Sloan Denise M, Marx Brian P, Lee Daniel J, Resick Patricia A
National Center for PTSD, Veterans Affairs Boston Health Care System, Boston, Massachusetts.
Boston University School of Medicine, Boston, Massachusetts.
JAMA Psychiatry. 2018 Mar 1;75(3):233-239. doi: 10.1001/jamapsychiatry.2017.4249.
Written exposure therapy (WET), a 5-session intervention, has been shown to efficaciously treat posttraumatic stress disorder (PTSD). However, this treatment has not yet been directly compared with a first-line PTSD treatment such as cognitive processing therapy (CPT).
To determine if WET is noninferior to CPT in patients with PTSD.
DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial conducted at a Veterans Affairs medical facility between February 28, 2013, and November 6, 2016, 126 veteran and nonveteran adults were randomized to either WET or CPT. Inclusion criteria were a primary diagnosis of PTSD and stable medication therapy. Exclusion criteria included current psychotherapy for PTSD, high risk of suicide, diagnosis of psychosis, and unstable bipolar illness. Analysis was performed on an intent-to-treat basis.
Participants assigned to CPT (n = 63) received 12 sessions and participants assigned to WET (n = 63) received 5 sessions. The CPT protocol that includes written accounts was delivered individually in 60-minute weekly sessions. The first WET session requires 60 minutes while the remaining 4 sessions require 40 minutes.
The primary outcome was the total score on the Clinician-Administered PTSD Scale for DSM-5; noninferiority was defined by a score of 10 points. Blinded evaluations were conducted at baseline and 6, 12, 24, and 36 weeks after the first treatment session. Treatment dropout was also examined.
For the 126 participants (66 men and 60 women; mean [SD] age, 43.9 [14.6] years), improvements in PTSD symptoms in the WET condition were noninferior to improvements in the CPT condition at each of the assessment periods. The largest difference between treatments was observed at the 24-week assessment (mean difference, 4.31 points; 95% CI, -1.37 to 9.99). There were significantly fewer dropouts in the WET vs CPT condition (4 [6.4%] vs 25 [39.7%]; χ21 = 12.84, Cramer V = 0.40).
Although WET involves fewer sessions, it was noninferior to CPT in reducing symptoms of PTSD. The findings suggest that WET is an efficacious and efficient PTSD treatment that may reduce attrition and transcend previously observed barriers to PTSD treatment for both patients and providers.
clinicaltrials.gov Identifier: NCT01800773.
书面暴露疗法（WET）是一种为期5节的干预措施，已被证明能有效治疗创伤后应激障碍（PTSD）。然而，这种治疗方法尚未与认知加工疗法（CPT）等一线PTSD治疗方法进行直接比较。
确定WET在PTSD患者中是否不劣于CPT。
设计、地点和参与者：在2013年2月28日至2016年11月6日于一家退伍军人事务医疗设施进行的这项随机临床试验中，126名退伍军人和非退伍军人成年人被随机分为WET组或CPT组。纳入标准为PTSD的主要诊断和稳定的药物治疗。排除标准包括当前针对PTSD的心理治疗、自杀高风险、精神病诊断以及不稳定的双相情感障碍。分析基于意向性治疗原则进行。
分配到CPT组（n = 63）的参与者接受12节治疗，分配到WET组（n = 63）的参与者接受5节治疗。包含书面记录的CPT方案在每周60分钟的单独疗程中进行。WET的第一节需要60分钟，其余4节需要40分钟。
主要结局是《精神疾病诊断与统计手册》第5版临床医生管理的PTSD量表的总分；非劣效性定义为10分的得分。在基线以及首次治疗后6周、12周、24周和36周进行盲法评估。还对治疗退出情况进行了检查。
对于126名参与者（66名男性和60名女性；平均[标准差]年龄，43.9[14.6]岁），在每个评估期，WET组PTSD症状的改善不劣于CPT组。治疗之间的最大差异在24周评估时观察到（平均差异，4.31分；95%置信区间，-1.37至9.99）。WET组的退出人数明显少于CPT组（4[6.4%]对25[39.7%]；χ21 = 12.84，克莱默V = 0.40）。
尽管WET的疗程较少，但在减轻PTSD症状方面不劣于CPT。研究结果表明，WET是一种有效且高效的PTSD治疗方法，可能会减少患者流失，并跨越先前观察到的患者和提供者在PTSD治疗方面的障碍。
clinicaltrials.gov标识符：NCT01800773。
