Wolf Gregory K, Mauntel Gregory J, Kretzmer Tracy, Crawford Eric, Thors Christina, Strom Thad Q, Vanderploeg Rodney D
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).
J Head Trauma Rehabil. 2018 Mar/Apr;33(2):E53-E63. doi: 10.1097/HTR.0000000000000344.
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.
VA polytrauma medical center.
Consecutive referrals for PTSD treatment of Active Duty (n = 17) or Veterans (n = 27) diagnosed with PTSD and TBI (N = 44).
Neurobehavioral Symptom Inventory, Key Behaviors Change Inventory, Self-Efficacy for Symptom Management, Posttraumatic Stress Disorder Checklist, and Beck Depression Inventory, 2nd edition.
Post hoc analysis of archival clinical effectiveness program evaluation data.
PE for PTSD.
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.
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.
探讨（a）创伤后应激障碍（PTSD）的延长暴露（PE）疗法在改善有轻度至重度创伤性脑损伤（TBI）病史的军人和退伍军人（VA）的脑震荡后症状（PCS）及其他结果方面的有效性的普遍性，以及（b）与PCS减轻相关的因素。
VA多创伤医疗中心。
连续转诊接受PTSD治疗的现役军人（n = 17）或退伍军人（n = 27），他们被诊断患有PTSD和TBI（N = 44）。
神经行为症状量表、关键行为变化量表、症状管理自我效能感量表、创伤后应激障碍检查表和贝克抑郁量表第二版。
对存档的临床有效性项目评估数据进行事后分析。
针对PTSD的PE疗法。
所有结局指标均有显著改善，效应量较大（科恩d值范围为0.68至2.02）。PCS的改善（科恩d = 1.21）与较低水平的VA服役相关残疾和PE治疗完成情况有关。
对于患有PTSD和TBI共病的参与者，与PE治疗相关的改善从PTSD结果推广到PCS及其他与TBI相关的结果。积极结果与TBI严重程度、治疗环境或退伍军人身份无关，但取决于PE治疗的完成情况和较低水平的VA服役相关残疾。
