Belleau Emily L, Chin Eu Gene, Wanklyn Sonya G, Zambrano-Vazquez Laura, Schumacher Julie A, Coffey Scott F
Department of Psychiatry and Human Behavior, The University of Mississippi Medical Center, United States.
Department of Psychiatry and Human Behavior, The University of Mississippi Medical Center, United States.
Behav Res Ther. 2017 Apr;91:43-50. doi: 10.1016/j.brat.2017.01.011. Epub 2017 Jan 25.
Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are commonly co-occurring disorders associated with more adverse consequences than PTSD alone. Prolonged exposure therapy (PE) is one of the most efficacious treatments for PTSD. However, among individuals with PTSD-SUD, 35-62% of individuals drop out of trauma-focused exposure treatments. Thus, it is important to identify predictors of PTSD treatment dropout among substance abusers with PTSD in order to gain information about adapting treatment strategies to enhance retention and outcomes. The current study explored pre-treatment predictors of early termination from PE treatment in a sample of 85 individuals receiving concurrent treatment for PTSD and a SUD in a residential treatment facility as part of a randomized controlled trial. The results indicated that less education and more anxiety sensitivity uniquely predicted PE treatment dropout. Demographic variables, PTSD severity, SUD severity, mental health comorbidities, and emotion regulation difficulties did not predict treatment dropout. These results suggest that adding pre-treatment interventions that address anxiety sensitivity, and promote social adjustment and cognitive flexibility, could possibly improve PE retention rates in clients with high anxiety or low education.
创伤后应激障碍（PTSD）和物质使用障碍（SUDs）是常见的共病障碍，与仅患PTSD相比，会带来更多不良后果。延长暴露疗法（PE）是治疗PTSD最有效的方法之一。然而，在患有PTSD-SUD的个体中，35%-62%的个体退出了以创伤为重点的暴露治疗。因此，识别患有PTSD的药物滥用者中PTSD治疗退出的预测因素非常重要，以便获取有关调整治疗策略以提高留存率和治疗效果的信息。作为一项随机对照试验的一部分，本研究在一家住院治疗机构中，对85名同时接受PTSD和SUD治疗的个体样本进行了探索，以了解PE治疗早期终止的治疗前预测因素。结果表明，受教育程度较低和焦虑敏感性较高是PE治疗退出的独特预测因素。人口统计学变量、PTSD严重程度、SUD严重程度、心理健康共病以及情绪调节困难并不能预测治疗退出。这些结果表明，增加针对焦虑敏感性、促进社会适应和认知灵活性的治疗前干预措施，可能会提高焦虑程度高或受教育程度低的患者的PE留存率。
