運用眼動減敏與歷程更新法於創傷後壓力症候群病人成效之統合分析

論文名稱：運用眼動減敏與歷程更新法於創傷後壓力症候群病人成效之統合分析研究所名稱：臺北醫學大學護理學研究所研究生名稱：陳櫻仁畢業時間：一百零二學年度第一學期指導教授：周桂如臺北醫學大學護理學研究所教授背景: 創傷後壓力症候群在臨床治療方面，以藥物治療和心理治療為主，而 EMDR為後期興起的一種治療創傷後壓力症候群之治療方式，在治療的花費時間方面，比起其他心理治療方式需要時間較短，同時在治療結果方面仍有顯著效果。方法: 本研究收集國內外從西元1991年1月至2011年12月所有已發表有關EMDR治療介入創傷後壓力症候群之量性研究文獻作為研究的樣本，並作量性回顧。為廣泛收集相關研究以電腦檢索各種系統及資料庫，並以Medical Subjet Headlings（MeSH）找尋與主題相關的群組，再以Google search engine輔助電腦資料庫登錄上可能出現的遺漏，及從已蒐集到的文獻中搜尋所附的參考文獻，找出資料庫中遺漏的研究文獻。結果:本研究結果顯示EMDR對於改善創傷後壓力症候群病人之PTSD症狀(g=-0.713，95% CI＝-0.920, -0.507) 、憂鬱程度(g=-0.651，95% CI＝-0.864, -0.438)、焦慮程度(g=-0.679，95% CI＝-0.915,-0.443)及主觀困擾(g=-0.956，95% CI＝-1.388, -0.525)，有顯著之效果且效果量皆為負向。再者，PTSD症狀改善效果量之研究特徵次群組分析中，僅發現治療師具有PTSD團體治療經驗之組別其效果量(g= -0.803)，治療師無PTSD團體治療經驗之組別(g= -0.234)，且兩組在統計上有顯著意義，其組間差異顯著(p=0.002)，在憂鬱程度改善效果量之研究特徵次群組分析，僅發現每次治療時間大於60分鐘之效果量(g= -0.811)優於每次治療時間小於等於60分鐘(g=-0.341)，且在統計上達顯著意義，其組間差異顯著(p=0.012)，在焦慮程度改善效果量之研究特徵次群組分析，亦發現每次治療時間大於60分鐘之效果量(g= -0.849)優於每次治療時間小於等於60分鐘(g=-0.414)，且在統計上達顯著意義，其組間差異顯著(p=0.042)。結論: 本研究證實了EMDR治療對於改善創傷後壓力症候群病人的PTSD症狀、憂鬱程度、焦慮程度及主觀困擾有明顯的成效。再者，此研究結果提供臨床醫療人員之參考依據並建議若運用EMDR於創傷後壓力症候群之病人時，其治療師背景應具備有PTSD團體治療經驗，並建議於每次療程時間應大於60分鐘，其改善效果量較佳。

關鍵字

創傷後壓力症候群；眼動減敏與歷程更新法；統合分析

並列摘要

Abstract Title of Thesis: Effectiveness of EMDR in PTSD Patients: A Meta-Analysis Institution: Graduate Institute of Nursing, Taipei Medical University Author: Chen Ying-Ren Thesis directed by: Kuei-Ru Chou, DNS, Professor Background: Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that has been used to treat subjects experiencing PTSD in recent years. Comparing with other psychotherapeutic approaches, EMDR is less time-consuming and had been beneficial in some studies. However, there is not yet comprehensive review on the effectiveness of EMDR on PTSD using subgroup analysis within the past ten years. Methods: We conducted a comprehensive search of 10 electronic databases to retrieve articles published between 1991 and 2011 using Medical Subject Heading (MeSH) keywords related to the topics. Publications not included in databases were included by screening with Google search engine. Results: EMDR have a negative and significant effect on PTSD symptoms (Hedge’s g-0.713; 95% CI, [-0.920, -0.507]), depression (Hedge’s g -0.651; 95% CI, [-0.864, -0.438]), anxiety (Hedge’s g-0.679; 95% CI, [-0.915,-0.443]) and subjective distress (Hedge’s g -0.956; 95% CI, [-1.388, -0.525]) in patients with PTSD.Subgroup analysis of study characteristics revealed significant differences in the effect sizes in the following categories: (1) on PTSD symptoms between therapists with and without experience in PTSD treatment (Hedge’s g value -0.803 vs. -0.234; p = 0.002). (2) on the degree of depression between treatment sessions longer and shorter than 60 minutes (Hedge’s g value -0.811 vs. -0.341; p = 0.012). (3) on anxiety between treatment sessions longer and shorter than 60 minutes (Hedge’s g value -0.849 vs. -0.414; p = 0.042). Conclusions: The results of this meta-analysis confirmed that the severity of PTSD symptoms, degree of anxiety, depression and subjective distress are reduced with EMDR treatment. Subgroup of analysis revealed that treatment session longer than 60 min and therapist with PTSD group therapy experience are the main moderaters of effect size in relieving anxiety, depression and symptoms of PTSD, respectively. Furthermore, the results of this study provide a reference for clinical medical staff and suggest that when implementing EMDR in patients with PTSD, therapist with PTSD group therapy experience is preferred for better response in PTSD symptom relief. EMDR sessions longer than 60 min are recommended to ease the anxiety and depression in PTSD patients.