Psychiatry. 2013 Winter;76(4):336-48. doi: 10.1521/psyc.2013.76.4.336.
To identify the extent to which evidence-based psychotherapy (EBP) and psychopharmacologic treatments for posttraumatic stress disorder (PTSD) are provided to U.S. service members in routine practice, and the degree to which they are consistent with evidence-based treatment guidelines.
We surveyed the majority of Army behavioral health providers (n = 2,310); surveys were obtained from 543 (26%). These clinicians reported clinical data on a total sample of 399 service member patients. Of these patients, 110 (28%) had a reported PTSD diagnosis. Data were weighted to account for sampling design and nonresponses.
Army providers reported 86% of patients with PTSD received evidence-based psychotherapy (EBP) for PTSD. As formal training hours in EBPs increased, reported use of EBPs significantly increased. Although EBPs for PTSD were reported to be widely used, clinicians who deliver EBP frequently reported not adhering to all core procedures recommended in treatment manuals; less than half reported using all the manualized core EBP techniques.
Further research is necessary to understand why clinicians modify EBP treatments, and what impact this has on treatment outcomes. More data regarding the implications for treatment effectiveness and the role of clinical context, patient preferences, and clinical decision-making in adapting EBPs could help inform training efforts and the ways that these treatments may be better adapted for the military.
确定美国现役军人在常规治疗中接受循证心理治疗（EBP）和精神药理学治疗创伤后应激障碍（PTSD）的程度，以及它们与循证治疗指南的一致程度。
我们调查了大多数陆军行为健康提供者（n=2310）；从 543 名（26%）中获得了调查。这些临床医生报告了总共 399 名现役军人患者的临床数据。这些患者中有 110 名（28%）报告有 PTSD 诊断。数据经过加权处理，以考虑抽样设计和无应答情况。
陆军提供者报告称，86%的 PTSD 患者接受了 PTSD 的循证心理治疗（EBP）。随着 EBP 正式培训时间的增加，报告的 EBP 使用显著增加。尽管 PTSD 的 EBP 被广泛报告使用，但提供 EBP 的临床医生经常报告不遵守治疗手册中推荐的所有核心程序；不到一半的人报告使用了所有的手册化核心 EBP 技术。
需要进一步研究以了解为什么临床医生会修改 EBP 治疗方法，以及这对治疗结果有什么影响。更多关于治疗效果的影响以及临床环境、患者偏好和临床决策在适应 EBP 中的作用的数据，可以帮助指导培训工作以及这些治疗方法如何更好地适应军队。
