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Behandelen van complexe posttraumatische stress-stoornis: een systematische review

Tuut, M.E. (2013) Behandelen van complexe posttraumatische stress-stoornis: een systematische review.

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Abstract:In this systematic review the current state of evidence concerning the treatment of adult people with complex post-traumatic stress disorder (PTSD) was evaluated. This involved already implemented and conventional interventions, as well as more innovative treatments. To address this issue, the following sub-questions were answered: 1) What is the effectiveness of different treatment options for patients suffering from complex PTSD? 2) Which treatment stages for people with complex PTSD are distinguished? 3) Which indicators are established to determine the effectiveness of the treatment options for complex PTSD in each stage? 4) Which health care providers have to be involved in the treatment of people with complex PTSD¬? The final goal of this review was to recommend to Dimence (Dutch organization for mental health care) qualitative well treatment options for people with complex PTSD. Although the current Dutch multidisciplinary guideline on PTSD does not differentiate between complex PTSD and simple PTSD, the hypothesis of this review is that it is relevant to adapt the treatment to the severity of the disorder. It is also expected that innovative treatments have been described that are promising for the future. Finally, the hypothesis is that phased treatment will be more effective than direct trauma confrontation. In order to answer the research questions, a literature study was carried out. Literature was systematically searched in PsycINFO, and afterwards selected, based on previously determined criteria. An amount of 60 articles was included, which were reviewed on quality and usability, again based on criteria that were set beforehand. It turned out that cognitive behavioral therapy with exposure and narrative exposure therapy is recommended as therapy of first choice for people with complex PTSD. Contrary to the expectations, there is no evidence for the effectiveness of eye movement desensitization and reprocessing therapy (EMDR). Given the availability of limited evidence, further research is recommended. There is still insufficient knowledge about the effectiveness of phased treatment and the evidence is inconsistent. It is therefore recommended to investigate the effectiveness of phased treatment. Until solid evidence is available, a phased treatment for people with complex PTSD is, based on consensus in clinical practice, recommended. This because there are no indications that this approach is harmful and a too rapid trauma confrontation can be unsafe for this population (for example suicide, therapy refusal, dissociation and self-injuring behavior). Phased treatment involves stabilization, trauma confrontation and integration of what was learned in daily life. The sub-questions related to the treatment indicators and treatment disciplines remain unanswered because the evidence was very weak, thus further research is suggested.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology MSc (66604)
Link to this item:http://purl.utwente.nl/essays/63350
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