APA practice guidelines for the
treatment of psychiatric
disorders
L’EFFICACIA DELLA PSICOTERAPIA
Perché affidarsi a trattamenti psicoterapici la cui efficacia sia stata sottoposta a verifiche
sperimentali? In fondo qualsiasi psicoterapeuta, corredato di una buona formazione e sufficiente
esperienza clinica, è in grado di orientarsi nel trattamento dei pazienti.
In realtà, la convinzione che un determinato approccio terapeutico funzioni non può fondarsi
unicamente sulla propria esperienza clinica: la verifica sperimentale ci consente di superare la
trappola pericolosa dell'auto-inganno, sostenuto dal desiderio di proteggere la fiducia nel metodo
terapeutico abbracciato (Migone, 2001).
I disturbi mentali costituiscano un grande problema di sanità pubblica per una serie di ragioni:
presentano un'elevata frequenza nella popolazione generale, in tutte le fasce d’età; sono fortemente
invalidanti nella vita quotidiana, nel lavoro/scuola, nelle relazioni interpersonali; infine, sono
onerosi i costi economici e sociali che ne derivano per i pazienti e per i familiari (Tansella e de
Girolamo, 2001). Tutto ciò rende indispensabile lo sforzo di offrire ai pazienti trattamenti elettivi
per i loro disturbi, la cui efficacia sia stata provata scientificamente (Barcaccia e Mancini, 2006).
In questi ultimi decenni c’è stata una vera e propria esplosione delle ricerche scientifiche sui
disturbi psichiatrici. Se ciò da un lato produce un continuo ampliamento delle conoscenze,
dall’altro rischia di generare confusione e disorientamento nel paziente e nel clinico che dovrà
occuparsi della sua cura.
L’APA (American Psychiatric Association) ha cominciato ad occuparsi di questi temi sulla
spinta del più vasto movimento EBM (Evidence-Based Medicine, medicina basata su prove di
efficacia), nato nel Regno Unito e fondato su alcuni semplici principi: se il clinico fa costantemente
riferimento a conoscenze scientifiche aggiornate, il trattamento dei pazienti migliora, in caso
contrario è destinato a peggiorare nel tempo; i clinici devono poter attingere agevolmente a
compendi selezionati da esperti sugli interventi più nuovi ed efficaci, e queste informazioni devono
ricevere ampia diffusione (Cochrane, 1999).
Proprio ispirandosi a questi principi, l’APA sviluppa linee-guida pratiche che nascono da
revisioni rigorose della letteratura scientifica sui diversi disturbi psichiatrici. Tali guide, rinnovate
ogni cinque anni circa, sintetizzano le conoscenze disponibili con lo scopo di assistere il curante
nelle sue decisioni cliniche affinché possa offrire a ciascun paziente il trattamento, farmacologico
e/o psicoterapico, dimostratosi più efficace per quel disturbo.
Da un’attenta analisi delle linee-guida stilate dall’APA (Practice Guidelines) emerge che la
psicoterapia Cognitivo-Comportamentale, con le sue diverse tecniche e strategie, rappresenta ad
oggi il trattamento di prima linea, la terapia da consigliare al paziente come primo ed elettivo
intervento, per molti disturbi psichiatrici (segue tabella sintetica con le linee-guida APA).
È d’obbligo, d'altronde, ricordare che l’assenza di alcune psicoterapie dall’elenco dei
trattamenti raccomandati non significa necessariamente che non funzionano, ma può, ad esempio,
derivare dalla mancanza o scarsità di ricerche rigorose condotte per valutarne l’efficacia (evidencebased).
•
Barcaccia B. e Mancini F., Psicoterapia basata su prove di efficacia e protocolli terapeutici
in uovo Manuale di Psicoterapia Cognitiva, Bara B. (a cura di), Bollati Boringhieri, 2006.
•
Cochrane A. Efficienza ed Efficacia. Riflessioni sui servizi sanitari Il Pensiero Scientifico
Editore, 1999
•
Department of Health Treatment Choice in Psychological Therapies and Counselling.
Evidence
Based
Clinical
Practice
Guideline
www.doh.gov.uk/mentalhealth/treatmentguideline
•
Kazdin A.E., Weisz J.R. Evidence-Based Psychotherapies for Children and Adolescents The
Guilford Press 2003
•
Kendall P.C., Chambless D.L., Eds. 1998. Empirically supported psychological therapies.
Journal of Consulting and Clinical Psychology 66:3-167 (special issue)
•
Lyddon W. J., Jones J. V. Jr., L’approccio evidence-based in psicoterapia McGraw-Hill
2002
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Morosini P., Michielin P. Efficacia delle psicoterapie. In: La salute mentale: Contro il
pregiudizio, il coraggio delle cure. Eds. Cassano G.B., Dell’Acqua G., Garattini S., Maj M.,
Morosini P., Muggia E., Munizza C., Racagni G., Tansella M. Roma: Il Pensiero Scientifico
Editore
2001.
Disponibile
all’indirizzo
web
http://www.salutementale-
oms.it/Psicoterapie.htm
•
Morosini P., de Girolamo G., Picardi A., Polidori G., Fassone G., Mazzotti E. Il Progetto
azionale Salute Mentale: motivazioni, storia, organizzazione, prodotti e prospettive In de
Girolamo G., Picardi A., Polidori G., Morosini P. (a cura di): Progetto azionale Salute
Mentale: rapporto della prima fase. Istituto Superiore di Sanità, serie Rapporti ISTISAN,
Roma,
2000.
Disponibile
all’indirizzo
web
http://www.iss.it/scientifica/pubblica/rapporti/00-12/parte1.PDF.
•
Roth A., Fonagy P. 1996. What Works for Whom? A Critical Review of Psychotherapy
Research. New York: Guilford. Ed.it. Roth A., Fonagy P. Psicoterapie e prove di efficacia.
Quale terapia per quale paziente Il Pensiero Scientifico Editore 1997
Facilitazione in 12-passi (TSF); Terapia
Psicodinamica e Interpersonale (IPT);
(CBT) + Farmaci + Terapia
Comportamentale
Depressione Maggiore
Delirium
Comportamenti Suicidari
Borderline
+ Farmaci centrati sui sintomi
Guideline Watch 2005
Guideline Watch 2005 Farmaci; Terapia Cognitivo-
Psicoeducazione di gruppo
Terapia Interpersonale; Problem-solving;
Comportamentali
Psicoeducazione; Programmi
Farmaci
Practice Guideline 2000 Terapia Cognitivo-Comportamentale;
Guideline Watch 2004
Practice Guideline 1999
Terapia Interpersonale; Psicodinamica
Terapia Dialettico-Comportamentale;
Analitica;
Terapia Cognitiva; Terapia Cognitivo-
Farmaci
Practice Guideline 2003 Terapia Cognitivo-Comportamentale +
Terapia Dialettico-Comportamentale
Practice Guideline 2001
Terapia Interpersonale e Familiare
Terapia Cognitivo-Comportamentale;
Farmaci
Practice Guideline 2002
Bipolare
Guideline Watch 2005
Terapia Comportamentale; Skills Training
Farmaci
Practice Guideline 2007
Alzheimer
coppia e familiare
comportamentale; Terapia di gruppo, di
Manuali di auto-aiuto; Auto-controllo
Terapia Motivazionale (MET);
Terapia Cognitivo-Comportamentale
Practice Guideline 2006
Abuso di Sostanze
(nicotina, alcool, cocaina, oppiacei)
Altri Trattamenti
Trattamento I Linea
Fonte
Disturbo
Tabella Riassuntiva (sintesi a cura di Teresa Cosentino)
Linee-guida pratiche dell’APA per il trattamento dei disturbi psichiatrici
7
6
5
4
3
2
1
bibliografici
Riferimenti
Post-traumatico da stress
Stress Acuto
Schizofrenia (fase stabile)
soggetti con HIV/AIDS
Disturbi psichiatrici (depressione) in
DOC
Farmaci
Farmaci
Comportamentale +Farmaci
Farmaci; Terapia Cognitivo-
Practice Guideline 2004 Terapia Cognitivo-Comportamentale;
Practice Guideline 2004
Guideline Watch 2006
Comportamentale + Farmaci
Farmaci; Terapia Cognitivo-
Practice Guideline 2007 Terapia Cognitivo-Comportamentale;
Comportamentale + Farmaci
Farmaci; Terapia Cognitivo-
Practice Guideline 1998 Terapia Cognitivo-Comportamentale;
Disturbo di Panico
Guideline Watch 2006
Practice Guideline 2006
Disturbi Alimentari
Terapia Cognitivo-Comportamentale
Comportamentale + Farmaci
Tecniche di Esposizione Prolungata
Stress Inoculation; Imagery Rehearsal e
Interventi Familiari; Training Assertivo
Comportamentale; Social Skills Training;
Terapia Cognitivo-Comportamentale;
Tecniche per la gestione dello Stress;
ed Interpersonale; Psicoeducazione;
Comportamentale; Terapia Psicodinamica
Terapia Cognitivo-Comportamentale;
gruppo e familiare; Farmaci
Terapia Interpersonale; Psicoterapia di
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12
11
10
9
8
Brani estrapolati dalle linee-guida per il trattamento dei singoli Disturbi
A. Coding System
Each recommendation is identified as meriting one of three categories of endorsement, based on the level of
clinical confidence regarding the recommendation:
[I] Recommended with substantial clinical confidence
[II] Recommended with moderate clinical confidence
[III] May be recommended on the basis of individual circumstances
Abuso di Sostanze Practice Guideline (maggio 2006)
Psychosocial treatments are essential components of a comprehensive treatment program [I]. Evidence-based
psychosocial treatments include cognitive-behavioral therapies (CBTs, e.g., relapse prevention, social skills
training), motivational enhancement therapy (MET), behavioral therapies (e.g., community reinforcement,
contingency management), 12-step facilitation (TSF), psychodynamic therapy/interpersonal therapy (IPT),
self-help manuals, behavioral self-control, brief interventions, case management, and group, marital, and
family therapies.
Nicotina
Psychosocial treatments are also effective for the treatment of nicotine dependence and include CBTs [I],
behavioral therapies [I], brief interventions [II], and MET [II] provided in individual [I], group [I], or
telephone [I] formats or via self-help materials [III] and Internet-based formats [III]. The efficacy of
treatment is related to the amount of psychosocial treatment received.
Alcool
Psychosocial treatments found effective for some patients with an alcohol use disorder include MET [I],
CBT [I], behavioral therapies [I], TSF [I], marital and family therapies [I], group therapies [II], and
psychodynamic therapy/IPT [III]. Recommending that patients participate in self-help groups, such as
Alcoholics Anonymous (AA), is often helpful [I].
Cocaina
For many patients with a cocaine use disorder, psychosocial treatments focusing on abstinence are effective
[I]. In particular, CBTs [I], behavioral therapies [I], and 12-step-oriented individual drug counseling [I] can
be useful, although efficacy of these therapies varies across subgroups of patients. Recommending regular
participation in a self-help group may improve the outcome for selected patients with a cocaine use disorder
[III].
Oppiacei
Psychosocial treatments are effective components of a comprehensive treatment plan for patients with an
opioid use disorder [II]. Behavioral therapies (e.g., contingency management) [II], CBTs [II],
psychodynamic psychotherapy [III], and group and family therapies [III] have been found to be effective for
some patients with an opioid use disorder. Recommending regular participation in self-help groups may also
be useful [III].
Alzheimer Practice Guideline (ottobre 2007)
In addition to the general psychosocial interventions subsumed under psychiatric management, a number of
specific interventions are appropriate for some patients. Few of these treatments have been subjected to
double-blind randomized evaluation, but some research, along with clinical practice, supports their
effectiveness. Behavior-oriented treatments are used to identify the antecedents and consequences of
problem behaviors and attempt to reduce the frequency of behaviors by directing changes in the environment
that alter these antecedents and consequences. Behavioral approaches have not been subjected to large
randomized clinical trials but are supported by small trials and case studies and are in widespread clinical use
[II].
Bipolare
•
Practice Guideline (aprile 2002)
The first-line pharmacological treatment for bipolar depression is the initiation of either lithium [I] or
lamotrigine [II].
Small studies have suggested that interpersonal therapy and cognitive behavior therapy may also be useful
when added to pharmacotherapy during depressive episodes in patients with bipolar disorder.
Trattamento di mantenimento
•
Guideline Watch (November 2005)
Knowledge of the utility of psychosocial interventions has expanded recently. Family-focused therapy is a
manualized psychosocial program involving all available family members in which weekly psychoeducation,
communication enhancement training, and problem-solving skills training occur adjunctively with
pharmacotherapy.
Another randomized, controlled study examined the utility of cognitive therapy in conjunction with
pharmacotherapy over a 12-month period. Those treated with cognitive therapy and pharmacotherapy had
significantly fewer bipolar episodes, days in an episode, and number of admissions.
Borderline
•
Practice Guideline (ottobre 2001)
The primary treatment for borderline personality disorder is psychotherapy, complemented by symptomtargeted pharmacotherapy [I].
Two psychotherapeutic approaches have been shown in randomized controlled trials to have efficacy:
psychoanalytic/psychodynamic therapy and dialectical behavior therapy [I].
•
Guideline Watch (Marzo 2005)
Evidence and opinion continue to support the recommendation of the 2001 guideline that psychotherapy
represents the primary, or core, treatment for this disorder and that adjunctive, symptom-targeted
pharmacotherapy can be helpful.
Persuasive data from randomized, controlled trials (RCTs) of BPD suggest that more than one type of
psychotherapy is effective, and additional studies are under way. Dialectical behavior therapy (DBT) has
been shown in an RCT to be effective for borderline symptoms in patients with comorbid BPD and substance
abuse, though no improvement was shown for the substance abuse itself. In another RCT, in patients with
BPD and comorbid opiate use, DBT was compared with comprehensive validation therapy (CVT). Both
types of treatment were effective.
Promising new psychotherapies for BPD are being piloted in open trials. These include interpersonal
therapy; cognitive therapy; cognitive analytic therapy (CAT), a fusion of cognitive and psychodynamic
therapy; and systems training for emotional predictability and problem solving (STEPPS), a cognitivebehavioral systems–based form of time-limited group treatment for patients with BPD.
Comportamenti Suicidari Practice Guideline (novembre 2003)
Psychotherapies and other psychosocial interventions play an important role in the treatment of individuals
with suicidal thoughts and behaviors [II]. A substantial body of evidence supports the efficacy of
psychotherapy in the treatment of specific disorders, such as nonpsychotic major depressive disorder and
borderline personality disorder, which are associated with increased suicide risk. For example, interpersonal
psychotherapy and cognitive behavior therapy have been found to be effective in clinical trials for the
treatment of depression. Therefore, psychotherapies such as interpersonal psychotherapy and cognitive
behavior therapy may be considered appropriate treatments for suicidal behavior, particularly when it occurs
in the context of depression [II]. In addition, cognitive behavior therapy may be used to decrease two
important risk factors for suicide: hopelessness [II] and suicide attempts in depressed outpatients [III]. For
patients with a diagnosis of borderline personality disorder, psychodynamic therapy and dialectical behavior
therapy may be appropriate treatments for suicidal behaviors [II], because modest evidence has shown these
therapies to be associated with decreased self-injurious behaviors, including suicide attempts.
In addition to pharmacotherapies and ECT, psychotherapies play a central role in the management of suicidal
behavior in clinical practice. Although few rigorous studies have directly examined whether these
interventions reduce suicide morbidity or mortality per se, clinical consensus suggests that psychosocial
interventions and specific psychotherapeutic approaches are of benefit to the suicidal patient. Furthermore, in
recent years, studies of psychotherapy have demonstrated its efficacy in treating disorders such as depression
and borderline personality disorder that are associated with increased suicide risk. For example, cognitive
behavior therapy, psychodynamic therapy, and interpersonal psychotherapy have been found effective in
clinical trials for the treatment of these disorders.
Depressione Maggiore
•
Practice Guideline (aprile 2000)
In the acute phase, in addition to psychiatric management, the psychiatrist may choose between several
initial treatment modalities, including pharmacotherapy, psychotherapy, the combination of medications plus
psychotherapy, or ECT [I]. Selection of an initial treatment modality should be influenced by both clinical
(e.g., severity of symptoms) and other factors (e.g., patient preference)
Cognitive behavioral therapy and interpersonal therapy are the psychotherapeutic approaches that have the
best documented efficacy in the literature for the specific treatment of major depressive disorder, although
rigorous studies evaluating the efficacy of psychodynamic psychotherapy have not been published [II].
•
Guideline Watch (settembre 2005)
The guideline recommends the serotonin modulator nefazodone as an effective medication for the treatment
of depression. As noted in the guideline, there is some evidence that addition of cognitive-behavior
psychotherapy may be beneficial for patients who have had only a partial response to pharmacotherapy.
Recent studies have provided additional support for the efficacy of a number of psychosocial treatment
approaches, including problem-solving treatment, group psychoeducation, and the cognitive behavioral
analysis system of psychotherapy. Additional meta-analyses have suggested that among psychotherapeutic
approaches, other bona fide psychotherapies have efficacy comparable with CBT for treating depression,
although more research with CBT has been done. Given the evidence for the benefits of exercise in older
depressed adults, exercise may also be of value in other subgroups of patients with major depression.
Recent meta-analysis suggested that a combination of psychotherapy and pharmacotherapy is more effective
than pharmacotherapy alone
Disturbi Alimentari
Practice Guideline (maggio 2006)
Anoressia Acuta
During acute refeeding and while weight gain is occurring, it is beneficial to provide anorexia nervosa
patients with individual psychotherapeutic management that is psychodynamically informed and provides
empathic understanding, explanations, praise for positive efforts, coaching, support, encouragement, and
other positive behavioral reinforcement [I]. Attempts to conduct formal psychotherapy with starving patients
who are often negativistic, obsessional, or mildly cognitively impaired may be ineffective [II].
Anoressia dopo il recupero del peso
To help prevent patients from relapsing, emerging data support the use of cognitive-behavioral
psychotherapy for adults [II]. For patients receiving cognitive-behavioral therapy (CBT) after weight
restoration, adding fluoxetine does not appear to confer additional benefits with respect to preventing relapse
[II].
Bulimia
For treating acute episodes of bulimia nervosa in adults, the evidence strongly supports the value of CBT as
the most effective single intervention [I]. Some patients who do not respond initially to CBT may respond
when switched to either interpersonal therapy (IPT) or fluoxetine [II] or other modes of treatment such as
family and group psychotherapies [III]. Controlled trials have also shown the utility of IPT in some cases
[II].
In clinical practice, many practitioners combine elements of CBT, IPT, and other psychotherapeutic
techniques. Compared with psychodynamic or interpersonal therapy, CBT is associated with more rapid
remission of eating symptoms [I], but using psychodynamic interventions in conjunction with CBT and other
psychotherapies may yield better global outcomes [II].
In some research, the combination of antidepressant therapy and CBT results in the highest remission rates;
therefore, this combination is recommended initially when qualified CBT therapists are available [II]. In
addition, when CBT alone does not result in a substantial reduction in symptoms after 10 sessions, it is
recommended that fluoxetine be added [II].
Disturbi alimentari non altrimenti specificati
Substantial evidence supports the efficacy of individual or group CBT for the behavioral and psychological
symptoms of binge eating disorder [I]. IPT and dialectical behavior therapy have also been shown to be
effective for behavioral and psychological symptoms and can be considered as alternatives [II].
Disturbo di Panico
•
Practice Guideline (maggio 1998)
Psychotherapy, specifically panic-focused cognitive behavioral therapy (CBT), and medications have both
been shown to be effective treatments for panic disorder [I]. There is no convincing evidence that one
modality is superior for all patients or for particular subpopulations of patients. The choice between
psychotherapy and pharmacotherapy depends on an individualized assessment of the efficacy, benefits, and
risks of each modality and the patient's personal preferences (including costs) [I]. In every case, the patient
should be fully informed by the psychiatrist about the availability and relative advantages and disadvantages
of CBT, antipanic medications, and other forms of treatment.CBT encompasses a range of treatments, each
consisting of several elements, including psychoeducation, continuous panic monitoring, development of
anxiety management skills, cognitive restructuring, and in vivo exposure. In practice, the types of therapy
encompassed by CBT are often quite diverse. It is unknown whether certain elements are more effective for
all patients or for specific patients. The efficacy of CBT for the treatment of panic disorder is supported by
extensive and high-quality data. Other psychotherapies may be considered in conjunction with psychiatric
management [III], but supplementation with (or replacement by) either CBT or an antipanic medication
should be strongly considered if there is no significant improvement within 6–8 weeks.
•
Guideline Watch (aprile 2006)
Cognitive behavior therapy remains the psychosocial treatment with the largest research base and most
demonstrated efficacy for treatment of panic disorder. A clear benefit of adding medication to CBT has yet
to be established, and there is a paucity of data examining the addition of CBT to medication. Other
psychotherapies either have proved inferior to medication and CBT or have not been evaluated in controlled
trials. Finally, more research is needed on assessing the long-term impact of medications and psychosocial
treatments, combining medication and psychosocial treatments, identifying factors that predict treatment
response, and ameliorating treatment-resistant panic disorder.
DOC Practice Guideline (luglio 2007)
In choosing a treatment approach, the clinician should consider the patient's motivation and ability to comply
with pharmacotherapy and psychotherapy [I]. CBT and serotonin reuptake inhibitors (SRIs) are
recommended as safe and effective first-line treatments for OCD [I]. Whether to utilize CBT, an SRI, or
combined treatment will depend on factors that include the nature and severity of the patient's symptoms, the
nature of any co-occurring psychiatric and medical conditions and their treatments, the availability of CBT,
and the patient's past treatment history, current medications, capacities, and preferences. CBT alone,
consisting of exposure and response prevention, is recommended as initial treatment for a patient who is not
too depressed, anxious, or severely ill to cooperate with this treatment modality, or who prefers not to take
medications and is willing to do the work that CBT requires [II]. An SRI alone is recommended for a patient
who is not able to cooperate with CBT, has previously responded well to a given drug, or prefers treatment
with an SRI alone [II]. Combined treatment should be considered for patients with an unsatisfactory response
to monotherapy [II], for those with co-occurring psychiatric conditions for which SRIs are effective [I], and
for those who wish to limit the duration of SRI treatment [II]. In the latter instance, uncontrolled follow-up
studies suggest that CBT may delay or mitigate relapse when SRI treatment is discontinued [II]. Combined
treatment or treatment with an SRI alone may also be considered in patients with severe OCD, since the
medication may diminish symptom severity sufficiently to allow the patient to engage in CBT [II].
CBT that relies primarily on behavioral techniques such as exposure and response prevention (ERP) is
recommended because it has the best evidentiary support [I]. Some data support the use of CBT that focuses
on cognitive techniques [II].
Cognitive-behavioral therapies have been delivered in individual, group, and family therapy sessions, with
session length varying from less than 1 hour to 2 hours. One group has explored a computer-based approach
coupled with a touch-tone telephone system accessible 24 hours a day. CBT sessions should be scheduled at
least once weekly [I]. Five ERP sessions per week may be more effective than once-weekly sessions but are
not necessarily more effective than twice-weekly sessions [II]. The number of treatment sessions, their
length, and the duration of an adequate trial have not been established, but expert consensus recommends
13–20 weekly sessions for most patients [I]. Clinicians should consider booster sessions for more severely ill
patients, for patients who have relapsed in the past, and for patients who show signs of early relapse [II].
HIV/AIDS Guideline Watch (aprile 2006)
Psychotherapeutic or psychopharmacological treatments shown to be effective in other populations are
useful also in the HIV-infected patient with co-occurring psychiatric disorders. Cognitive behavior therapy
groups, educational programs, and stress management techniques have also been shown to improve
depression in patients with HIV. Psychodynamic, cognitive behavior, and interpersonal therapies are also
applicable to the HIV population.
Schizofrenia Practice Guideline (febbraio 2004)
A number of psychosocial treatments have demonstrated effectiveness during the stable phase. They include
family intervention [I], supported employment [I], assertive community treatment [I], skills training [II], and
cognitive behaviorally oriented psychotherapy [II]. In the same way that psychopharmacological
management must be individually tailored to the needs and preferences of the patient, so too should the
selection of psychosocial treatments [I]. The selection of appropriate psychosocial treatments is guided by
the circumstances of the individual patient's needs and social context [II]
Stress Acuto e Post Traumatico da stress Practice Guideline (November 2004)
Some evidence is available about the effectiveness of psychotherapeutic intervention immediately after
trauma in preventing development of ASD or PTSD. Studies of cognitive behavior therapy in motor vehicle
and industrial accident survivors as well as in victims of rape and interpersonal violence suggest that
cognitive behavior therapies may speed recovery and prevent PTSD when therapy is given over a few
sessions beginning 2–3 weeks after trauma exposure [II].
For patients with a diagnosis of ASD or PTSD, available evidence and clinical experience suggest that a
number of psychotherapeutic interventions may be useful. Patients with ASD may be helped by cognitive
behavior therapy and other exposure-based therapies [II]. In addition, cognitive behavior therapy is an
effective treatment for core symptoms of acute and chronic PTSD [I]. EMDR is also effective [II]. Stress
inoculation, imagery rehearsal, and prolonged exposure techniques may also be indicated for treatment of
PTSD and PTSD-associated symptoms such as anxiety and avoidance [II]. The shared element of controlled
exposure of some kind may be the critical intervention.
SELEZIO,E DEI RIFERIME,TI BIBLIOGRAFICI CITATI ,ELLE LI,EE-GUIDA DEI
SI,GOLI DISTURBI CHE RIMA,DA,O ALLA CBT
1. Abuso di Sostanze
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•
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•
•
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Cohen-Mansfield J: Nonpharmacologic interventions for inappropriate behaviors in dementia: a
review, summary, and critique. Am J Geriatr Psychiatry 2001; 9:361–381
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3. Bipolare
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