童年创伤与恐慌症:儿童虐待史对疾病严重程度和治疗反应的影响》(The Impact of History of Child Abuse on Illness Severity and Treatment Response.

IF 2.3 Q2 PSYCHOLOGY, CLINICAL
Sarah J Kay, John R Keefe, Barbara L Milrod, Jacques P Barber
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引用次数: 0

摘要

目的:经历过儿童虐待的患者通常临床表现复杂;儿童虐待史(HCA)是否会影响心理治疗效果尚不清楚。作者研究了儿童虐待史、临床基线变量和三种不同的惊恐障碍(PD)心理疗法后这些变量的变化之间的关系:两百名患有惊恐障碍(伴有或不伴有广场恐惧症)的成年人被随机分配到两个地点的三种治疗方法中的一种:以惊恐为重点的心理动力学心理疗法(PFPP)、认知行为疗法(CBT)或应用放松训练(ART)。比较了患有和未患有 HCA 的患者在人口统计学和临床变量方面的差异。主要分析涉及不同治疗方法之间达到恐慌症严重程度量表(PDSS)临床反应标准的几率,并通过 HCA 进行调节。这种影响通过 PDSS 和社会心理功能(希恩残疾量表)的连续结果进行检验:结果:与未患 HCA 的患者(154 人)相比,患 HCA 的患者(46 人)的 PD 症状(d=0.60)、广场恐惧症(d=0.47)和合并抑郁症(d=0.46)明显更严重;心理社会功能障碍(d=0.63)和焦虑敏感性(d=0.75)明显更差;人格障碍负担更重(d=0.45)--尤其是 C 群障碍(d=0.47)--以及人际关系问题更严重(d=0.54)。HCA 对临床反应的可能性有明显的调节作用,可预测对 ART(B=-2.05,95% CI=-4.17~-0.30,OR=0.13,z=-2.14,p=0.032)无反应,但对 CBT 或 PFPP 无反应。在预测PDSS变化斜率方面,HCA与治疗条件没有相互作用:本研究的结果突出了HCA在制定治疗建议中的重要性。提高PD患者对HCA对PD严重程度和治疗反应性影响的认识可能会改善治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Childhood Trauma and Panic Disorder: The Impact of History of Child Abuse on Illness Severity and Treatment Response.

Objective: Patients who have experienced child abuse often have complex clinical presentations; whether a history of child abuse (HCA) affects psychotherapy outcomes is unclear. The authors examined relationships between HCA, clinical baseline variables, and change in these variables after three different psychotherapies for panic disorder (PD).

Methods: Two hundred adults with PD (with or without agoraphobia) were randomly assigned to one of three treatments across two sites: panic-focused psychodynamic psychotherapy (PFPP), cognitive-behavioral therapy (CBT), or applied relaxation training (ART). Differences in demographic and clinical variables between those with and without HCA were compared. The primary analysis addressed odds of meeting clinical response criteria on the Panic Disorder Severity Scale (PDSS) between treatments, as moderated by HCA. This effect was examined via continuous outcomes on the PDSS and psychosocial functioning (Sheehan Disability Scale).

Results: Compared with patients without HCA (N=154), patients with HCA (N=46) experienced significantly more severe symptoms of PD (d=0.60), agoraphobia (d=0.47), and comorbid depression (d=0.46); significantly worse psychosocial impairment (d=0.63) and anxiety sensitivity (d=0.75); greater personality disorder burden (d=0.45)-particularly with cluster C disorders (d=0.47)-and more severe interpersonal problems (d=0.54). HCA significantly moderated the likelihood of clinical response, predicting nonresponse to ART (B=-2.05, 95% CI=-4.17 to -0.30, OR=0.13, z=-2.14, p=0.032) but not CBT or PFPP. HCA did not interact with treatment condition to predict slopes of PDSS change.

Conclusions: The results of this study highlight the importance of HCA in formulating treatment recommendations. Increased awareness of HCA's effects on severity of PD and treatment responsiveness among patients with PD may improve outcomes.

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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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