在退伍军人中同时发生的创伤后应激障碍和强迫症障碍的基于暴露的治疗:大规模模型的可行性
Stephanie M Haft1,2, Sheila A M Rauch1,2, Barbara O Rothbaum1
1Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA.
Journal of traumatic stress
|September 27, 2025
概括
暴露治疗模式结合暴露和反应预防 (ERP) 和长期暴露 (PE) 有效地减少了退伍军人同时出现强迫症 (OCD) 和创伤后应激障碍 (PTSD) 的症状. 综合和序列方法显示可靠的症状改善.
科学领域:
- 精神病学和行为科学 精神病学和行为科学
- 临床心理学 临床心理学
- 创伤研究 创伤研究
背景情况:
- 基于暴露的疗法,包括强迫症 (OCD) 的暴露和反应预防 (ERP) 和创伤后应激障碍 (PTSD) 的长期暴露 (PE),是黄金标准的治疗方法.
- 同时出现的强迫症和创伤后应激障碍很普遍,但对基于暴露的综合干预措施的研究仍然有限.
- 退伍军人代表着强迫症和创伤后应激障碍的比例很高的人群,需要量身定制的治疗方法.
研究的目的:
- 试点和评估四种不同的基于暴露的治疗模式,用于患有强迫症和PTSD同时发生的退伍军人.
- 为了比较顺序与集成ERP和PE治疗方法的疗效.
- 确定有效的策略来测序和整合对伴随性疾病的暴露疗法.
主要方法:
- 结合ERP和PE的四种治疗模式在临床环境中进行了试点测试:两个顺序 (大规模PE然后间隔ERP;间隔ERP然后大规模ERP/PE) 和两个集成 (ERP与PE元素;PE与ERP元素).
- 案例研究说明了每一种治疗方法.
- 对强迫症和PTSD的症状严重程度进行了评估,以确定可靠的变化 (RC).
主要成果:
- 测序 (模型2) 和集成 (模型3和4) 方法都显示了强迫症和PTSD症状严重程度的显著降低.
- 在想象性PE暴露之前强调强迫症心理教育和响应预防的模型特别有效.
- 在强迫症 (RC = 2.35-4.06) 和PTSD (RC = 4.46-7.39) 中观察到可靠的变化.
结论:
- 基于暴露的治疗方法,当适当地调整和排序时,可以有效地管理退伍军人同时出现的强迫症和PTSD.
- 结合ERP和PE元素的综合模型,首先关注OCD管理,显示出有希望的结果.
- 建议进一步进行大规模,严格的研究,以优化共患性强迫症和PTSD的暴露治疗方案.
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