Markowitz John C, Neria Yuval, Lovell Karina, Van Meter Page E, Petkova Eva
Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Depress Anxiety. 2017 Aug;34(8):692-700. doi: 10.1002/da.22619. Epub 2017 Apr 4.
Moderators of differential psychotherapy outcome for posttraumatic stress disorder (PTSD) are rare, yet have crucial clinical importance. We tested the moderating effects of trauma type for three psychotherapies in 110 unmedicated patients with chronic DSM-IV PTSD.
Patients were randomized to 14 weeks of prolonged exposure (PE, N = 38), interpersonal psychotherapy (IPT, N = 40), or relaxation therapy (RT, N = 32). The Clinician-Administered PTSD Scale (CAPS) was the primary outcome measure. Moderator candidates were trauma type: interpersonal, sexual, physical. We fit a regression model for week 14 CAPS as a function of treatment (a three-level factor), an indicator of trauma type presence/absence, and their interactions, controlling for baseline CAPS, and evaluated potential confounds.
Thirty-nine (35%) patients reported sexual, 68 (62%) physical, and 102 (93%) interpersonal trauma. Baseline CAPS scores did not differ by presence/absence of trauma types. Sexual trauma as PTSD criterion A significantly moderated treatment effect: whereas all therapies had similar efficacy among nonsexually-traumatized patients, IPT had greater efficacy among sexually traumatized patients (efficacy difference with and without sexual trauma: IPT vs. PE and IPT vs. RT P's < .05), specifically in PTSD symptom clusters B and D (P's < .05).
Few studies have assessed effects of varying trauma types on effects of differing psychotherapies. In this exploratory study, sexual trauma moderated PTSD outcomes of three therapies: IPT showed greater benefit for sexually traumatized patients than PE or RT. The IPT focuses on affect to help patients determine trust in their current environments may particularly benefit patients who have suffered sexual assault.
创伤后应激障碍（PTSD）不同心理治疗效果的调节因素很少见，但具有至关重要的临床意义。我们在110名未用药的慢性DSM-IV PTSD患者中测试了三种心理治疗中创伤类型的调节作用。
患者被随机分配接受为期14周的延长暴露疗法（PE，N = 38）、人际心理治疗（IPT，N = 40）或放松疗法（RT，N = 32）。临床医生管理的PTSD量表（CAPS）是主要结局指标。调节因素候选变量为创伤类型：人际、性、身体。我们构建了一个回归模型，将第14周的CAPS作为治疗（一个三级因素）、创伤类型存在/不存在的指标及其相互作用的函数，同时控制基线CAPS，并评估潜在的混杂因素。
39名（35%）患者报告有性创伤，68名（62%）有身体创伤，102名（93%）有人际创伤。基线CAPS评分不因创伤类型的存在/不存在而有所不同。作为PTSD A标准的性创伤显著调节了治疗效果：在非性创伤患者中，所有疗法的疗效相似，而在性创伤患者中，IPT的疗效更佳（有性创伤和无性创伤时的疗效差异：IPT与PE以及IPT与RT相比，P值均<0.05），特别是在PTSD症状簇B和D中（P值<0.05）。
很少有研究评估不同创伤类型对不同心理治疗效果的影响。在这项探索性研究中，性创伤调节了三种疗法对PTSD的治疗效果：与PE或RT相比，IPT对性创伤患者显示出更大的益处。IPT侧重于情感，以帮助患者确定对当前环境的信任，这可能对遭受性侵犯的患者特别有益。
