Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System.
Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System.
J Consult Clin Psychol. 2019 Mar;87(3):246-256. doi: 10.1037/ccp0000386.
One in 3 veterans will dropout from trauma-focused treatments for posttraumatic stress disorder (PTSD). Social environments may be particularly important to influencing treatment retention. We examined the role of 2 support system factors in predicting treatment dropout: social control (direct efforts by loved ones to encourage veterans to participate in treatment and face distress) and symptom accommodation (changes in loved ones' behavior to reduce veterans' PTSD-related distress).
Veterans and a loved one were surveyed across 4 VA hospitals. All veterans were initiating prolonged exposure therapy or cognitive processing therapy (n = 272 dyads). Dropout was coded through review of VA hospital records.
Regression analyses controlled for traditional, individual-focused factors likely to influence treatment dropout. We found that, even after accounting for these factors, veterans who reported their loved ones encouraged them to face distress were twice as likely to remain in PTSD treatment than veterans who denied such encouragement.
Clinicians initiating trauma-focused treatments with veterans should routinely assess how open veterans' support systems are to encouraging veterans to face their distress. Outreach to support networks is warranted to ensure loved ones back the underlying philosophy of trauma-focused treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
每 3 名退伍军人中就有 1 名将退出创伤后应激障碍（PTSD）的创伤聚焦治疗。社会环境可能对影响治疗保留特别重要。我们研究了两个支持系统因素在预测治疗脱落中的作用：社会控制（亲人直接努力鼓励退伍军人参与治疗并面对痛苦）和症状适应（亲人行为的改变以减轻退伍军人的 PTSD 相关痛苦）。
在 4 家退伍军人事务部医院对退伍军人和一位亲人进行了调查。所有退伍军人都开始接受长时间暴露疗法或认知加工疗法（n = 272 对）。通过审查退伍军人事务部医院的记录来编码脱落。
回归分析控制了可能影响治疗脱落的传统、以个体为中心的因素。我们发现，即使考虑到这些因素，报告亲人鼓励他们面对痛苦的退伍军人留在 PTSD 治疗中的可能性是那些否认这种鼓励的退伍军人的两倍。
为退伍军人启动创伤聚焦治疗的临床医生应定期评估退伍军人的支持系统对鼓励退伍军人面对痛苦的开放程度。有必要向支持网络开展宣传，以确保亲人支持创伤聚焦治疗的基本理念。（APA，2019 年，所有权利保留）。
