Vera Mildred, Reyes-Rabanillo María L, Juarbe Deborah, Pérez-Pedrogo Coralee, Olmo Alicia, Kichic Rafael, Chaplin William F
Center for Evaluation and Sociomedical Research and Department of Health Services Administration, School of Public Health, Medical Science Campus, University of Puerto Rico, San Juan, Puerto Rico.
BMC Res Notes. 2011 Oct 17;4:415. doi: 10.1186/1756-0500-4-415.
Most of the empirical studies that support the efficacy of prolonged exposure (PE) for treating posttraumatic stress disorder (PTSD) have been conducted on white mainstream English-speaking populations. Although high PTSD rates have been reported for Puerto Ricans, the appropriateness of PE for this population remains unclear. The purpose of this study was to examine the feasibility of providing PE to Spanish speaking Puerto Ricans with PTSD. Particular attention was also focused on identifying challenges faced by clinicians with limited experience in PE. This information is relevant to help inform practice implications for training Spanish-speaking clinicians in PE.
Fourteen patients with PTSD were randomly assigned to receive PE (n = 7) or usual care (UC) (n = 7). PE therapy consisted of 15 weekly sessions focused on gradually confronting and emotionally processing distressing trauma-related memories and reminders. Five patients completed PE treatment; all patients attended the 15 sessions available to them. In UC, patients received mental health services available within the health care setting where they were recruited. They also had the option of self-referring to a mental health provider outside the study setting. The Clinician-Administered PTSD Scale (CAPS) was administered at baseline, mid-treatment, and post-treatment to assess PTSD symptom severity. Treatment completers in the PE group demonstrated significantly greater reductions in PTSD symptoms than the UC group. Forty percent of the PE patients showed clinically meaningful reductions in PTSD symptoms from pre- to post-treatment.
PE appears to be viable for treating Puerto Rican Spanish-speaking patients with PTSD. This therapy had good patient acceptability and led to improvements in PTSD symptoms. Attention to the clinicians' training process contributed strongly to helping them overcome the challenges posed by the intervention and increased their acceptance of PE.
大多数支持延长暴露疗法（PE）治疗创伤后应激障碍（PTSD）疗效的实证研究都是在以英语为母语的白人主流群体中进行的。尽管波多黎各人的PTSD发病率很高，但PE对该群体的适用性仍不明确。本研究的目的是检验为患有PTSD的讲西班牙语的波多黎各人提供PE的可行性。同时，还特别关注识别PE经验有限的临床医生所面临的挑战。这些信息有助于为培训讲西班牙语的临床医生进行PE治疗提供实践指导。
14名PTSD患者被随机分配接受PE治疗（n = 7）或常规护理（UC）（n = 7）。PE治疗包括每周15次治疗，重点是逐渐面对并从情感上处理与创伤相关的痛苦记忆和提示物。5名患者完成了PE治疗；所有患者都参加了提供给他们的15次治疗。在UC组中，患者接受了招募他们的医疗机构内提供的心理健康服务。他们也可以选择自行转诊到研究机构以外的心理健康服务提供者处。在基线、治疗中期和治疗后使用临床医生管理的PTSD量表（CAPS）评估PTSD症状的严重程度。PE组的治疗完成者在PTSD症状方面的减轻程度明显大于UC组。40%的PE患者在治疗前后PTSD症状有临床意义的减轻。
PE似乎对治疗患有PTSD的讲西班牙语的波多黎各患者是可行的。这种疗法具有良好的患者接受度，并能改善PTSD症状。关注临床医生的培训过程对帮助他们克服干预带来的挑战并提高他们对PE的接受度起到了很大作用。
