儿童地震灾害创伤后应激障碍的心理干预策略初探

文章探讨了儿童灾难后心理应激状态下出现的创伤后应激障碍,分析了不同灾难下儿童经历创伤后应激障碍的发生率和儿童创伤后应激障碍的症状表现,并对经历地震的儿童创伤后应激障碍的干预提出一些有效的途径。     

儿童创伤后应激障碍及其游戏治疗

本研究分析了儿童创伤后应激障碍的症状特点,指出其与成人创伤后应激障碍症状表现的差异。游戏治疗是适合儿童危机干预的心理治疗方法。本研究介绍了国内外常用的游戏治疗的基本方法。绘画、互说故事、玩偶游戏、棋类游戏等,及其在儿童创伤后应激障碍心理治疗中的应用。     

儿童创伤后应激障碍的特点及治疗方法简

创伤后应激障碍（Post-traumatic stress disorder,PTSD）会阻碍儿童日后独立性和自主性等健康心理的发展,到成年期可导致一系列的心理障碍。本研究分析了儿童创伤后应激障碍的症状特点,指出其与成人创伤后应激障碍症状表现的差异。对目前存在的针对儿童创伤后应激障的治疗方法进行了分析。     

地震灾区儿童心理创伤及其干预策略

5·12大地震,使灾区儿童在重建家园的同时,亦需重视心灵重建。本文介绍了创伤、心理创伤与创伤后应激障碍的概念,创伤后应激障碍的测量及各种干预策略,以期为灾区儿童健康心理素质的重塑提供方法上的指导。     

心理剧疗法与儿童创伤后应激障碍的治疗

本文分析了儿童创伤后应激障碍的特点,指出其与成人创伤后应激障碍症状表现的差异。心理剧疗法是团体疗法的一种,是适合儿童危机干预的心理治疗方法。本文介绍了心理剧疗法的主要特点、具体实施步骤以及运用于治疗儿童创伤后应激时需要注意的几点问题。     

地震受灾儿童创伤后应激障碍的识别及干预

地震、车祸等突发性、灾难性事件发生后,幸存者容易出现创伤后应激障碍（PTSD）,严重威胁到他们的心理健康。对于身心发育尚不成熟的受灾儿童而言,PTSD更会影响他们的健康成长。因此,识别汶川大地震中受灾儿童的创伤后应激障碍并及时进行心理干预,是非常有必要的。     

儿童创伤后应激障碍干预的原则和方法述略

对于经历灾难之后出现创伤后应激障碍的儿童,我们应当予以关注.对儿童创伤后应激障碍的干预应遵循正常化、协同化和个性化原则.当前的几种主要干预方法之中,认知行为疗法(CBT)得到了广泛的认可和运用.本文重点介绍基于认知行为疗法的情绪和人际调节技能训练法(STAIR).     

游戏治疗在儿童创伤后应激障碍中的应用

游戏治疗是以游戏作为媒介,为儿童提供游戏活动而展开心理援助的一种心理治疗理论和技术。本文介绍儿童在经历创伤后的特殊心理表现以及具体游戏治疗在儿童创伤后的应激障碍中所具有的积极作用。     

创伤后应激障碍的研究综述

本文通过综述创伤后应激障碍的起源、概念、临床表现、诊断与鉴别、病因以及治疗方法,来增进人们对创伤后应激障碍的了解,以及为创伤后应激障碍患者提供更密切的关注与更好的帮助。     

汶川地震灾后儿童心理创伤的表现、评估及重建

汶川地震造成儿童不同程度的心理创伤,形成儿童创伤后应激障碍,并在身心、精神、认知以及行为方面均有所表现。因此需要给予儿童更多的心理照顾以帮助他们度过危机。本文考察了地震灾后儿童心理创伤的阶段性和年龄性特征,提出灾后儿童心理的康复与重建需要开展多层面心理评估,并着重分析了开展地震灾后儿童心理康复与重建的基本原则、辅导策略、活动方式以及服务技巧。     

The roles of peritraumatic dissociation, child physical abuse, and child sexual abuse in the development of posttraumatic stress disorder and adult victimization

OBJECTIVE: Previous research has indicated that women who experience childhood physical abuse or childhood sexual abuse are at increased risk for posttraumatic stress disorder (PTSD) and adult victimization. Recently, peritraumatic dissociation (PD) has been suggested as another possible risk factor for PTSD and adult victimization. The purpose of the present study was to investigate the effects of childhood physical and sexual abuse and PD on PTSD and adult victimization. METHOD: A sample of 467 female college students completed questionnaires about childhood and adult sexual and physical abuse experiences, PD, and PTSD symptoms. RESULTS: The combined sexual and physical abuse (CA) and sexual abuse only (SA) groups reported significantly higher numbers of PTSD symptoms than the physical abuse only (PA) and no abuse (NA) groups. The CA and PA groups reported significantly more adult sexual and physical victimization than the SA and NA groups. Across all four groups, higher levels of PD were associated with higher levels of PTSD and adult sexual and physical victimization. CONCLUSIONS: The results of the current study suggest that different types of childhood abuse may lead to different adult problems. The results also indicated that PD may have a broad effect on PTSD development and adult victimization.     

Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents

OBJECTIVE: Child abuse is a risk factor for developing Posttraumatic Stress Disorder (PTSD) and subsequent Substance Use Disorder (SUD). The purpose of this review is to summarize current knowledge about effective treatments for adolescent abuse-related PTSD, SUD, and the co-occurrence of these conditions.METHOD: The literature on empirical treatment studies for these conditions in adolescence was reviewed, summarized, and synthesized.RESULTS: Randomized controlled studies of abuse-related PTSD and SUD in adolescents have supported the efficacy of cognitive behaviorally-based individual and family treatment components. Components overlap considerably in empirically supported treatments for each disorder. An integrated treatment approach is described for use in adolescents with abuse-related PTSD and SUD, with recommendations for optimizing services for this population and for future research.CONCLUSIONS: The available evidence on effective treatments suggests that integrated PTSD- and SUD-focused cognitive-behavioral and family treatment for adolescents with comorbid abuse-related PTSD and SUD may optimize outcomes for this population.     

舟曲儿童自我意识对创伤后应激障碍的影响分析

为了探讨创伤后应激障碍与自我意识的关系,为创伤后应激障碍的治疗方向提供依据。采用分层整群抽样的方法用儿童自我意识量表和创伤后应激障碍17项筛查问卷对舟曲县的596名学生进行问卷调查。结果显示:男、女生在行为、焦虑和合群分量表均存在极其显著性差异;除躯体外貌和属性分量表与PTSD无显著性相关外,其余分量表均与PTSD总分之间存在极其显著的负相关关系;除智力与学校情况和躯体外貌与属性分量表在PTSD等级上无显著性差异外,总分和其余分量表得分在PTSD等级上均存在极其显著性差异。加强对自我意识各维度的关注与改变,将有益于PTSD的预防和治疗。     

Differential symptom pattern of post-traumatic stress disorder (PTSD) in maltreated children with and without concurrent depression

OBJECTIVE: The present study attempted to examine specific differences in the Post-Traumatic Stress Disorder (PTSD) symptomatology among abused children with and without concurrent depression. METHOD: PTSD and depressive symptoms were identified that discriminate between 98 children divided into three groups: (1) abused children with PTSD, (2) nonabused children who meet criteria for Major Depressive Disorder (MDD), and (3) abused children with both PTSD and MDD. RESULTS: Analyses revealed that nine items reflecting depressive symptomatology, primarily vegetative symptoms, differentiated the diagnostic groups (PTSD-only, MDD-only, and the combined group). A discriminant analysis revealed that the sum of responses to the nine significant items adequately predicted diagnostic classification for those with PTSD and depression, but did not correctly diagnose any in the combined group. Analyses also revealed that three post-trauma symptoms, including psychological amnesia, flashbacks/reenactments, and sleep difficulties, discriminated between the groups. The PTSD-only group reported more episodes of psychological amnesia while the PTSD and MDD group experienced more flashbacks. CONCLUSIONS: For the sample of abused children examined, these results illuminate differences with respect to PTSD symptom presentation for those children with PTSD who have a concurrent depressive disorder and their nondepressed counterparts. Children with PTSD who have a concurrent depression report greater levels of intrusive PTSD-related symptoms.     

Barriers to self-compassion for female survivors of childhood maltreatment: The roles of fear of self-compassion and psychological inflexibility

Preliminary evidence has demonstrated the benefits of targeting self-compassion in the treatment of posttraumatic stress disorder (PTSD). However, survivors of childhood maltreatment may present with unique challenges that compromise the effectiveness of these and other PTSD treatments. Specifically, childhood maltreatment victims often exhibit a marked fear and active resistance of self-kindness and warmth (i.e., fear of self-compassion). Victims may also attempt to control distressing internal experiences in a way that hinders engagement in value-based actions (i.e., psychological inflexibility). Research suggests that psychological inflexibility exacerbates the negative effects of fear of self-compassion. The present study expanded on previous research by examining the relations among childhood maltreatment, fear of self-compassion, psychological inflexibility, and PTSD symptom severity in 288 college women. As expected, moderate to severe levels of childhood maltreatment were associated with greater fear of self-compassion, psychological inflexibility, and PTSD symptom severity compared to minimal or no childhood maltreatment. A mediation analysis showed that childhood maltreatment had a significant indirect effect on PTSD symptom severity via fear of self-compassion, although a conditional process analysis did not support psychological inflexibility as a moderator of this indirect effect. A post hoc multiple mediator analysis showed a significant indirect effect of childhood maltreatment on PTSD symptom severity via psychological inflexibility, but not fear of self-compassion. These findings highlight the importance of addressing fear of self-compassion and psychological inflexibility as barriers to treatment for female survivors of childhood maltreatment.     

Child physical abuse and the related PTSD in Taiwan: The role of Chinese cultural background and victims' subjective reactions

Objective

This study aimed to investigate child physical abuse (CPA) while taking into account the more rigorous definitions of CPA in the Chinese societies. The prevalence of CPA and CPA-related PTSD were estimated, together with the examination of peri-traumatic subjective reactions and their impacts on PTSD.

Methods

In a Taiwanese sample of 1966 4th to 8th graders, the Chinese version of UCLA PTSD Reaction Index for DSM-IV (Steinberg, Brymer, Decker, & Pynoos, 2004) was used to investigate the lifetime exposure to CPA. A sub-sample of 236 traumatized CPA victims was examined with respect to related PTSD symptoms.

Results

Thirty-four percent of the children had been exposed to CPA. The estimated current prevalence of full and partial PTSD was 13.6% and 16.9%, respectively.

Conclusions

The current CPA prevalence was found to be higher than the Western countries, but lower than the previous findings in other East Asian societies. The full PTSD prevalence was close to the findings in the Western countries, whereas sub-clinical PTSD was less observed in Taiwan. Peri-traumatic subjective reactions, that is, Criterion A2 and perceived threat, were shown to be major predictors of PTSD symptom severity. The role of attitudes of child discipline in the Chinese societies in the prevalence of CPA and CPA-related PTSD is discussed.

Practice implications

By providing explicit epidemiological information of CPA and CPA-related PTSD in Taiwan, the current study extends our understanding of CPA and CPA-related PTSD more broadly from Western countries to the Eastern societies. By separately investigating CPA relating to different perpetrators, cross-study comparison is enhanced. In the current study, the significance of considering cultural background in defining CPA and examining CPA-related PTSD was pointed out. Meanwhile, the role of victims’ subjective reactions in the psychopathology of PTSD is highlighted. The findings and discussions could contribute for generating a more sophisticated clinical practice, especially with Asian or Chinese cases.     

疫情背景下大学生创伤后应激障碍研究

对大学生进行创伤后应激障碍调查,了解其心理危机现状,是危机干预的第一步。通过对漳州地区高职院校1161名学生进行疫情一个月后创伤后应激障碍调查,为再次返校后的心理干预工作提供重要依据。调查得出结论:PTSD占全体大学生的比例为2.41%,各年级大学生存在PTSD的比例介于2%-3%之间;PTSD在不同专业大学生之间不存在差异,但是在不同性别之间存在差异,男生存在PTSD的比例高于女生;男生的症状普遍比女生的症状更严重。     

Sexual abuse but not posttraumatic stress disorder is associated with neurocognitive deficits in South African traumatized adolescents

ObjectivesNeurocognitive impairments are commonly observed in adults suffering from posttraumatic stress disorder (PTSD). The picture is less clear in adolescents. Childhood sexual abuse (CSA) may have an independent influence on neuropsychological test performance and provide partial explanatory power of the inconsistent findings. We hypothesized that adolescents with PTSD who have also suffered sexual abuse would have most pronounced deficits on neurocognitive testing.MethodsIn a cross-sectional design, 105 traumatized South African adolescents, of whom 52 fulfilled criteria of PTSD and 34 reported CSA, were studied. A comprehensive neurocognitive battery including tests of memory, executive functioning, and language was used to analyze the associations of neurocognitive impairments with PTSD and CSA.ResultsAdolescents reporting CSA manifested impairments in proactive and retroactive interference tasks on the Rey Auditory Verbal Learning test and in the copy condition of the Rey Osterrieth figure test, indicating deficits in attention and working memory. Against our hypothesis, no independent effects of PTSD were found on neurocognitive performance. Results were independent of comorbid psychiatric diagnoses.ConclusionsSexual abuse seems to have an independent influence on attention and working memory. This could be an early sign of hippocampal impairment.     

Gender differences in social reactions to abuse disclosures, post-abuse coping, and PTSD of child sexual abuse survivors

OBJECTIVE:This research examines the understudied issue of gender differences in disclosure, social reactions, post-abuse coping, and PTSD of adult survivors of child sexual abuse (CSA). METHOD:Data were collected on a cross-sectional convenience sample of 733 college students completing a confidential survey about their demographic characteristics, sexual abuse experiences, disclosure characteristics, post-abuse coping, and social reactions from others. RESULTS:Female students reported greater prevalence and severity of CSA, more distress and self-blame immediately post-assault, and greater reliance on coping strategies of withdrawal and trying to forget than male students. Women were more likely to have disclosed their abuse to others, to have received positive reactions, and to report greater PTSD symptom severity, but were no more likely to receive negative reactions upon disclosure than men. Women delaying disclosure had greater PTSD symptom severity, whereas men's symptoms did not vary by timing of disclosure. Additional regression analyses examined predictors of PTSD symptom severity and negative and positive social reactions to abuse disclosures. CONCLUSIONS:Several gender differences were observed in this sample of college students in terms of sexual abuse experiences, psychological symptoms, coping, PTSD, and some aspects of disclosure and social reactions from others.     

Childhood trauma,PTSD, and psychosis: Findings from a highly traumatized,minority sample

Trauma, especially early life trauma, is a risk factor for the development of both posttraumatic stress disorder and psychosis. The goal of the present study was to determine specific associations between exposure to childhood abuse, PTSD symptoms, and current psychotic disorder. Subjects were recruited from a public, urban hospital (N = 328, >90% African American). Psychotic disorders were measured using the MINI International Neuropsychiatric Interview, PTSD was measured using the Clinician Administered PTSD Scale, child abuse was measured with the Childhood Trauma Questionnaire, and lifetime trauma exposure was measured with the Traumatic Events Inventory. Logistic regression analyses showed that both child abuse and current PTSD were statistically significant predictors of psychotic disorder beyond the effects of lifetime trauma load. When PTSD symptom clusters were examined, avoidance and numbing symptoms showed unique association with psychotic disorder independent of demographic variables and trauma exposure. Using bootstrapping techniques, we found a full indirect effect of PTSD on the association between child abuse and, suggesting a particularly important role of PTSD symptoms in relation to psychotic disorder in the presence of early life trauma. Because this is a cross-sectional study, continued research is needed to determine causality of such models. Identifying co-occurring psychosis and PTSD, particularly in populations with high levels of trauma exposure, is critical and will likely aid in more successful treatment interventions.