Some individuals with posttraumatic stress disorder (PTSD) are at elevated risk of reexposure to trauma during treatment. Trauma-focused cognitive-behavioral therapies (CBT) are recommended as first-line PTSD treatments but have generally been tested with exclusion criteria related to risk for trauma exposure. Therefore, there is limited knowledge on how to best treat individuals with PTSD under ongoing threat of reexposure. This paper systematically reviewed the effectiveness of CBTs for PTSD in individuals with ongoing threat of reexposure. Literature searches yielded 21 studies across samples at ongoing risk of war-related or community violence (n = 14), domestic violence (n = 5), and work-related traumatic events (n = 2). Medium to large effects were found from pre to posttreatment and compared with waitlist controls. There were mixed findings for domestic violence samples on long-term outcomes. Treatment adaptations focused on establishing relative safety and differentiating between realistic threat and generalized fear responses. Few studies examined whether ongoing threat influenced treatment outcomes or whether treatments were associated with adverse events. Thus, although the evidence is promising, conclusions cannot be firmly drawn about whether trauma-focused CBTs for PTSD are safe and effective for individuals under ongoing threat. Areas for further inquiry are outlined.

一些患有创伤后应激障碍 (PTSD) 的人在治疗期间再次暴露于创伤的风险较高。以创伤为中心的认知行为疗法 (CBT) 被推荐作为 PTSD 的一线治疗方法，但通常已经用与创伤暴露风险相关的排除标准进行了测试。因此，关于如何在持续的再暴露威胁下最好地治疗 PTSD 患者的知识有限。本文系统地回顾了 CBT 对有持续再暴露威胁的个体的 PTSD 的有效性。文献搜索产生了 21 项研究，涉及持续存在战争相关或社区暴力风险 ( n  = 14)、家庭暴力 ( n  = 5) 和工作相关创伤事件 ( n = 2)。从治疗前到治疗后发现了中到大的影响，并与候补名单对照进行了比较。对家庭暴力样本的长期结果有不同的发现。治疗适应侧重于建立相对安全性并区分现实威胁和普遍恐惧反应。很少有研究检查持续威胁是否影响治疗结果或治疗是否与不良事件相关。因此，尽管证据是有希望的，但无法确定针对 PTSD 的针对创伤的 CBT 对持续受到威胁的个体是否安全有效。概述了进一步调查的领域。