创伤后应激障碍与创伤性脑损伤共病：退伍军人和现役军人中，延长暴露疗法治疗创伤后应激障碍的结果对脑震荡后症状、认知及自我效能的推广应用

Comorbid Posttraumatic Stress Disorder and Traumatic Brain Injury: Generalization of Prolonged-Exposure PTSD Treatment Outcomes to Postconcussive Symptoms, Cognition, and Self-Efficacy in Veterans and Active Duty Service Members.

作者信息

Wolf Gregory K, Mauntel Gregory J, Kretzmer Tracy, Crawford Eric, Thors Christina, Strom Thad Q, Vanderploeg Rodney D

机构信息

Mental Health and Behavioral Sciences, James A. Haley Veterans Hospital, Tampa, Florida (Drs Wolf, Mauntel, Kretzmer, Thors, and Vanderploeg); Departments of Psychiatry and Behavioral Neurosciences (Drs Kretzmer and Vanderploeg) and Psychology (Dr Vanderploeg), University of South Florida, Tampa, Florida; Defense and Veterans Brain Injury Center, Tampa, Florida (Dr Vanderploeg); Durham VA Medical Center, VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Dr Crawford); and Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota (Dr Strom).

出版信息

J Head Trauma Rehabil. 2018 Mar/Apr;33(2):E53-E63. doi: 10.1097/HTR.0000000000000344.

DOI:10.1097/HTR.0000000000000344

PMID:28926486

Abstract

OBJECTIVES

To examine (a) generalization of the effectiveness of prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) in improving postconcussive symptoms (PCSs) and other outcomes in military service members and Veterans (VA) with histories of mild to severe traumatic brain injury (TBI), and (b) factors associated with PCS reduction.

SETTING

VA polytrauma medical center.

PARTICIPANTS

Consecutive referrals for PTSD treatment of Active Duty (n = 17) or Veterans (n = 27) diagnosed with PTSD and TBI (N = 44).

MAIN OUTCOME MEASURES

Neurobehavioral Symptom Inventory, Key Behaviors Change Inventory, Self-Efficacy for Symptom Management, Posttraumatic Stress Disorder Checklist, and Beck Depression Inventory, 2nd edition.

DESIGN

Post hoc analysis of archival clinical effectiveness program evaluation data.

INTERVENTIONS

PE for PTSD.

RESULTS

There were significant improvements on all outcome measures with large effect sizes (Cohen's d ranging from 0.68 to 2.02). Improvement on PCS (Cohen's d = 1.21) was associated with lower levels of VA service-connected disability and PE treatment completion.

CONCLUSION

PE treatment-related improvements for participants with comorbid PTSD and TBI generalize from PTSD outcomes to PCS and other TBI-related outcomes. Positive outcomes were independent of TBI severity, treatment setting, or Veteran status, but dependent upon PE treatment completion and lower levels of VA service-connected disability.

摘要