Supplementary Material for: A Randomized Controlled Clinical Trial of Dialogical Exposure Therapy versus Cognitive Processing Therapy for Adult Outpatients Suffering from PTSD after Type I Trauma in Adulthood

Background: Although there are effective treatments for posttraumatic stress disorder (PTSD), there is little research on treatments with non-cognitive-behavioural backgrounds, such as gestalt therapy. We tested an integrative gestalt-derived intervention, dialogical exposure therapy (DET), against an established cognitive-behavioural treatment (cognitive processing therapy, CPT) for possible differential effects in terms of symptomatic outcome and drop-out rates. Methods: We randomized 141 treatment-seeking individuals with a diagnosis of PTSD to receive either DET or CPT. Therapy length in both treatments was flexible with a maximum duration of 24 sessions. Results: Dropout rates were 12.2% in DET and 14.9% in CPT. Patients in both conditions achieved significant and large reductions in PTSD symptoms (Impact of Event Scale - Revised; Hedges' g = 1.14 for DET and d = 1.57 for CPT) which were largely stable at the 6-month follow-up. At the posttreatment assessment, CPT performed statistically better than DET on symptom and cognition measures. For several outcome measures, younger patients profited better from CPT than older ones, while there was no age effect for DET. Conclusions: Our results indicate that DET merits further research and may be an alternative to established treatments for PTSD. It remains to be seen whether DET confers advantages in areas of functioning beyond PTSD symptoms.

背景：尽管创伤后应激障碍（posttraumatic stress disorder, PTSD）已有成熟有效的治疗方案，但针对非认知行为取向疗法（如格式塔疗法（gestalt therapy））的相关研究仍较为匮乏。本研究对比了整合自格式塔疗法的干预手段——对话暴露疗法（dialogical exposure therapy, DET）与临床常用的认知行为疗法——认知加工治疗（cognitive processing therapy, CPT），旨在探究二者在症状结局与脱落率方面的差异效应。
方法：本研究将141名符合创伤后应激障碍诊断、主动寻求治疗的个体随机分配至DET组或CPT组。两种治疗方案的疗程均采用灵活设置，最长治疗时长为24次会谈。
结果：DET组的脱落率为12.2%，CPT组为14.9%。两组患者的创伤后应激障碍症状均出现显著且大幅的改善（采用事件影响量表-修订版（Impact of Event Scale - Revised）评估；DET组的Hedges' g值为1.14，CPT组为1.57），且该改善在6个月随访时基本保持稳定。在治疗后评估中，CPT组在症状与认知维度的测量指标上表现优于DET组，差异具有统计学意义。此外，多项结局指标显示，年轻患者从CPT中获益优于年长患者，而DET的疗效未受年龄因素影响。
结论：本研究结果表明，对话暴露疗法（DET）值得开展进一步研究，或可作为创伤后应激障碍现有标准治疗的替代方案。至于DET是否能在创伤后应激障碍症状以外的功能领域展现优势，仍有待后续研究验证。