咨询师如何帮助PTSD来访者面对创伤？（part 2）

　　关于创伤后应激障碍(PTSD)、精神创伤（trauma）以及可用的治疗和资源,而以下将会带大家了解，心理咨询中的具体一些手段与细节。

　　01. 利用CBT作为治愈创伤的工具

　　咨询师在使用CBT治疗创伤时，可采用的方式是多变的。以下将介绍在各个阶段所需要做的工作，以及会用到治疗方式。

　　（1）评估症状

　　第一步需要通过访谈评估来访者，收集ta们在创伤、诱因和症状方面的信息，以便提供最佳的治疗计划。

　　（2）治疗的基本原理

　　接下来，向来访者深入分析和概述ta们的PTSD症状，并通过易于理解的类比，让ta们了解自己的创伤。

　　（3）消除对思想的压抑

　　告诉来访者不要压制想法，而是要让思想自然而然地产生。这样会消除对痛苦想法的回避，帮助ta们面对并解决恐惧。

　　（4）心理教育

　　心理教育将帮助来访者对PTSD有更多认识，了解大脑对创伤和暴露的反应，以及为什么创伤记忆没有得到处理（Bremner，2006）。

　　（5）放松的方法

　　利用放松的方法来帮助受访者减轻压力。比如呼吸练习、引导想象和肌肉放松。

　　（6）认知结构调整

　　帮助受访者在安全条件下重温ta们的创伤。针对特定的区域，让受访者逐一描述事件的细节，就像让ta们重温那段经历一样。这一步骤将帮助受访者处理创伤记忆。

　　（7）识别触发因素

　　在这个阶段，帮助受访者识别那些会引起负面想法的侵入性记忆重新出现的触发因素。

　　帮助ta们区分这些触发因素，并认识到这些触发因素与创伤事件本身是无关的，同时学习如何将这些触发因素与创伤事件分离。

　　（8）想象技术

　　想象技术有助于改变记忆的意义（Arntz，2012）。让受访者从不同的角度看待自己的想象。这种技术将帮助受访者提高他们的洞察力，从而让创伤信息得到更有效的处理。

　　02. 关于PTSD患者团体治疗的说明

　　如果来访者正在寻求PTSD的治疗，咨询师需要帮助ta们选择是个人还是团体治疗。

　　以下几点可能有助于受访者做出正确的决定。

　　（1）验证问题

　　受访者会看到团体中其ta人所经历的睡眠、食欲、认知、愤怒和情绪问题。这有助于受访者验证自己是否有相同的经历。

　　（2）帮助ta人

　　帮助ta人可以促进受访者在应对和管理PTSD症状方面的自尊、信念和自信心。

　　（3）社会支持

　　团体治疗可以帮助患有PTSD的人克服创伤的负面影响。受访者会感到自己并不孤独，并形成一个互相支持的网络。

　　（4）咨询师个人关注点的局限性

　　团体治疗的一个缺点是，咨询师的注意力会被参与者分担。一些受访者可能会觉得自己需要治疗师更多的关注，而这种关注只能通过个人治疗而不是团体治疗来获得。

　　（5）保密性

　　患有PTSD的人可能会有不信任和偏执的感觉，会对ta人的意图有偏颇的判断（Freeman等人，2013）。

　　ta们可能不愿意敞开心扉，不愿在团体中分享经历。咨询师在决定采取哪种干预方式时，需要考虑到这一点。

　　03. 最后想说

　　人的一生中，创伤会不可避免地至少会出现一次，甚至不止一次（Copeland，2007）。更不幸的是，当创伤没有得到解决就会发展成PTSD。

　　PTSD被认为是 "炮弹休克 "和 "战斗创伤 "的时代已经过去了，现在它被认为是属于正式焦虑症的一组症状。

　　这篇文章对创伤、PTSD和治疗途径提供了非常丰富的信息，不过这是关于PTSD心理治疗的第二部分，感兴趣的朋友可以点击下方链接来查看第一部分。

　　References：

　　American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

　　Aranda, B. D. E., Ronquillo, N. M., & Calvillo, M. E. N. (2015). Neuropsychological and physiological outcomes pre- and post-EMDR therapy for a woman with PTSD: A case study. Journal of EMDR Practice and Research, 9(4), 174–187.

　　Arntz, A. (2012). Imagery rescripting as a therapeutic technique: Review of clinical trials, basic studies, and research agenda. Journal of Experimental Psychopathology, 3(2), 189–208.

　　Beals, J., Manson, S. M., Croy, C., Klein, S. A., Whitesell, N. R., Mitchell, C. M., & AI-SUPERPFP Team. (2013). Lifetime prevalence of posttraumatic stress disorder in two American Indian reservation populations. Journal of Traumatic Stress, 26(4), 512–520.

　　Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20–28.

　　Bremner J. D. (2006). Traumatic stress: effects on the brain. Dialogues in Clinical Neuroscience, 8(4), 445–461.

　　Brewin, C. R., Dalgleish, T., & Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review, 103(4), 670–686.

　　Bryant, R. A., Friedman, M. J., Spiegel, D., Ursano, R., & Strain, J. (2011). A review of acute stress disorder in DSM-5. Depression and Anxiety, 28(9), 802–817.

　　Bub, K., & Lommen, M. J. J. (2017). The role of guilt in posttraumatic stress disorder. European Journal of Psychotraumatology, 8(1), 1407202.

　　Chen, R., Gillespie, A., Zhao, Y., Xi, Y., Ren, Y., & McLean, L. (2018). The efficacy of eye movement desensitization and reprocessing in children and adults who have experienced complex childhood trauma: A systematic review of randomized controlled trials. Frontiers in Psychology, 11(9), 534.

　　Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64(5), 577–584.

　　Creamer, M., Burgess, P., & McFarlane, A. C. (2001). Post-traumatic stress disorder: Findings from the Australian National Survey of Mental Health and Well-being. Psychological Medicine, 31(7), 1237–1247.

　　Davidson, J., Baldwin, D., Stein, D. J., Kuper, E., Benattia, I., Ahmed, S., … Musgnung, J. (2006). Treatment of posttraumatic stress disorder with venlafaxine extended release: A 6-month randomized controlled Trial. Archives of General Psychiatry, 63(10), 1158–1165.

　　Doblin, R. (2002). A clinical plan for MDMA (ecstasy) in the treatment of posttraumatic stress disorder (PTSD): Partnering with the FDA. Journal of Psychoactive Drugs, 34(2), 185–194.

　　Elbert, T., & Schauer, M. (2002). Burnt into memory. Nature, 419(6910), 883.

　　Eftekhari, A., Stines, L. R., & Zoellner, L. A. (2006). Do you need to talk about it? prolonged exposure for the treatment of chronic PTSD. The Behavior Analyst Today, 7(1), 70–83.

　　Fasipe, O. J. (2019). The emergence of new antidepressants for clinical use: Agomelatine paradox versus other novel agents. IBRO Reports, 9(6), 95–110.

　　Frewen, P. A., & Lanius, R. A. (2006). Toward a psychobiology of posttraumatic self-dysregulation: Reexperiencing, hyperarousal, dissociation, and emotional numbing. Annals of the New York Academy of Sciences, 1071, 110–124.

　　Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. Guilford Press.

　　Freeman, D., Thompson, C., Vorontsova, N., Dunn, G., Carter, L. A., Garety, P., … Ehlers, A. (2013). Paranoia and post-traumatic stress disorder in the months after a physical assault: A longitudinal study examining shared and differential predictors. Psychological Medicine, 43(12), 2673–2684.

　　Gray, M., Litz, B., & Papa, A. (2006). Crisis debriefing: What helps, and what might not. Good intentions are admirable, but providing effective treatment contributes more. Current Psychiatry, 10, 17–29.

　　Hawley, L. L., Rector, N. A., & Laposa, J. M. (2016). Examining the dynamic relationships between exposure tasks and cognitive restructuring in CBT for SAD: Outcomes and moderating influences. Journal of Anxiety Disorders, 39, 10–20.

　　Kessler, R. C., Rose, S., Koenen, K. C., Karam, E. G., Stang, P. E., Stein, D. J., … Viana, M. (2014). How well can post-traumatic stress disorder be predicted from pre-trauma risk factors? An exploratory study in the WHO World Mental Health Surveys. World Psychiatry, 13(3), 265–274.

　　Kroll, J. (2003). Posttraumatic symptoms and the complexity of responses to trauma. The Journal of the American Medical Association, 290(5), 667–670.

　　Lancaster, C. L., Teeters, J. B., Gros, D. F., & Back, S. E. (2016). Posttraumatic stress disorder: Overview of evidence-based assessment and treatment. Journal of Clinical Medicine, 5(11), 105.

　　Marken, P. A., & Munro, J. S. (2000). Selecting a selective serotonin reuptake inhibitor: Clinically important distinguishing features. Primary Care Companion to the Journal of Clinical Psychiatry, 2(6), 205–210.

　　Malkinson, R. (2010). Cognitive-behavioral grief therapy: The ABC model of rational-emotion behavior therapy. Psihologijske Teme, 19(2), 289–305.

　　Marlowe, D. H. (2001). Psychological and psychosocial consequences of combat and deployment with special emphasis on the Gulf War. RAND Corporation.

　　McCorry, L. K. (2007). Physiology of the autonomic nervous system. American Journal of Pharmaceutical Education, 71(4), 78.

　　Morgan, L. (2020). MDMA-assisted psychotherapy for people diagnosed with treatment-resistant PTSD: What it is and what it isn’t. Annals of General Psychiatry, 19, 33.

　　Monson, C. M., & Shnaider, P. (2014). Treating PTSD with cognitive-behavioral therapies: Interventions that work. American Psychological Association.

　　Miller, M. W., Wolf, E. J., Logue, M. W., & Baldwin, C. T. (2013). The retinoid-related orphan receptor alpha (RORA) gene and fear-related psychopathology. Journal of Affective Disorders, 151, 702–708.

　　Mitchell, J. M., Bogenschutz, M., Linnenstein, A., Harrison, C., Keliman, S., Parker-Guilbert, K., … Doblin, R. (2021). MDMA-assisted therapy for severe PTSD: A randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine, 27, 1025–1033.

　　Murray, H., Pethania, Y., & Medin, E. (2021). Survivor guilt: A cognitive approach. Cognitive Behaviour Therapist, 14, e28.

　　Myers, C. S. (1915). A contribution to the study of shell shock.: Being an account of three cases of loss of memory, vision, smell, and taste, admitted into the Duchess of Westminster’s War Hospital, Le Touquet. The Lancet, 185(4772), 316–330.

　　Neria, Y., Nandi, A., & Galea, S. (2008). Post-traumatic stress disorder following disasters: A systematic review. Psychological Medicine, 38(4), 467–80.

　　Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Narloch, V. F. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduction Journal, 18, 40.

　　Rauch, S. A., Eftekhari, A., & Ruzek, J. I. (2012). Review of exposure therapy: A gold standard for PTSD treatment. Journal of Rehabilitation Research and Development, 49(5), 679–687.

　　Sareen, J. (2014). Posttraumatic stress disorder in adults: Impact, comorbidity, risk factors, and treatment. Canadian Journal of Psychiatry, 59(9), 460–467.

　　Schauer, M., Neuner, F., & Elbert, T. (2011). Narrative exposure therapy. A short-term intervention for traumatic stress disorders after war, terror or torture. Hogrefe & Huber Publishers.

　　Schnyder, U., Ehlers, A., Elbert, T., Foa, E. B., Gersons, B. P. R., Resick P. A., … Cloitre, M. (2015). Psychotherapies for PTSD: What do they have in common? European Journal of Psychotraumatology, 6, 28186.

　　Schouten, K. A., de Niet, G. J., Knipscheer, J. W., Kleber, R. J., & Hutschemaekers, G. J. M. (2014). The effectiveness of art therapy in the treatment of traumatized adults. Trauma, Violence, & Abuse, 16(2), 220–228.

　　Schwartzkopff, L., Gutermann, J., Steil, R., & Müller-Engelmann, M. (2021). Which trauma treatment suits me? Identification of patients’ treatment preferences for posttraumatic stress disorder (PTSD). Frontiers in Psychology, 12, 12.

　　Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. Guilford Press.

　　Shapiro, F. (2007). EMDR, adaptive information processing, and case conceptualization. Journal of EMDR Practice and Research, 1(2), 68–87.

　　Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: Addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18(1), 71–77.

　　Sloan, D. M., Unger, W., & Beck, J. G. (2016). Cognitive-behavioral group treatment for veterans diagnosed with PTSD: Design of a hybrid efficacy-effectiveness clinical trial. Contemporary Clinical Trials, 47, 123–130.

　　Stein, M. B., Walker, J. R., & Hazen, A. L. (1997). Full and partial posttraumatic stress disorder: Findings from a community survey. American Journal of Psychiatry, 154, 1114–1119.

　　van der Kolk, B. A., McFarlane, A. C., & Weisaeth, L. (1996). Traumatic stress: The effects of overwhelming experience on mind, body, and society. Guilford Press.

　　van der Kolk, B. (2000). Posttraumatic stress disorder and the nature of trauma. Dialogues in Clinical Neuroscience, 2(1), 7–22.

　　Warman, D. M., Grant, P., Sullivan, K., Caroff, S., & Beck, A. T. (2005). Individual and group cognitive-behavioral therapy for psychotic disorders: A pilot investigation. Journal of Psychiatric Practice, 11(1), 27–34.

　　Watkins, L., Sprang, K., & Rothbaum, B. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 2(12), 258.

　　Weiss, D. S. (2007). The Impact of Event Scale: Revised. In J.P. Wilson & C.S. Tang (Eds.), Cross-cultural assessment of psychological trauma and PTSD (pp. 219–238). Springer.

　　Wessely, S., Bryant, R. A., Greenberg, N., Earnshaw, M., Sharpley, J., & Hughes, J. H. (2008). Does psychoeducation help prevent post traumatic psychological distress? Psychiatry, 71(4), 287–302.

　　Zhao, M., Yang, J., Wang, W., Ma, J., Zhang, J., Zhao, X., … Yang, Y. (2017). Meta-analysis of the interaction between serotonin transporter promoter variant, stress, and posttraumatic stress disorder. Scientific Reports, 7(1), 16532.

　　YDL编译：Livvy，KGG

凡注明”来源：XXX“的作品，均转载自其他媒体，转载目的在于传递更多信息，并不代表本网赞同其观点和对其真实性负责。本网转载其他媒体之稿件，意在为公共提供免费服务。如稿件版权单位或个人不想再本网发布，可与本网联系，本网将立即将其撤除。