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标题：Complex PTSD and phased treatment in refugees: a debate piece
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作者：F. Jackie June ter Heide ; Trudy M. Mooren ; Rolf J. Kleber 等
期刊名称：European Journal of Psychotraumatology
印刷版ISSN：2000-8198
电子版ISSN：2000-8066
出版年度：2016
卷号：7
DOI：10.3402/ejpt.v7.28687%40zept20.2016.7.issue-s1
语种：English
出版社：Taylor & Francis Group
摘要：BackgroundAsylum seekers and refugees have been claimed to be at increased risk of developing complex posttraumatic stress disorder (complex PTSD). Consequently, it has been recommended that refugees be treated with present-centred or phased treatment rather than stand-alone trauma-focused treatment. This recommendation has contributed to a clinical practice of delaying or waiving trauma-focused treatment in refugees with PTSD.ObjectiveThe aim of this debate piece is to defend two theses: (1) that complex trauma leads to complex PTSD in a minority of refugees only and (2) that trauma-focused treatment should be offered to all refugees who seek treatment for PTSD.MethodsThe first thesis is defended by comparing data on the prevalence of complex PTSD in refugees to those in other trauma-exposed populations, using studies derived from a systematic review. The second thesis is defended using conclusions of systematic reviews and a meta-analysis of the efficacy of psychotherapeutic treatment in refugees.ResultsResearch shows that refugees are more likely to meet a regular PTSD diagnosis or no diagnosis than a complex PTSD diagnosis and that prevalence of complex PTSD in refugees is relatively low compared to that in survivors of childhood trauma. Effect sizes for trauma-focused treatment in refugees, especially narrative exposure therapy (NET) and culturally adapted cognitive-behaviour therapy (CA-CBT), have consistently been found to be high.ConclusionsComplex PTSD in refugees should not be assumed to be present on the basis of complex traumatic experiences but should be carefully diagnosed using a validated interview. In line with treatment guidelines for PTSD, a course of trauma-focused treatment should be offered to all refugees seeking treatment for PTSD, including asylum seekers.
关键词：Posttraumatic stress; trauma; torture; prevalence; efficacy; ISTSS treatment guidelines; asylum seekers; ICD-11; narrative exposure therapy; culturally adapted cognitive-behaviour therapy