Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Cook, Hoff, Harpaz-Rotem); National Center for PTSD, U.S. Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven (Cook, Hoff, Harpaz-Rotem); National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont (Schnurr); Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Schnurr); Center for Health Research, Kaiser Permanente, Honolulu (Simiola).
Psychiatr Serv. 2019 Jul 1;70(7):553-560. doi: 10.1176/appi.ps.201800338. Epub 2019 Apr 10.
This observational study examined the association between patient outcomes at 39 U.S. Department of Veterans Affairs residential treatment programs for veterans with posttraumatic stress disorder (PTSD) and the degree of adoption of two evidence-based psychotherapies, prolonged exposure and cognitive processing therapy. The hypothesis was that a higher degree of adoption would be associated with better outcomes.
Providers (N=171) completed a qualitative interview and quantitative survey about their level of adoption of prolonged exposure delivered individually and cognitive processing therapy delivered in individual or group formats. On the basis of responses, programs were assigned to one of three adoption categories: little or no adoption of either therapy (N=8), some adoption, (N=9), and high adoption (N=22). A linear mixed model compared patient outcomes (e.g., PTSD and depression symptom severity, substance use, and distress) between adoption groups.
The sample of veterans consisted of 2,834 who completed an assessment of PTSD symptoms and functioning at program intake and again at either program discharge or at 4 months postdischarge. Improvements in PTSD, distress, and alcohol use were noted over time for all programs, with decreases at follow-up. No effects of adoption group or a group × time interaction were noted for any outcome.
Moderate to large effects were noted across all programs. However, programs that used prolonged exposure and cognitive processing therapy with most or all patients did not see greater reductions in PTSD or depression symptoms or alcohol use, compared with programs that did not use these evidence-based psychotherapies.
本观察性研究考察了美国退伍军人事务部（VA） 171 家退伍军人 PTSD 住院治疗项目中，两种循证心理疗法（延长暴露疗法和认知加工疗法）的采用程度与患者结局之间的关系。假设是采用程度越高，结局越好。
治疗提供者（N=171）完成了关于其单独采用延长暴露疗法和个体或团体形式采用认知加工疗法的程度的定性访谈和定量调查。根据回答情况，将项目分为以下三种采用程度类别：两种疗法均未采用（N=8）、部分采用（N=9）和高度采用（N=22）。线性混合模型比较了不同采用程度组患者结局（如 PTSD 和抑郁症状严重程度、物质使用和痛苦）。
退伍军人样本由 2834 名在项目入组时和在项目出院时或出院后 4 个月时完成 PTSD 症状和功能评估的退伍军人组成。所有项目在随访期间均观察到 PTSD、痛苦和酒精使用随时间的改善，而在随访时则下降。未观察到采用程度组或组×时间交互作用对任何结局有影响。
所有项目均观察到中等至较大的效果。然而，与未采用这些循证心理疗法的项目相比，采用延长暴露疗法和认知加工疗法治疗大多数或所有患者的项目，并未观察到 PTSD 或抑郁症状或酒精使用减少程度的更大改善。
