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외상후 스트레스 장애에 대한 심리치료 효과 개관 : 재난 생존자를 중심으로

Review of Psychological Treatment for Post-Traumatic Stress Disorder : Focus on Survivors of Disaster

이현지|김대호|장은영
대한불안의학회 (Korean Academy of Anxiety Disorders)|2016.10|대한불안의학회지 (Anxiety and Mood)|제12권 제2호|pp. 69-78

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재난Disaster외상후 스트레스 장애인지행동치료Post-traumatic stress disorderEMDR노출치료Cognitive behavior therapyExposure therapyEye movement desensitization and reprocessing
주제분류정신과학

초록

Objective : Disaster causes psychological distress to a large number of people in a short period of time, by both direct and indirect exposure to traumatic events embedded in various realms of disaster experience. Optimal, well-planned treatment interventions should follow from the early acute period to recovery phase, extending up to several months later. In this context, there is an increasing need for systemic review to gain comprehensive insights for disaster interventions. These need to be added to public policy, and for the prevention and treatment of disaster-related psychopathology. Here, we review the published studies on psychological interventions for disaster-related posttraumatic stress disorder. Methods : Specific psychological interventions regarded as effective treatments for have been selected for this review, such as CBT (Cognitive-Behavior Therapy), Exposure Therapy, EMDR (Eye Movement Desensitization & Reprocessing), SIT (Stress Inoculation Therapy) and Psychoeducation. In addition, natural disasters, industrial disasters, and accidents involving aircraft and ships were also categorized as disasters, along with war and combat trauma. Results : Cognitive behavior therapy and exposure therapy had the strongest research support for effectiveness, and could be considered as the first-choice treatment for disaster-related PTSD. The second line of treatment is EMDR, although this treatment modality has the advantage of reaching certain treatment improvements in fewer sessions. However, the effects of SIT and psychoeducation to the survivors of disasters, remains unclear at this point. Additionally, we propose the possibilities of using virtual reality component and imagery rescripting as modified forms of traditional cognitive behavior therapy and exposure therapy. Conclusion : Cognitive behavior therapy and exposure therapy, deemed effective treatments for various trauma, are considered to be effective for survivors from disasters. However, the efficacy of other interventions has not yet been examined methodologically in well-designed studies, such as randomized controlled trials. In particular, future empirical studies are needed, since it is difficult to conclude that psychological interventions have similar effects on different types of disasters. (Anxiety and Mood 2016;12(2):69-78)

Abstract

Objective : Disaster causes psychological distress to a large number of people in a short period of time, by both direct and indirect exposure to traumatic events embedded in various realms of disaster experience. Optimal, well-planned treatment interventions should follow from the early acute period to recovery phase, extending up to several months later. In this context, there is an increasing need for systemic review to gain comprehensive insights for disaster interventions. These need to be added to public policy, and for the prevention and treatment of disaster-related psychopathology. Here, we review the published studies on psychological interventions for disaster-related posttraumatic stress disorder. Methods : Specific psychological interventions regarded as effective treatments for have been selected for this review, such as CBT (Cognitive-Behavior Therapy), Exposure Therapy, EMDR (Eye Movement Desensitization & Reprocessing), SIT (Stress Inoculation Therapy) and Psychoeducation. In addition, natural disasters, industrial disasters, and accidents involving aircraft and ships were also categorized as disasters, along with war and combat trauma. Results : Cognitive behavior therapy and exposure therapy had the strongest research support for effectiveness, and could be considered as the first-choice treatment for disaster-related PTSD. The second line of treatment is EMDR, although this treatment modality has the advantage of reaching certain treatment improvements in fewer sessions. However, the effects of SIT and psychoeducation to the survivors of disasters, remains unclear at this point. Additionally, we propose the possibilities of using virtual reality component and imagery rescripting as modified forms of traditional cognitive behavior therapy and exposure therapy. Conclusion : Cognitive behavior therapy and exposure therapy, deemed effective treatments for various trauma, are considered to be effective for survivors from disasters. However, the efficacy of other interventions has not yet been examined methodologically in well-designed studies, such as randomized controlled trials. In particular, future empirical studies are needed, since it is difficult to conclude that psychological interventions have similar effects on different types of disasters. (Anxiety and Mood 2016;12(2):69-78)

참고문헌 (67)

  1. Harvey AG, "Cognitive behaviour therapy for posttraumatic stress disorder", Clin Psychol Rev, 23, pp.501~522 (2003)
  2. Allen JG, "Coping with trauma: Hope through understanding" (2005), American Psychitric Association
  3. O’Donnell ML, "Prior trauma and psychiatric history as risk factors for intentional and unintentional injury in Australia", J Trauma, 66, pp.470~476 (2009)
  4. Cahill SP, "Dissemination of exposure therapy in the treatment of posttraumatic stress disorder", J Trauma Stress, 19, pp.597~610 (2006)
  5. Alessandra Pereira Lopes, "Systematic Review of the Efficacy of Cognitive-Behavior Therapy Related Treatments for Victims of Natural Disasters: A Worldwide Problem", PLoS ONE, 9(10), pp.e109013~ (2014), Public Library of Science (PLoS)[DOI]
  6. Patcho N. Santiago, "A Systematic Review of PTSD Prevalence and Trajectories in DSM-5 Defined Trauma Exposed Populations: Intentional and Non-Intentional Traumatic Events", PLoS ONE, 8(4), pp.e59236~ (2013), Public Library of Science (PLoS)[DOI]
  7. van Minnen A, "Changes in comorbid conditions after prolonged exposure for PTSD: a literature review", Curr Psychiatry Rep, 17, pp.549~564 (2015)
  8. Beck AT, "The diagnosis and management of depression" (1967), University of Pennsylvania Press
  9. Bisson JI, "Psychological treatment of post-traumatic stress disorder", The Cochrane Library, 3, pp.1~61 (2005)
  10. La Greca AM, "Treatment and prevention of posttraumatic stress reactions in children and adolescents exposed to disasters and terrorism: what is the evidence?", Child Dev, 3, pp.4~10 (2009)
  11. Foa EB, "Efficacy and costeffectiveness of psychotherapy: Clinical Practice", pp.23~61 (1999), American Psychiatric Association
  12. Bisson JI, "Early cognitive-behavioural therapy for post-traumatic stress symptoms after physical injury. randomised controlled trial", Br J Psychiatry, 184, pp.63~69 (2004)
  13. Monson CM, "Cognitive processing therapy for veterans with militaryrelated posttraumatic stress disorder", J Consult Clin Psychol, 74, pp.898~907 (2006)
  14. Nacasch N, "Prolonged exposure therapy for chronic combat-related PTSD: a case report of five veterans", CNS Spectr, 12, pp.690~695 (2007)
  15. Brewin CR, "Promoting mental health following the London bombings:a screen and treat approach", J Trauma Stress, 21, pp.3~8 (2008)
  16. Difede J, "A randomized controlled clinical treatment trial for World Trade Center attack-related PTSD in disaster workers", J Nerv Ment Dis, 195, pp.861~865 (2007)
  17. Gillespie K, "Community based cognitive therapy in the treatment of posttraumatic stress disorder following the Omagh bomb", Behav Res Ther, 40, pp.345~357 (2002)
  18. Salloum A, "Evaluation of individual and group grief and trauma interventions for children post disaster", J Clin Child Adolesc Psychol, 37, pp.495~507 (2008)
  19. Blanchard EB, "A controlled evaluation of cognitive behavioural therapy for posttraumatic stress in motor vehicle accident survivors", Behav Res Ther, 41, pp.79~96 (2003)
  20. Gillespie K, "Community based cognitive therapy in the treatment of posttraumatic stress disorder following the Omagh bomb", Behav Res Ther, 40, pp.345~357 (2002)
  21. Foa EB, "The validation of a selfreport measure of posttraumatic stress disorder: the Posttraumatic Diagnostic Scale", Psychol Assess, 9, pp.445~451 (1997)
  22. Weathers FW, "Psychometric properties of nine scoring rules for the Clinician-Administered Posttraumatic Stress Disorder Scale", Psychol Assess, 11, pp.124~133 (1999)
  23. Steinberg AM, "The UCLA PTSD Reaction Index", Curr Psychiatry Rep, 6, pp.96~100 (2004)
  24. Foa EB, "Emotional processing of fear: exposure to corrective information", Psychol Bull, 99, pp.20~35 (1986)
  25. McLean CP, "Prolonged exposure therapy for post-traumatic stress disorder: a review of evidence and dissemination", Expert Rev Neurother, 11, pp.1151~1163 (2011)
  26. Schauer M, "Narrative exposure therapy: a shortterm treatment for traumatic stress disorders after war, terror, or torture" (2005), Hogrefe & Huber
  27. Foa E, "Pathological anxiety: Emotional processing in etiology and treatment", pp.3~24 (2006), The Guilford Press
  28. Zang Y, "Adapting narrative exposure therapy for Chinese earthquake survivors: a pilot randomised controlled feasibility study", BMC Psychiatry, 14, pp.262~273 (2014)
  29. Neuner F, "A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement", J Consult Clin Psychol, 72, pp.579~587 (2004)
  30. Schaal S, "Narrative exposure therapy versus interpersonal psychotherapy. a pilot randomized controlled trial with Rwandan genocide orphans", Psychother Psychosom, 78, pp.298~306 (2009)
  31. Neuner F, "Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial", J Consult Clin Psychol, 76, pp.686~694 (2008)
  32. Zang Y, "A randomised controlled pilot study: the effectiveness of narrative exposure therapy with adult survivors of the Sichuan earthquake", BMC Psychiatry, 13, pp.41~51 (2013)
  33. Başoğlu M, "Singlesession behavioral treatment of earthquake-related posttraumatic stress disorder: a randomized waiting list controlled trial", J Trauma Stress, 18, pp.1~11 (2005)
  34. Steenkamp MM, "Psychotherapy for Military-Related PTSD: a review of randomized clinical trials", JAMA, 314, pp.489~500 (2015)
  35. Shapiro F, "Eyemovement desensitizationand reprocessing" (1995), The Guilford Press
  36. Shapiro F, "EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma" (1997), Basic Books
  37. McNally RJ, "EMDR and Mesmerism: a comparative historical analysis", J Anxiety Disord, 13, pp.225~236 (1999)
  38. Davidson PR, "Eye movement desensitization and reprocessing (EMDR): a meta-analysis", J Consult Clin Psychol, 69, pp.305~316 (2001)
  39. Jarero I, "The EMDR protocol for recent critical incidents: application in a disaster mental health continuum of care context", J of EMDR Prac Res, 5, pp.82~94 (2011)
  40. Carlijn de Roos, "A randomised comparison of cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) in disaster-exposed children", European Journal of Psychotraumatology, 2(1), pp.5694~ (2011), Informa UK Limited[DOI]
  41. Natha F, "The effectiveness of EMDR in reducing psychological distress in survivors of natural disasters: a review", J EMDR Prac Res, 8, pp.157~170 (2014)
  42. Meichenbaum D, "Self-instructional strategy training: a cognitive prothesis for the aged", Hum Dev, 17, pp.273~280 (1974)
  43. Lazarus RS, "Progress on a cognitive-motivational-relational theory of Emotion", Am Psychol, 46, pp.819~834 (1991)
  44. Foa EB, "A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims", J Consult Clin Psychol, 67, pp.194~200 (1999)
  45. Foa EB, "Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling", J Consult Clin Psychol, 59, pp.715~723 (1991)
  46. Lukens EP, "Psychoeducation as evidence-based practice: considerations for practice, research, and policy", Br Treat Cris Interv, 4, pp.205~225 (2004)
  47. Pratt SI, "Evaluation of a PTSD psychoeducational program for psychiatric inpatients", J Ment Health, 14, pp.121~127 (2005)
  48. Najavits LM, "Clinicians' views on treating posttraumatic stress disorder and substance use disorder", J Subst Abuse Treat, 22, pp.79~85 (2002)
  49. Kubany ES, "Cognitive trauma therapy for battered women with PTSD: preliminary findings", J Trauma Stress, 16, pp.81~91 (2003)
  50. Howard JM, "Psychoeducation as a response to community disaster", Br Treat Cris Interv, 4, pp.1~10 (2004)
  51. Cukor J, "Emerging treatments for PTSD", Clin Psychol Rev, 29, pp.715~726 (2009)
  52. Kessler RC, "Posttraumatic stress disorder: the burden to the individual and to society", J Clin Psychiatry, 61, pp.4~12 (2000)
  53. Hoge CW, "Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care", N Engl J Med, 351, pp.13~22 (2004)
  54. Gerardi M, "Virtual reality exposure therapy using a virtual Iraq: case report", J Trauma Stress, 21, pp.209~213 (2008)
  55. Difede J, "Virtual reality exposure therapy for World Trade Center Post-traumatic Stress Disorder: a case report", Cyberpsychol Behav, 5, pp.529~535 (2002)
  56. Smucker MR, "Imagery Rescripting:a new treatment for survivors of childhood sexual abuse suffering from post-traumatic stress", J Cogn Psychother: An Int Quart, 9, pp.3~17 (1995)
  57. Arntz A, "Treatment of PTSD: a comparison of imaginal exposure with and without imagery rescripting", J Behav Ther Exp Psychiatry, 38, pp.345~370 (2007)
  58. Grunert BK, "Imagery rescripting and reprocessing therapy after failed prolonged exposure for post-traumatic stress disorder following industrial injury", J Behav Ther Exp Psychiatry, 38, pp.317~328 (2007)
  59. Martin GL, "Behavior modification: What it is and how to do it" (2011), Pearson Education, Inc.: Prentice-Hall
  60. Hayes S C, "Acceptance and Commitment Therapy: An experiential approach to behavior change" (1999), The Guilford Press
  61. Forman EM, "A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression", Behav Modif, 31, pp.772~799 (2007)
  62. 최현옥, "The Effects of the Korean Mindfulness-Based Stress Reduction(K-MBSR) Program on Posttraumatic Stress Disorder Symptoms, Experiential Avoidance, and Shame in North Korean Defectors", Korean Journal of Health Psychology, 16(3), pp.469~482 (2011), Korean Health Psychological Association[DOI]
  63. Sharpley JG, "Pre-deployment stress briefing: does it have an effect?", Occup Med, 58, pp.30~34 (2008)
  64. Jenkins SR, "Social support and debriefing efficacy among emergency medical workers after a mass shooting incidents", J Soc Behav Pers, 11, pp.477~492 (1996)
  65. Chemtob CM, "Postdisaster psychosocial intervention: a field study of the impact of debriefing on psychological distress", Am J Psychiatry, 154, pp.415~417 (1997)
  66. Kenardy JA, "Stress debriefing and patterns of recovery following a natural disaster", J Trauma Stress, 9, pp.37~49 (1996)
  67. Wessely S, "Psychological debriefing is a waste of time", Br J Psychiatry, 183, pp.12~14 (2003)

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