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Hotspots in Trauma Memories and Their Relationship to Successful Trauma-Focused Psychotherapy: A Pilot Study

Authors

  • Mirjam J. Nijdam,

    Corresponding author
    • Center for Psychological Trauma, Department of Psychiatry, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
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  • Melanie A. M. Baas,

    1. Center for Psychological Trauma, Department of Psychiatry, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
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  • Miranda Olff,

    1. Center for Psychological Trauma, Department of Psychiatry, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
    2. Arq Psychotrauma Expert Group, Diemen, The Netherlands
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  • Berthold P. R. Gersons

    1. Center for Psychological Trauma, Department of Psychiatry, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
    2. Arq Psychotrauma Expert Group, Diemen, The Netherlands
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  • This research was supported by the Academic Medical Center at the University of Amsterdam.

Correspondence concerning this article should be addressed to Mirjam J. Nijdam, Center for Psychological Trauma, Department of Psychiatry, Academic Medical Center at the University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. E-mail: m.j.nijdam@amc.uva.nl

Abstract

Imaginal exposure is an essential element of trauma-focused psychotherapies for posttraumatic stress disorder (PTSD). Exposure should in particular focus on the “hotspots,” the parts of trauma memories that cause high levels of emotional distress which are often reexperienced. Our aim was to investigate whether differences in the focus on hotspots differentiate between successful and unsuccessful trauma-focused psychotherapies. As part of a randomized trial, 45 PTSD patients completed brief eclectic psychotherapy for PTSD. We retrospectively assessed audio recordings of therapy sessions of 20 patients. Frequency of hotspots and the associated emotions, cognitions, and characteristics were compared for the most successful (n = 10) versus the least successful (n = 10) treatments. The mean number of unique hotspots per patient was 3.20, and this number did not differ between successful and unsuccessful treatments. In successful treatments, however, hotspots were more frequently addressed (r = .48), and they were accompanied by more characteristics of hotspots (r = .39), such as an audible change in affect, indicating medium- to large-sized effects. Repeatedly focusing on hotspots and looking for associated characteristics of hotspots may help clinicians to enhance the efficacy of imaginal exposure for patients who would otherwise show insufficient response to treatment.

Traditional and Simplified Chinese Abstracts by AsianSTSS

標題:一個關於創傷記憶「熱點」和成功的聚焦創傷心理治療的先導研究。

撮要:創傷後壓力症(PTSD)治療中聚焦創傷的心理治療的關鍵是意象暴露。暴露必須關注「熱點」,即創傷記憶中引致極大情緒悲痛 (亦常會令人再體驗)的部份。我們探究「熱點」聚焦的差異能否分辨成功或不成功的聚焦創傷心理治療。在一隨機研究中抽取45位PTSD病人完成PTSD短期折衷心理治療。我們亦追溯20位病人的治療錄音作評估。最高成功率(n=10)及最低成功率(n=10)的治療組別會以「熱點」密度、相關情緒、認知及特徵作比較。每位病人的獨特「熱點」平均數為3.20,而此數目在最高及最低成功率組別間無差別。但在成功治療組別中,「熱點」會被更多提及(r=.48),有更多特徵(r=.39)(如情緒在聲線方面的改變);展示中到大效應。經常聚焦「熱點」和追尋相連特徵,或可使醫生在病人未對治療有明顯效果時增加意象暴露的功效。

标题:一个关于创伤记忆「热点」和成功的聚焦创伤心理治疗的试点研究。

撮要:创伤后压力症(PTSD)治疗中聚焦创伤的心理治疗的关键是意象暴露。暴露必须关注「热点」,即创伤记忆中引致极大情绪悲痛 (亦常会令人再体验)的部份。我们探究「热点」聚焦的差异能否分辨成功或不成功的聚焦创伤心理治疗。在一随机研究中抽取45位PTSD病人完成PTSD短期折衷心理治疗。我们亦追溯20位病人的治疗录音作评估。最高成功率(n=10)及最低成功率(n=10)的治疗组别会以「热点」密度、相关情绪、认知及特征作比较。每位病人的独特「热点」平均数为3.20,而此数目在最高及最低成功率组别间无差别。但在成功治疗组别中,「热点」会被更多谈起(r=.48),有更多特征(r=.39)(如情绪出现时的声音改变);展示中到大效应。经常聚焦「热点」和追寻相连特征,或可使医生在病人未对治疗有明显效果时增加意象暴露的功效。

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