Inhoud
Vermeende contra-indicaties voor (imaginaire) exposurebehandeling van PTSS onder de loep
Samenvatting
Hoewel van alle gangbare behandelingen voor posttraumatische stressstoornis (PTSS) de empirische onderbouwing voor exposuretherapie het sterkst is, zijn behandelaars toch terughoudend in het toepassen ervan. Dit vanwege de idee dat er voor veel PTSS-patiënten contra-indicaties bestaan, in het bijzonder voor patiënten met comorbide problematiek. Omdat comorbiditeit bij PTSS hoog is, is het van belang bij deze patiënten te bezien of er mogelijk sprake is van een contra-indicatie voor exposure. In deze overzichtsstudie bespreken wij de empirische argumenten voor of tegen exposurebehandeling voor patiënten die naast PTSS andere, vaak aan de PTSS-gerelateerde problematiek hebben ontwikkeld, waaronder dissociatie, borderline persoonlijkheidsstoornis, psychotische stoornissen, suïcidaliteit, zelfverwonding, middelenafhankelijkheid of - misbruik of depressie. De conclusie luidt dat ook bij patiënten met comorbide aandoeningen exposure veilig en effectief kan worden toegepast, waarbij veelal zowel de symptomen van de PTSS als die van de comorbide stoornissen afnemen. Ook indien er sprake is van ernstige comorbiditeit kan de PTSS met exposure worden behandeld, al is een geïntegreerde of gelijktijdige benadering waarbij de comorbide klachten worden gevolgd en behandeld dan raadzaam.
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