Holder Nicholas, Holliday Ryan, Pai Anushka, Surís Alina
a Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center.
Behav Med. 2017 Jul-Sep;43(3):184-190. doi: 10.1080/08964289.2016.1276430.
Cognitive Processing Therapy (CPT) is an effective evidence-based treatment for many, but not all, veterans with posttraumatic stress disorder (PTSD). Understanding the factors that contribute to poorer response to CPT is important for providing the best care to veterans diagnosed with PTSD. Researchers investigating the effectiveness of CPT for individuals with comorbid personality symptoms have found that borderline personality disorder (BPD) characteristics do not negatively affect treatment outcome; however, participants in those studies were not diagnosed with BPD. The current pilot study investigated the effect of a BPD diagnosis on CPT dropout and outcomes. Data were compiled from a larger randomized clinical trial. Twenty-seven female veterans with military sexual trauma-related PTSD received CPT. Dropout was evaluated by treatment completion and number of sessions attended. Treatment outcome was assessed by the Clinician Administered PTSD Scale (CAPS) and the PTSD Checklist (PCL). No significant differences were observed between veterans with and without BPD comorbidity for number of treatment sessions attended, and there was not a significant relationship between comorbidity status and treatment completion. A hierarchical linear modeling approach was used with BPD entered as a level 2 predictor of outcome. In our sample, veterans with BPD had higher PTSD symptom severity on the CAPS at baseline compared to veterans without BPD comorbidity. CPT was effective in reducing PTSD symptoms; however, BPD diagnosis did not influence treatment response over time on the CAPS or PCL. Our results provide initial support for the use of CPT in female veterans with MST-related PTSD and comorbid BPD.
认知加工疗法（CPT）是一种针对许多（但并非所有）创伤后应激障碍（PTSD）退伍军人的行之有效的循证治疗方法。了解导致CPT疗效较差的因素对于为被诊断患有PTSD的退伍军人提供最佳治疗至关重要。研究CPT对伴有共病性人格症状个体有效性的研究人员发现，边缘性人格障碍（BPD）特征不会对治疗结果产生负面影响；然而，这些研究中的参与者并未被诊断为BPD。当前的这项试点研究调查了BPD诊断对CPT退出率和治疗结果的影响。数据来自一项更大规模的随机临床试验。27名患有与军事性创伤相关PTSD的女性退伍军人接受了CPT治疗。通过治疗完成情况和参加的疗程数来评估退出率。治疗结果通过临床医生管理的PTSD量表（CAPS）和PTSD检查表（PCL）进行评估。在参加治疗疗程数方面，患有和未患有BPD共病的退伍军人之间未观察到显著差异，并且共病状态与治疗完成情况之间也没有显著关系。采用分层线性建模方法，将BPD作为结果的二级预测因子纳入。在我们的样本中，与未患有BPD共病的退伍军人相比，患有BPD的退伍军人在基线时CAPS上的PTSD症状严重程度更高。CPT在减轻PTSD症状方面是有效的；然而，BPD诊断并未随时间影响CAPS或PCL上的治疗反应。我们的结果为在患有与军事性创伤相关PTSD和共病BPD的女性退伍军人中使用CPT提供了初步支持。
