Triagem e tratamento somático do transtorno de estresse pós-traumático em população adulta exposta a experiências traumáticas

Abstract

Posttraumatic Stress Disorder (PTSD) is characterized by the development of psychological, physiological and behavioral clinical symptoms after exposure to one or more traumatic events that may vary between different individuals, presenting different combinations of symptomatic patterns included in the diagnostic criteria for the disease in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Physiological stress is the way in which the body responds to traumatic events, which have become increasingly common with the increasing violence in urban centers, being demonstrated by the frequent occurrence of robberies or assaults followed by death, leading to the onset of PTSD and worsens the impact on mental health. Currently, evidence from studies on the neurobiology of PTSD has demonstrated neural systems particularly involved in its pathophysiology and different types of treatment approaches. For example, somatic approaches and therapeutic methods, including the SE™ method - Somatic Experiencing® (Somatic Experience), focused on improving the symptoms of chronic stress and post-traumatic stress. In this context, the objectives of this study involve 3 aspects related to PTSD: 1) Investigate the state of the art in the use of somatic therapies, particularly the SETM method, applied to the treatment of PTSD; (2) Evaluate the effect of SETM in men victims of assault in the city of Natal, medicated and non-medicated, with clinical diagnosis of PTSD; (3) Validate a questionnaire for screening PTSD based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In the first study, a literature review on somatic approaches was carried out, demonstrating that techniques and methods such as Yoga, Mindfulness, Brainspotting and SETM presented positive results in reducing PTSD symptoms with individual, group and couple visits. However, despite the efficacy of these treatments, there was a low academic production, particularly from SETM, with research only in international settings and mostly developed with male individuals. In the second study, a sample composed of 23 participants was used, six of whom were using (GM group) and 17 were not using medication (GS group) for PTSD, to investigate the effectiveness of the treatment using the SETM method. The results showed a significant decrease in PTSD symptoms on the psychometric scales, with a significant increase in the scores of positive affect and perception of well-being, the latter scale evaluated in the 3-month follow-up after therapy. The method proved to be effective for both GM and GS, with mild and moderate degrees of PTSD being the most benefited. There were no significant differences when considering the classification of PTSD in acute and chronic. Both groups showed discreet responses in relation to cortisol. On the other hand, DHEA showed a significant decrease, suggesting a neuroprotective role, in addition to being positively associated with CRP before treatment, when both biological markers were high. It can be suggested that the effectiveness of SETM was significant since both medicated and non-medicated patients benefited equally. Therefore, the use of SETM proved to be a complementary treatment that can be better used by professionals who work with PTSD. Study 3 aimed to validate an instrument based on DSM-5 for screening and checking PTSD symptoms. The proposed scale was constructed with 41 items and answered by 408 participants (254 women and 154 men), resulting in four empirical factors, grouping items of different symptomatic criteria of PTSD. Exploratory factor analysis, covering the analysis of factor loads, indicated a one-dimensional construct on the scale. The four factors (Hyperstimulation, Difficulties in cognition and mood, Intrusion and Avoidance) presented values of internal consistency calculated by the Cronbach's Alpha test equal to 0.94, 0.83, 0.94 and 0.70, respectively. The means obtained from the four factors of the groups of subjects diagnosed (n = 152) and not diagnosed with PTSD (n = 249) was significantly different (p = 0.000). Thus, it was possible to demonstrate a strongly significant correlation between the factors and the score of the Event Impact Scale. This study adds important results in a relatively new and emerging field of research, currently more based on structural and functional neuroimaging studies and on neurobiological models of trauma and PTSD based on neural networks.