Crawford Eric Floyd, Wolf Gregory K, Kretzmer Tracy, Dillon Kirsten H, Thors Christina, Vanderploeg Rodney D
*VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center; †Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC; ‡Mental Health and Behavioral Sciences, James A. Haley Veterans Affairs Medical Center; and §Departments of Psychiatry and Neurosciences, and Psychology, University of South Florida, Tampa, FL.
J Nerv Ment Dis. 2017 Feb;205(2):140-146. doi: 10.1097/NMD.0000000000000594.
In contrast to concerns that cognitive limitations and neurobehavioral symptoms (NBS) associated with traumatic brain injury (TBI) may inhibit treatment effectiveness, a recent study found prolonged exposure (PE) led to large reductions in posttraumatic stress disorder (PTSD) symptoms among Iraq-Afghanistan veterans with a range of TBI severity (article by Wolf, Kretzmer, Crawford, Thors, Wagner, Strom, Eftekhari, Klenk, Hayward, and Vanderploeg [J Trauma Stress 28:339-347, 2015]). We further examined this sample of 69 veterans to determine whether system, veteran, and therapist factors predicted clinically significant responses. Results of hierarchical, logistic regressions revealed that therapist training in PE and lower service connection were associated with increased odds of large decreases in PTSD symptoms after adjusting for the robust effect of PE sessions completed. Other patient-level factors including age, time since injury, and baseline NBS were unrelated to significant improvements. Findings emphasized the impact of PE dosage, indicated greater mastery of the protocol was beneficial, and showed that service connection could impede self-reported, clinically significant change during PE in this important cohort.
与创伤性脑损伤（TBI）相关的认知局限和神经行为症状（NBS）可能会抑制治疗效果的担忧相反，最近一项研究发现，延长暴露疗法（PE）使一系列TBI严重程度的伊拉克-阿富汗退伍军人的创伤后应激障碍（PTSD）症状大幅减轻（Wolf、Kretzmer、Crawford、Thors、Wagner、Strom、Eftekhari、Klenk、Hayward和Vanderploeg撰写的文章[《创伤应激杂志》28:339 - 347，2015年]）。我们进一步研究了这69名退伍军人的样本，以确定系统、退伍军人和治疗师因素是否能预测具有临床意义的反应。分层逻辑回归结果显示，在调整完成的PE疗程的显著效果后，治疗师接受PE培训以及较低的服役关联与PTSD症状大幅减轻的几率增加相关。其他患者层面的因素，包括年龄、受伤后的时间以及基线NBS，与显著改善无关。研究结果强调了PE剂量的影响，表明对该方案的更好掌握是有益的，并且表明服役关联可能会阻碍这一重要队列在PE期间自我报告的、具有临床意义的改变。
