果较差。这些综合证据表明,临床医生应考虑针对成功治疗反应的潜在障碍采取有针对性的方法。(PsycInfo Database Record (c) 2024 APA,保留所有权利)。
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来源期刊
Psychological bulletin
Psychological bulletin 医学-心理学
CiteScore
33.60
自引率
0.90%
发文量
21
期刊介绍: Psychological Bulletin publishes syntheses of research in scientific psychology. Research syntheses seek to summarize past research by drawing overall conclusions from many separate investigations that address related or identical hypotheses. A research synthesis typically presents the authors' assessments: -of the state of knowledge concerning the relations of interest; -of critical assessments of the strengths and weaknesses in past research; -of important issues that research has left unresolved, thereby directing future research so it can yield a maximum amount of new information.
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