Algemene conlusies mbt psychologische interventies bij PTSS (versi

Richtlijntekst: VERSIE 2009

De laatste jaren zijn een aantal RCTs gepubliceerd naar de effecten van psychologische behandelingen. Op basis van de resultaten van dit onderzoek zijn traumagerichte CGT en EMDR de eerste keus behandelingen. De keuze te starten voor traumagerichte CGT dan wel EMDR zal in de praktijk vooral worden gemaakt op basis van de beschikbare kennis en kunde bij een individuele therapeut of de desbetreffende instelling.

Bij onvoldoende effect overgaan op een variant van CGT of (na EMDR) traumagerichte CGT.

Wel moet bedacht worden dat het bestaande onderzoek meestal betrekking heeft op patiënten die lijden onder de gevolgen van soms éénmalig (type 1 trauma) maar vaker meervoudig seksueel trauma of op

Vietnamveteranen. Enerzijds doet dit vermoeden dat de effectiviteit van de onderzochte behandelingen niet alleen geldt voor de gevolgen van éénmalig trauma. Anderzijds is het een open vraag of de resultaten zich laten generaliseren naar de behandeling van patiënten met complexe PTSS (ook al is dit het gevolg van eenmalige traumatisering), patiënten die lijden onder de gevolgen van herhaalde en langdurige traumatisering (al dan niet op jonge leeftijd). EMDR lijkt met name effectief bij enkelvoudige trauma‟s die op volwassen leeftijd zijn ontstaan. Bij 6 maanden was 75% van deze groep PTSS patiënten asymptomatisch terwijl dat in de trauma groep met „childhood onset‟ slechts 33% was (Van der Kolk et al., 2007). Er zijn aanwijzingen dat traumagerichte CGT niet alleen bij Type I, maar ook bij type II trauma effectief is (Clarke, Rizvi, & Resick, 2008; Hembree, Cahill, & Foa, 2004; McDonagh, Friedman, McHugo, Ford, Sengupta, Mueser, Demment, Fournier, & Schnurr, 2005).

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