National Center for PTSD-Pacific Islands Division, Department of Veterans Affairs Pacific Islands Healthcare System, 3375 Koapaka St., Honolulu, HI 96819, USA.
J Clin Psychiatry. 2010 Jul;71(7):855-63. doi: 10.4088/JCP.09m05604blu. Epub 2010 Jan 26.
To demonstrate the noninferiority of a telemedicine modality, videoteleconferencing, compared to traditional in-person service delivery of a group psychotherapy intervention for rural combat veterans with posttraumatic stress disorder (PTSD).
A randomized controlled noninferiority trial of 125 male veterans with PTSD (according to DSM criteria on the Clinician-Administered PTSD Scale) and anger difficulties was conducted at 3 Veterans Affairs outpatient clinics. Participants were randomly assigned to receive anger management therapy delivered in a group setting with the therapist either in-person (n = 64) or via videoteleconferencing (n = 61). Participants were assessed at baseline, midtreatment (3 weeks), posttreatment (6 weeks), and 3 and 6 months posttreatment. The primary clinical outcome was reduction of anger difficulties, as measured by the anger expression and trait anger subscales of the State-Trait Anger Expression Inventory-2 (STAXI-2) and by the Novaco Anger Scale total score (NAS-T). Data were collected from August 2005 to October 2008.
Participants in both groups showed significant and clinically meaningful reductions in anger symptoms, with posttreatment and 3 and 6 months posttreatment effect sizes ranging from .12 to .63. Using a noninferiority margin of 2 points for STAXI-2 subscales anger expression and trait anger and 4 points for NAS-T outcomes, participants in the videoteleconferencing condition demonstrated a reduction in anger symptoms similar ("non-inferior") to symptom reductions in the in-person groups. Additionally, no significant between-group differences were found on process variables, including attrition, adherence, satisfaction, and treatment expectancy. Participants in the in-person condition reported significantly higher group therapy alliance.
Clinical and process outcomes indicate delivering cognitive-behavioral group treatment for PTSD-related anger problems via videoteleconferencing is an effective and feasible way to increase access to evidence-based care for veterans residing in rural or remote locations.
展示远程医疗模式——视频会议，与传统的面对面小组心理治疗服务相比，在为农村地区患有创伤后应激障碍（PTSD）的战斗退伍军人提供服务时，具有非劣效性。
在 3 家退伍军人事务部门诊，对 125 名患有 PTSD（根据 Clinician-Administered PTSD Scale 上的 DSM 标准）和愤怒问题的男性退伍军人进行了一项随机对照非劣效性试验。参与者被随机分配接受团体治疗，治疗师或面对面（n=64）或通过视频会议（n=61）进行。参与者在基线、治疗中期（3 周）、治疗后（6 周）以及治疗后 3 个月和 6 个月进行评估。主要临床结果是减少愤怒困难，通过 State-Trait Anger Expression Inventory-2（STAXI-2）的愤怒表达和特质愤怒分量表以及 Novaco Anger Scale 总分（NAS-T）来衡量。数据收集于 2005 年 8 月至 2008 年 10 月。
两组参与者的愤怒症状均显著且具有临床意义的减轻，治疗后和治疗后 3 个月和 6 个月的效应大小范围从.12 到.63。使用 STAXI-2 分量表愤怒表达和特质愤怒的非劣效性边界为 2 分和 NAS-T 结果的 4 分，视频会议组参与者的愤怒症状减轻与面对面组相似（“非劣效”）。此外，在过程变量（包括流失、依从性、满意度和治疗期望）上，两组之间没有发现显著差异。面对面组的参与者报告称，他们对团体治疗联盟的满意度更高。
临床和过程结果表明，通过视频会议为 PTSD 相关愤怒问题提供认知行为团体治疗是一种有效且可行的方法，可以增加居住在农村或偏远地区的退伍军人获得循证护理的机会。
