کارشناسان تروما چه زمانی مواجهه درمانی را برای بیماران مبتلا به PTSD را انتخاب می کنند؟ یک مطالعه کنترل شده عوامل درمانگر و بیمار

To investigate when and why therapists opt for or rule out imaginal exposure (IE) for patients with posttraumatic stress disorder (PTSD), 255 trauma experts were randomized to two conditions in which they were presented with four cases in which the patients' comorbidity and treatment preferences were manipulated. The results confirmed IE to be an underutilized approach, with the majority of professionals being undertrained in the technique. As predicted, the patient factors influenced the expert's choice of therapy: in case of a comorbid depression, IE was significantly less preferred than medication. Also, IE was significantly more likely to be offered when patients expressed a preference for trauma-focused treatment. The therapist factors were also found to be importantly related to treatment preferences, with high credibility in the technique being positively related to the therapists' preference for IE. Perceived barriers to IE, such as a fear of symptom exacerbation and dropout, were negatively related to the perceived suitability of the treatment when patients had suffered multiple traumas in childhood. The results are discussed in the light of clinical implications and the need of exposure training for trauma professionals.

Despite the strong evidence for the efficacy of exposure techniques in the treatment of posttraumatic stress disorder (PTSD; Cahill, Rothbaum, Resick, & Folette, 2009), the approach is underutilized in clinical practice (Becker et al., 2004 and Rosen et al., 2005). In their survey, Becker et al. (2004) showed that a large majority (83%) of the 207 licensed doctoral-level psychologists questioned never opted for exposure therapy to treat their PTSD patients. But what are the reasons for this underutilization? Why do therapists fail to exploit exposure-based treatments for this population in spite of their proven effectiveness? Which therapist-related and patient-related factors are implicated here and how do they interact (Becker, Darius, & Schaumberg, 2007)? Although mostly explorative in nature, some studies have begun to delineate predictive factors of clinicians' treatment preferences. To add to the existing knowledge, apart from a comprehensive therapist survey, we conducted a controlled study among experts working in this trauma field in which we evaluated the effects of several therapist and patient factors on the preference for one of four recommended and widely used treatments for PTSD.