Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA.
J Consult Clin Psychol. 2011 Oct;79(5):590-9. doi: 10.1037/a0024466.
To examine the effectiveness of group cognitive processing therapy (CPT) relative to trauma-focused group treatment as usual (TAU) in the context of a Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) residential rehabilitation program.
Participants were 2 cohorts of male patients in the same program treated with either CPT (n = 104) or TAU (n = 93; prior to the implementation of CPT). Cohorts were compared on changes from pre- to posttreatment using the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and other measures of symptoms and functioning. Minorities represented 41% of the sample, and the mean age was 52 years (SD = 9.22). The CPT group was significantly younger and less likely to receive disability benefits for PTSD; however, these variables were not related to outcome.
Analyses of covariance controlling for intake symptom levels and cohort differences revealed that CPT participants evidenced more symptom improvement at discharge than TAU participants on the PCL, F(3, 193) = 15.32, p < .001, b = 6.25, 95% CI [3.06, 9.44], and other measures. In addition, significantly more patients treated with CPT were classified as "recovered" or "improved" at discharge, χ2(1, N = 197) = 4.93, p = .032.
There is still room for improvement, as substantial numbers of veterans continue to experience significant symptoms even after treatment with CPT in a residential program. However, CPT appears to produce significantly more symptom improvement than treatment conducted before the implementation of CPT. The implementation of this empirically supported treatment in VHA settings is both feasible and sustainable and is likely to improve care for male veterans with military-related PTSD.
在退伍军人事务部（VHA）创伤后应激障碍（PTSD）住院康复项目的背景下，研究团体认知加工治疗（CPT）相对于以创伤为中心的团体治疗常规（TAU）的有效性。
两组男性患者参加了相同的治疗项目，一组接受 CPT 治疗（n = 104），另一组接受 TAU 治疗（n = 93；在实施 CPT 之前）。使用 PTSD 检查表（PCL；Weathers 等人，1993）和其他症状和功能测量工具，比较从治疗前到治疗后的变化。少数族裔占样本的 41%，平均年龄为 52 岁（SD = 9.22）。CPT 组明显更年轻，且不太可能因 PTSD 而获得残疾福利；然而，这些变量与结果无关。
协方差分析控制了摄入症状水平和队列差异，结果显示，CPT 组患者在 PCL 上的症状改善程度显著高于 TAU 组，F（3, 193）= 15.32，p <.001，b = 6.25，95%CI [3.06, 9.44]，以及其他措施。此外，在出院时，接受 CPT 治疗的患者中有更多的患者被归类为“康复”或“改善”，χ2（1，N = 197）= 4.93，p =.032。
即使在住院康复项目中接受 CPT 治疗后，仍有大量退伍军人继续经历显著的症状，这方面仍有改进空间。然而，CPT 似乎比实施 CPT 之前的治疗产生了更显著的症状改善。在 VHA 环境中实施这种经验支持的治疗方法既可行又可持续，并且可能改善与军事相关 PTSD 的男性退伍军人的护理。
