针对创伤后应激障碍的人际心理疗法和心理动力学心理疗法的元分析。

IF 2.3 Q2 PSYCHOLOGY, CLINICAL
John R Keefe, Duncan Kimmel, Erica Weitz
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引用次数: 0

摘要

目的:针对创伤后应激障碍(PTSD)的以创伤为重点的认知行为疗法的缓解率约为 30%-40%。另外,人际交往心理疗法(IPT)和心理动力学心理疗法(PDT)主要针对创伤后应激障碍中的依恋、心理化和社会联系障碍,可能会对一些患者有所帮助。作者对这些以人际关系和情感为导向的创伤后应激障碍治疗方法进行了一项荟萃分析:在之前荟萃分析的基础上,作者搜索了随机对照试验(RCT),比较了 IPT 或 PDT 与其他已确立的创伤后应激障碍治疗方法或对照条件对确诊为创伤后应激障碍的成人的治疗效果。随机效应荟萃分析用于评估结果效应大小和辍学率。通过随机对照试验心理疗法质量评定量表(Randomized Controlled Trial Psychotherapy Quality Rating Scale)对RCT进行评分:共确定了 10 项将 IPT 或 PDT 与对照(k=7)或积极治疗(k=4)条件进行比较的 RCT(其中 8 项为 IPT),其中 9 项具有足够的质量。综合分析后,IPT(k=5)和 PDT(k=2)总体上优于对照组(g=-1.14,p=0.011 [单用 IPT 也是如此:g=-0.88,p=0.034]),也优于等待组(g=-1.49)和照常治疗组(g=-0.70)。然而,效应大小可能因异常值或发表偏差而被夸大。IPT(k=3)和PDT(k=1)一起分析时,与其他积极的创伤后应激障碍治疗方法(主要是暴露型心理疗法)相比,疗效相当,单用IPT时的辍学率也较低(IPT和PDT一起分析时,相对风险=0.63,p=0.049;单用IPT时,相对风险=0.61,p=0.098):以情感为中心的疗法有望治疗创伤后应激障碍。IPT已在多项试验中证明了其疗效,而PDT的证据基础尚不充分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Meta-Analysis of Interpersonal and Psychodynamic Psychotherapies for Posttraumatic Stress Disorder.

Objective: Established trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder (PTSD) have remission rates of approximately 30%-40%. Alternatively, interpersonal psychotherapy (IPT) and psychodynamic psychotherapy (PDT) focus on disrupted attachment, mentalization, and social connection in PTSD and may help some patients. The authors conducted a meta-analysis on these interpersonal and affect-oriented approaches to treating PTSD.

Methods: Building on a prior meta-analysis, the authors searched for randomized controlled trials (RCTs) comparing IPT or PDT with other established PTSD treatments or control conditions for adults diagnosed as having PTSD. Random-effects meta-analyses were conducted to assess outcome effect sizes and dropout rates. RCTs were rated via the Randomized Controlled Trial Psychotherapy Quality Rating Scale.

Results: Ten RCTs (eight of IPT) comparing IPT or PDT with control (k=7) or active treatment (k=4) conditions were identified, nine of which were of adequate quality. IPT (k=5) and PDT (k=2), when analyzed together, were superior to control conditions overall (g=-1.14, p=0.011 [as was IPT alone: g=-0.88, p=0.034]) and to waitlist (g=-1.49) and treatment-as-usual (g=-0.70) groups. Effect sizes, however, may have been inflated by outliers or publication bias. IPT (k=3) and PDT (k=1), when analyzed together, were equally efficacious compared with other active PTSD treatments (primarily exposure-based psychotherapies), as was IPT alone, and had lower dropout rates (relative risk=0.63, p=0.049 for IPT and PDT analyzed together; relative risk=0.61, p=0.098 for IPT alone).

Conclusions: Affect-focused therapies hold promise in the treatment of PTSD. IPT has demonstrated efficacy in multiple trials, whereas the evidence base for PDT is sparse.

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来源期刊
AMERICAN JOURNAL OF PSYCHOTHERAPY
AMERICAN JOURNAL OF PSYCHOTHERAPY PSYCHOLOGY, CLINICAL-
CiteScore
2.90
自引率
4.00%
发文量
39
期刊介绍: Founded in 1939, the American Journal of Psychotherapy (AJP) has long been a leader in the publication of eclectic articles for all psychotherapists. Transtheoretic in reach (offering information for psychotherapists across all theoretical foundations), the goal of AJP is to present an overview of the psychotherapies, subsuming a host of schools, techniques, and psychological modalities within the larger domain of clinical practice under broad themes including dynamic, behavioral, spiritual, and experiential.
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