Freedman Sara A, Dayan Ehud, Kimelman Yael Bleich, Weissman Heidi, Eitan Renana
School of Social Work, Bar Ilan University, Ramat Gan, Israel.
Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel;
Eur J Psychotraumatol. 2015 Apr 2;6:25608. doi: 10.3402/ejpt.v6.25608. eCollection 2015.
Posttraumatic stress disorder (PTSD) develops in approximately 20% of people exposed to a traumatic event, and studies have shown that cognitive-behavioral therapy (CBT) is effective as a treatment for chronic PTSD. It has also been shown to prevent PTSD when delivered early after a traumatic event. However, studies have shown that uptake of early treatment is generally low, and therefore, the need to provide interventions through other mediums has been identified. The use of technology may overcome barriers to treatment.
This paper describes a randomized controlled trial that will examine an early CBT intervention for PTSD. The treatment incorporates virtual reality (VR) as a method for delivering exposure-based elements of the treatment. The intervention is Internet based, such that the therapist and patient will "meet" in a secure online site. This site will also include multi-media components of the treatment (such as videos, audios, VR) that can be accessed by the patient between sessions.
Two hundred patients arriving to a Level 1 emergency department following a motor vehicle accident will be randomly assigned to either treatment or control groups. Inclusion criteria are age 18-65, PTSD symptoms 2 weeks posttrauma related to current trauma, no suicidality, no psychosis. Patients will be assessed by telephone by a team blind to the study group, on four occasions: before and after treatment, and 6 and 12 months posttreatment. The primary outcome is PTSD symptoms at follow up. Secondary outcomes include depression and cost effectiveness. Analyses will be on an intention-to-treat basis.
The results will provide more insight into the effects of preventive interventions, in general, and Internet-based early interventions, in particular, on PTSD, in an injured population, during the acute phase after trauma. We will discuss possible strengths and limitations.
约20%经历创伤事件的人会患上创伤后应激障碍（PTSD），研究表明认知行为疗法（CBT）对慢性PTSD有效。研究还表明，在创伤事件后尽早进行该疗法可预防PTSD。然而，研究显示早期治疗的接受率普遍较低，因此已确定需要通过其他媒介提供干预措施。技术的使用可能会克服治疗障碍。
本文描述一项随机对照试验，该试验将研究针对PTSD的早期CBT干预。该治疗采用虚拟现实（VR）作为提供基于暴露疗法元素的方法。干预基于互联网，治疗师和患者将在一个安全的在线平台“见面”。该平台还将包括治疗的多媒体组件（如视频、音频、VR），患者可在疗程之间访问。
200名在机动车事故后前往一级急诊科的患者将被随机分配到治疗组或对照组。纳入标准为年龄18 - 65岁、创伤后2周出现与当前创伤相关的PTSD症状、无自杀倾向、无精神病。由对研究组不知情的团队通过电话对患者进行四次评估：治疗前、治疗后、治疗后6个月和12个月。主要结局是随访时的PTSD症状。次要结局包括抑郁和成本效益。分析将基于意向性分析。
研究结果将更深入地了解预防性干预措施，特别是基于互联网的早期干预措施，对创伤后急性期受伤人群的PTSD的影响。我们将讨论可能的优势和局限性。
