VA San Diego Healthcare System.
National Center for PTSD.
Psychol Trauma. 2017 Aug;9(Suppl 1):74-84. doi: 10.1037/tra0000127. Epub 2016 Jun 20.
Acceptance and commitment therapy (ACT) is a widely utilized psychotherapeutic approach, but randomized, controlled studies are lacking in veterans. This study evaluated the efficacy of ACT for emotional distress among veterans of the conflicts in Iraq and Afghanistan.
One hundred sixty veterans (80% male, Mage = 34 years) with anxiety or depressive disorder according to the (4th ed.) were randomized to ACT or present-centered therapy (PCT) and assessed before, during, and after treatment and during 3- to 12-month follow-up. The primary outcome was general distress as measured by the Brief Symptom Inventory-18 Global Severity Index. Additional outcomes included symptomatology, disability, quality of life, acceptability, and satisfaction.
There was improvement following treatment in the whole sample across a variety of measures, including general distress (d = 0.74, 95% confidence interval [CI: 0.52, 0.96]) and functioning (d = 0.71, 95% CI [0.50, 0.93]) and moderate to high levels of satisfaction with treatment. Response to the 2 interventions did not differ on the primary outcome or most secondary outcomes, although ACT led to greater improvement in insomnia than did PCT (ds = 0.63 and 0.08, respectively). Treatment dropout did not differ by condition but was high (41.9%).
ACT's efficacy in this group was modest and generally did not differ from that for PCT. Additional work is needed to understand the reasons that ACT did not perform as well as predicted in this veteran sample. (PsycINFO Database Record
接受与承诺疗法（ACT）是一种广泛应用的心理治疗方法，但在退伍军人中缺乏随机对照研究。本研究评估了 ACT 对伊拉克和阿富汗冲突退伍军人情绪困扰的疗效。
160 名患有焦虑或抑郁障碍的退伍军人（80%为男性，平均年龄为 34 岁）根据《精神障碍诊断与统计手册》（第 4 版）进行了随机分组，分别接受 ACT 或以当下为中心的疗法（PCT），并在治疗前、治疗期间和治疗后以及 3 至 12 个月的随访期间进行评估。主要结局是用Brief Symptom Inventory-18 全球严重程度指数测量的一般困扰。其他结局包括症状、残疾、生活质量、可接受性和满意度。
整个样本在各种测量指标上都有改善，包括一般困扰（d = 0.74，95%置信区间[CI：0.52，0.96]）和功能障碍（d = 0.71，95%CI [0.50，0.93]），以及对治疗的中度至高度满意度。两种干预措施在主要结局或大多数次要结局上的反应没有差异，尽管 ACT 导致失眠改善程度大于 PCT（ds = 0.63 和 0.08）。治疗脱落率不因条件而异，但很高（41.9%）。
ACT 在该人群中的疗效中等，通常与 PCT 没有差异。需要进一步研究以了解 ACT 在这个退伍军人样本中表现不如预期的原因。
