Department of Psychiatry and Behavioral Sciences, at the University of Washington School of Medicine in Seattle, WA, USA.
Psychiatry. 2011 Fall;74(3):207-23. doi: 10.1521/psyc.2011.74.3.207.
Cognitive Behavioral Therapy (CBT) interventions are efficacious in reducing posttraumatic stress disorder (PTSD) but are challenging to implement in acute care and other non-specialty mental health settings. This investigation identified barriers impacting CBT delivery through a content analysis of interventionist chart notes from an acute care PTSD prevention trial. Only 8.5% of all intervention patients were able to complete CBT. Lack of engagement, clinical and logistical barriers had the greatest impact on CBT entry. Treatment preferences and stigma only prevented entry when more primary barriers resolved. Patients with prior diagnosis of alcohol abuse or dependence were able to enter CBT after six months of sobriety. Based on the first trial, we developed a CBT readiness assessment tool. We implemented and evaluated the tool in a second early intervention trial. Lack of engagement emerged again as the primary impediment to CBT entry. Patients who were willing to enter CBT treatment but demonstrated high rates of past trauma or diagnosis of PTSD were also the least likely to engage in any PTSD treatment one month post-discharge. Findings support the need for additional investigations into engagement and alternative delivery strategies, including those which dismantle traditional office-based, multi-session CBT into stepped, deliverable components.
认知行为疗法（CBT）干预措施在减少创伤后应激障碍（PTSD）方面非常有效，但在急性护理和其他非专业心理健康环境中实施具有挑战性。本研究通过对急性护理 PTSD 预防试验中干预者图表记录的内容分析，确定了影响 CBT 实施的障碍。只有 8.5%的所有干预患者能够完成 CBT。缺乏参与、临床和后勤障碍对 CBT 的进入影响最大。只有当主要障碍得到解决时，治疗偏好和耻辱感才会成为进入的障碍。在六个月的戒酒期后，有酒精滥用或依赖既往诊断的患者能够接受 CBT。基于第一项试验，我们开发了一种 CBT 准备评估工具。我们在第二项早期干预试验中实施并评估了该工具。缺乏参与再次成为 CBT 进入的主要障碍。那些愿意接受 CBT 治疗但过去创伤或 PTSD 诊断率较高的患者，在出院后一个月也最不可能接受任何 PTSD 治疗。研究结果支持进一步研究参与和替代交付策略的必要性，包括将传统的基于办公室、多阶段的 CBT 分解为可交付的分步组件。
