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      Prevention and treatment of PTSD: the current evidence base Translated title: Prevención y Tratamiento del TEPT: La base de evidencia actual Translated title: PTSD 的 预防和治疗: 现阶段的证据基础

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          ABSTRACT

          Post-traumatic stress disorder is a common condition that affects millions of people across the world. Up to date recommendations based on the best available evidence are vital to prevent and treat this debilitating condition. In this issue, we are bringing together a series of systematic reviews and meta-analyses that underpinned the development of the 2018 International Society for Traumatic Stress Studies Guidelines.

          The strongest evidence was found for psychological treatments for PTSD, in particular for cognitive behavioural therapy with a trauma focus (CBT-TF)(generic), cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation and reprocessing (EMDR) and prolonged exposure (PE). For the subgroup of military personnel and veterans, results were less impressive. Dropout from trauma-focused psychological treatments was higher than for other forms of psychological treatment for PTSD in adults. For early interventions, CBT-TF, CT and EMDR were recommended. With regard to pharmacological approaches, a number of them were effective but with a low effect size. Of the pharmacologically assisted psychotherapies, MDMA-assisted psychotherapy was promising. Six complementary and alternative approaches showed emerging evidence.

          We now have an evidence base for a diverse range of pharmacological, psychological and other approaches that should facilitate their implementation and lead to the more effective management of people affected by traumatic events.

          HIGHLIGHTS

          • A diverse range of pharmacological, psychological and other approaches now have an evidence base for the prevention and treatment of PTSD.• This editorial introduces the EJPT special issue that considers these interventions and their relative strengths in more detail.

          El trastorno de estrés postraumático es una condición frecuente que afecta a millones de personas en el mundo. Las recomendaciones actualizadas basadas en las mejores evidencias disponibles son vitales para prevenir y tratar esta condición debilitante. En este número, reunimos una serie de revisiones sistemáticas y metanálisis que respaldaron el desarrollo de las Guías Clínicas de la Sociedad Internacional para el Estudio del Estrés Traumático del 2018.

          La evidencia más sólida se encontró para los tratamientos psicológicos para el TEPT, en particular para la terapia cognitivo conductual centrada en el trauma (CBT-TF por sus siglas en inglés) (genérica), la terapia de procesamiento cognitivo (CPT por sus siglas en inglés), terapia cognitiva (CT por sus siglas en ingles), desensibilización y reprocesamiento por movimientos oculares (EMDR) y exposición prolongada (PE por sus siglas en inglés). Para el subgrupo de personal militar y veteranos, los resultados fueron menos impresionantes. El abandono de los tratamientos psicológicos centrados en el trauma fue mayor que otras formas de tratamientos psicológicos para TEPT en adultos. Para intervenciones tempranas, se recomendaron la CBT-TF, CT y EMDR. Con respecto a los enfoques farmacológicos varios de ellos fueron efectivos pero con un tamaño de efecto bajo. De las psicoterapias asistidas farmacológicamente la psicoterapia asistida con MDMA fue prometedora. Seis enfoques complementarios y alternativos mostraron evidencia emergente.

          Ahora tenemos una base de evidencia para una amplia gama de enfoques farmacológicos, psicológicos y de otro tipo que deberían facilitar su implementación y conducir a un manejo más efectivo de las personas afectadas por eventos traumáticos.

          创伤后应激障碍是一种影响着全世界数百万人的普遍疾病。基于最佳可用证据的最新建议对于预防和治疗这种致衰疾病至关重要。在本期杂志中, 我们将集中呈现一系列系统综述和元分析, 在其支撑下 2018 年《国际创伤应激研究学会指南》得以制定。

          最有力证据的支持创伤后应激障碍的心理治疗, 特别是聚焦创伤的认知行为疗法 (CBT-TF) (通用), 认知加工疗法 (CPT), 认知疗法 (CT), 眼球脱敏和再加工 (EMDR) 和延长暴露治疗 (PE) 。对于军事人员和退伍老兵的亚群来说, 效果相对较差。成人的创伤后应激障碍治疗中, 聚焦创伤心理治疗所致的脱落率高于其他形式的心理治疗。对于早期干预, 建议使用 CBT-TF, CT 和 EMDR 。许多药理学方法有效, 但效果量很小。在药理辅助的心理治疗中, MDMA 辅助的心理治疗是有前途的。六种辅助和替代方法开始显示出新的证据。

          现在我们拥有的证据基础包括各种药理, 心理和其它方法。这些证据应有助于实施这些疗法, 并对受创伤事件影响的人们进行更有效的管理。

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          Trauma and PTSD in the WHO World Mental Health Surveys

          ABSTRACT Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their ‘worst.’ Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD. Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the ‘worst’ lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk. Conclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.
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            Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis

            ABSTRACT Background: Psychological therapies are the recommended first-line treatment for post-traumatic stress disorder (PTSD). Previous systematic reviews have grouped theoretically similar interventions to determine differences between broadly distinct approaches. Consequently, we know little regarding the relative efficacy of the specific manualized therapies commonly applied to the treatment of PTSD. Objective: To determine the effect sizes of manualized therapies for PTSD. Methods: We undertook a systematic review following Cochrane Collaboration guidelines. A pre-determined definition of clinical importance was applied to the results and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results: 114 randomized-controlled trials (RCTs) of 8171 participants were included. There was robust evidence that the therapies broadly defined as CBT with a trauma focus (CBT-T), as well as Eye Movement Desensitization and Reprocessing (EMDR), had a clinically important effect. The manualized CBT-Ts with the strongest evidence of effect were Cognitive Processing Therapy (CPT); Cognitive Therapy (CT); and Prolonged Exposure (PE). There was also some evidence supporting CBT without a trauma focus; group CBT with a trauma focus; guided internet-based CBT; and Present Centred Therapy (PCT). There was emerging evidence for a number of other therapies. Conclusions: A recent increase in RCTs of psychological therapies for PTSD, results in a more confident recommendation of CBT-T and EMDR as the first-line treatments. Among the CBT-Ts considered by the review CPT, CT and PE should be the treatments of choice. The findings should guide evidence informed shared decision-making between patient and clinician.
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              Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis

              ABSTRACT Background: Despite the established efficacy of psychological therapies for post-traumatic stress disorder (PTSD) there has been little systematic exploration of dropout rates. Objective: To ascertain rates of dropout across different modalities of psychological therapy for PTSD and to explore potential sources of heterogeneity. Method: A systematic review of dropout rates from randomized controlled trials (RCTs) of psychological therapies was conducted. The pooled rate of dropout from psychological therapies was estimated and reasons for heterogeneity explored using meta-regression. Results:: The pooled rate of dropout from RCTs of psychological therapies for PTSD was 16% (95% CI 14–18%). There was evidence of substantial heterogeneity across studies. We found evidence that psychological therapies with a trauma-focus were significantly associated with greater dropout. There was no evidence of greater dropout from therapies delivered in a group format; from studies that recruited participants from clinical services rather than via advertisements; that included only military personnel/veterans; that were limited to participants traumatized by sexual traumas; that included a higher proportion of female participants; or from studies with a lower proportion of participants who were university educated. Conclusions: Dropout rates from recommended psychological therapies for PTSD are high and this appears to be particularly true of interventions with a trauma focus. There is a need to further explore the reasons for dropout and to look at ways of increasing treatment retention.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8198
                2000-8066
                31 January 2021
                2021
                31 January 2021
                : 12
                : 1
                : 1824381
                Affiliations
                [a ]National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine; , Cardiff, UK
                [b ]Amsterdam UMC, Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam, The Netherlands & ARQ National Psychotrauma Centre; , Diemen, The Netherlands
                Author notes
                CONTACT Jonathan I. Bisson bissonji@ 123456cf.ac.uk National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine; , Cardiff, UK
                Author information
                https://orcid.org/0000-0001-5170-1243
                https://orcid.org/0000-0003-1016-9515
                Article
                1824381
                10.1080/20008198.2020.1824381
                8725725
                34992739
                f3595198-c8fc-46b3-8874-4e0c16ddd3bf
                © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Editorial
                Editorial

                Clinical Psychology & Psychiatry
                ptsd,prevention,treatment,psychotherapy,pharmacotherapy,complementary interventions,dropout,tept,prevención,tratamiento,psicoterapia,farmacoterapia,intervenciones complementarias,abandono,创伤后应激障碍,预防,治疗,心理治疗,药物治疗,辅助干预,脱落

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