Najavits Lisa M, Johnson Kay M
Treatment Innovations, Newton Centre, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Am J Addict. 2014 Sep-Oct;23(5):415-22. doi: 10.1111/j.1521-0391.2014.12127.x. Epub 2014 Mar 15.
Creating Change (CC) is a new past-focused behavioral therapy model developed for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD). It was designed to address current gaps in the field, including the need for a past-focused PTSD/SUD model that has flexibility, can work with complex clients, responds to the staffing and resource limitations of SUD and other community-based treatment programs, can be conducted in group or individual format, and engages clients and clinicians. It was designed to follow the style, tone, and format of Seeking Safety, a successful present-focused PTSD/SUD model. CC can be used in conjunction with SS and/or other models if desired.
We conducted a pilot outcome trial of the model with seven men and women outpatients diagnosed with current PTSD and SUD, who were predominantly minority and low-income, with chronic PTSD and SUD. Assessments were conducted pre- and post-treatment.
Significant improvements were found in multiple domains including some PTSD and trauma-related symptoms (eg, dissociation, anxiety, depression, and sexual problems); broader psychopathology (eg, paranoia, psychotic symptoms, obsessive symptoms, and interpersonal sensitivity); daily life functioning; cognitions related to PTSD; coping strategies; and suicidal ideation (altogether 19 variables, far exceeding the rate expected by chance). Effect sizes were consistently large, including for both alcohol and drug problems. No adverse events were reported.
Despite study methodology limitations, CC is promising.
Clients can benefit from past-focused therapy that addresses PTSD and SUD in integrated fashion.
“创造改变”（CC）是一种新的以过去为重点的行为治疗模式，专为创伤后应激障碍（PTSD）和物质使用障碍（SUD）共病而开发。它旨在填补该领域当前的空白，包括需要一种灵活的、能够与复杂客户合作、应对物质使用障碍及其他基于社区的治疗项目的人员配备和资源限制、可以以团体或个体形式进行、并能吸引客户和临床医生的以过去为重点的创伤后应激障碍/物质使用障碍模式。它旨在遵循“寻求安全”（Seeking Safety）的风格、语气和形式，“寻求安全”是一种成功的以当前为重点的创伤后应激障碍/物质使用障碍模式。如有需要，CC可与“寻求安全”及/或其他模式结合使用。
我们对该模式进行了一项试点结果试验，研究对象为7名被诊断患有当前创伤后应激障碍和物质使用障碍的门诊男女患者，他们主要是少数族裔且低收入，患有慢性创伤后应激障碍和物质使用障碍。在治疗前和治疗后进行评估。
在多个领域发现了显著改善，包括一些创伤后应激障碍和与创伤相关的症状（如解离、焦虑、抑郁和性问题）；更广泛的精神病理学症状（如偏执、精神病性症状、强迫症状和人际敏感性）；日常生活功能；与创伤后应激障碍相关的认知；应对策略；以及自杀意念（总共19个变量，远远超过偶然预期的发生率）。效应量一直很大，包括酒精和药物问题方面。未报告不良事件。
尽管研究方法存在局限性，但“创造改变”模式很有前景。
客户可以从以过去为重点的治疗中受益，这种治疗以综合方式解决创伤后应激障碍和物质使用障碍问题。
