Trauma-focused psychotherapies, in particular prolonged exposure (PE) therapy, have been recognized as the "gold standard" for the treatment of posttraumatic stress disorder (PTSD). But effectiveness and implementation data show that a large proportion of patients who undergo exposure therapy retain their PTSD diagnosis, and implementation studies have shown low engagement and high dropout rates. Meanwhile, non-trauma-focused therapies have shown promise in treating PTSD. In this review, we aim to answer the question of whether exposure is necessary to treat PTSD by integrating clinical and research literature from multiple perspectives. We review the roots of exposure therapy in both psychodynamic and behavioral paradigms and their proposed mechanisms. We then review non-trauma-focused treatments and their proposed mechanisms. We conclude that the specific form of exposure required by PE is not necessary for symptom remission. Finally, common psychotherapy factors may facilitate patient self-directed exposure outside of the therapy context. These findings should alter the direction of clinical research to identify the therapy processes that most effectively promote the processing of trauma memories. With respect to clinical practice, shared decision-making should allow for increased patient autonomy in choosing either trauma-focused or non-trauma-focused treatments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

中文翻译：

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暴露或不暴露：创伤后应激障碍治疗的综合视角。


以创伤为中心的心理治疗，尤其是延长暴露 （PE） 治疗，已被公认为治疗创伤后应激障碍 （PTSD） 的“金标准”。但有效性和实施数据表明，接受暴露疗法的很大一部分患者保留了他们的 PTSD 诊断，实施研究表明参与度低，退出率高。与此同时，非创伤聚焦疗法在治疗 PTSD 方面显示出前景。在这篇综述中，我们旨在通过从多个角度整合临床和研究文献来回答治疗 PTSD 是否有必要暴露的问题。我们回顾了心理动力学和行为范式中暴露疗法的根源及其提出的机制。然后，我们回顾了以创伤为中心的非创伤治疗及其提出的机制。我们得出结论，PE 所需的特定暴露形式对于症状缓解不是必需的。最后，常见的心理治疗因素可能有助于患者在治疗环境之外进行自我导向的暴露。这些发现应该改变临床研究的方向，以确定最有效地促进创伤记忆处理的治疗过程。在临床实践方面，共同决策应允许患者在选择以创伤为重点或非以创伤为重点的治疗时增加自主权。（PsycInfo 数据库记录 （c） 2024 APA，保留所有权利）。