Feasibility of brief intensive exposure therapy for PTSD patients with childhood sexual abuse: a brief clinical report

Despite the strong empirical support for the effectiveness of exposure-based treatments in ameliorating post-traumatic stress disorder (PTSD), improvement of treatment is wanted given relatively high dropout rates and challenges of treating patients with high comorbidity and treatment-interfering stressors. The purpose of the current paper is to introduce an intensive exposure treatment program, illustrated by four case descriptions of PTSD patients, who suffered multiple (sexual) traumas in childhood, had high levels of comorbidity and psychosocial stressors, and failed to improve during “regular” trauma-focused treatment programs. The program consisted of psychoeducation, prolonged imaginal exposure, exposure <i>in vivo</i>, exposure by drawings combined with narrative reconstructing, and writing assignments about central trauma-related cognitions. The treatment included 5 working days with individual sessions (in total 30 h of treatment) provided by a team of four therapists. The PTSD symptoms of all patients decreased substantially and the effect sizes were large (Cohen's d resp. 1.5 [pre–post], 2.4 [pre-FU1 month], and 2.3 [pre-FU3 months]). Also, none of the patients showed symptom worsening or dropped out. The evaluation of these four pilot cases suggests that it is possible to intensify exposure treatment, even for multiple traumatized PTSD patients with high comorbidity. We concluded that the first results of this new, intensive exposure program for PTSD patients with childhood sexual abuse are promising. For abstract or full text in other languages, please see Supplementary files under Reading Tools online

尽管基于暴露的疗法在改善创伤后应激障碍（post-traumatic stress disorder, PTSD）方面具备坚实的实证支持，但鉴于其相对较高的患者脱落率，以及治疗共病水平较高且存在干扰治疗的应激源的患者所面临的挑战，仍需对该类疗法进行改进。本文旨在介绍一种强化型暴露治疗方案，并辅以4例PTSD患者的病例阐释：这些患者童年时期曾遭受多次（性）创伤，共病水平较高且伴随显著社会心理应激源，且在“常规”创伤聚焦疗法中未获得症状改善。
该治疗方案涵盖心理教育、延长想象暴露、实景暴露（in vivo）、结合叙事重构的绘画暴露，以及针对核心创伤相关认知的写作任务。治疗由四名治疗师组成的团队实施，共持续5个工作日，包含个体诊疗环节，总治疗时长达30小时。
所有患者的PTSD症状均出现显著缓解，效应量均较大（科恩d值分别为：前测-后测1.5、前测-1个月随访2.4、前测-3个月随访2.3）。此外，无任何患者出现症状恶化或治疗脱落的情况。
对这4例先导病例的评估结果显示，即便针对存在多次创伤史且共病水平较高的PTSD患者，强化暴露疗法也具备实施可行性。我们由此得出结论：针对童年期遭受性虐待的PTSD患者的新型强化暴露疗法，其初步结果颇具应用前景。如需获取其他语言的摘要或全文，请参阅在线阅读工具项下的补充文件。