Resick Patricia A, Wachen Jennifer Schuster, Mintz Jim, Young-McCaughan Stacey, Roache John D, Borah Adam M, Borah Elisa V, Dondanville Katherine A, Hembree Elizabeth A, Litz Brett T, Peterson Alan L
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center.
National Center for PTSD at VA Boston Healthcare System.
J Consult Clin Psychol. 2015 Dec;83(6):1058-1068. doi: 10.1037/ccp0000016. Epub 2015 May 4.
To determine whether group therapy improves symptoms of posttraumatic stress disorder (PTSD), this randomized clinical trial compared efficacy of group cognitive processing therapy (cognitive only version; CPT-C) with group present-centered therapy (PCT) for active duty military personnel.
Patients attended 90-min groups twice weekly for 6 weeks at Fort Hood, Texas. Independent assessments were administered at baseline, weekly before sessions, and 2 weeks, 6 months, and 12 months posttreatment. A total of 108 service members (100 men, 8 women) were randomized. Inclusion criteria included PTSD following military deployment and medication stability. Exclusion criteria included suicidal/homicidal intent or other severe mental disorders requiring immediate treatment. Follow-up assessments were administered regardless of treatment completion. Primary outcome measures were the PTSD Checklist (Stressor Specific Version; PCL-S) and Beck Depression Inventory-II. The Posttraumatic Stress Symptom Interview (PSS-1) was a secondary measure.
Both treatments resulted in large reductions in PTSD severity, but improvement was greater in CPT-C. CPT-C also reduced depression, with gains remaining during follow-up. In PCT, depression only improved between baseline and before Session 1. There were few adverse events associated with either treatment.
Both CPT-C and PCT were tolerated well and reduced PTSD symptoms in group format, but only CPT-C improved depression. This study has public policy implications because of the number of active military needing PTSD treatment, and demonstrates that group format of treatment of PTSD results in significant improvement and is well tolerated. Group therapy may an important format in settings in which therapists are limited.
为了确定团体治疗是否能改善创伤后应激障碍（PTSD）的症状，这项随机临床试验比较了团体认知加工疗法（仅认知版本；CPT-C）与团体以当前为中心疗法（PCT）对现役军人的疗效。
患者在得克萨斯州胡德堡每周参加两次90分钟的团体治疗，共持续6周。在基线、每次治疗前一周、治疗后2周、6个月和12个月进行独立评估。共有108名军人（100名男性，8名女性）被随机分组。纳入标准包括军事部署后发生的PTSD以及药物治疗稳定。排除标准包括自杀/杀人意图或其他需要立即治疗的严重精神障碍。无论治疗是否完成，均进行随访评估。主要结局指标是创伤后应激障碍检查表（应激源特定版本；PCL-S）和贝克抑郁量表第二版。创伤后应激症状访谈（PSS-1）是次要指标。
两种治疗方法都使PTSD严重程度大幅降低，但CPT-C的改善更为显著。CPT-C还减轻了抑郁症状，随访期间仍有改善。在PCT中，抑郁仅在基线至第1次治疗前有所改善。两种治疗方法相关的不良事件都很少。
CPT-C和PCT的耐受性都很好，且以团体形式治疗可减轻PTSD症状，但只有CPT-C改善了抑郁症状。由于需要治疗PTSD的现役军人数量众多，这项研究具有公共政策意义，并表明团体形式治疗PTSD能带来显著改善且耐受性良好。在治疗师有限的环境中，团体治疗可能是一种重要的治疗形式。
