Veterans Affairs (VA) Center of Excellence for Stress and Mental Health; VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; California School of Professional Psychology at Alliant International University; 10455 Pomerado Rd. San Diego, CA 92131, United States; Department of Psychiatry, University of California, San Diego; 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Healthcare System; 3350 La Jolla Village Drive, San Diego, CA 92161, United States.
Veterans Affairs (VA) Center of Excellence for Stress and Mental Health; VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; Department of Psychiatry, University of California, San Diego; 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Healthcare System; 3350 La Jolla Village Drive, San Diego, CA 92161, United States.
J Anxiety Disord. 2019 May;64:45-54. doi: 10.1016/j.janxdis.2019.02.003. Epub 2019 Feb 21.
Although prolonged exposure (PE) has strong support for treating posttraumatic stress disorder (PTSD), there is little research on PE for older adults. Likewise, Relaxation Training (RT) has shown some benefit for PTSD, but has not been adequately tested in this population.
This study represents the first randomized controlled trial of two active psychotherapies for PTSD among older adults. Male combat veterans (N = 87; mean age = 65 years) were randomly assigned to 12 sessions of PE (n = 41) or RT (n = 46). Clinician-administered and self-report assessments were conducted at pre-treatment, post-treatment, and six-month follow-up; self-reported symptoms were also measured at each treatment session.
Multi-level modeling indicated that Clinician-Administered PTSD Scale scores significantly decreased from pre-treatment to follow-up, but the time by treatment condition interaction was not significant. Pre- to post-treatment change was large in PE and moderate in RT, but many gains were lost at follow-up. For self-reported PTSD symptoms, a significant time by treatment condition interaction emerged, suggesting that participants who received PE had both greater decreases in symptoms and a greater rebound in self-reported PTSD symptoms than those who received RT. Unlike PTSD symptoms, depression symptoms neither changed nor were moderated by treatment condition from pre-treatment to follow-up. For self-reported PTSD and depression symptoms assessed at each session, time significantly predicted symptom reductions across psychotherapy sessions.
PE and RT are well-tolerated, feasible, and effective for older adults, though treatment gains were not maintained at follow-up.
clinicaltrials.gov Identifier: NCT00539279.
虽然延长暴露（PE）在治疗创伤后应激障碍（PTSD）方面具有强大的支持，但针对老年人的 PE 研究却很少。同样，放松训练（RT）也显示出对 PTSD 的一些益处，但在该人群中尚未得到充分测试。
本研究代表了针对老年人 PTSD 的两种积极心理疗法的首次随机对照试验。男性战斗退伍军人（N=87；平均年龄=65 岁）被随机分配到 12 节 PE（n=41）或 RT（n=46）中。在治疗前、治疗后和 6 个月随访时进行了临床医生管理的评估和自我报告评估；在每次治疗时也测量了自我报告的症状。
多层次建模表明，从治疗前到随访时，临床医生管理的 PTSD 量表评分显著降低，但治疗条件的时间交互作用并不显著。PE 治疗后的变化较大，而 RT 治疗后的变化中等，但随访时许多收益都丧失了。对于自我报告的 PTSD 症状，出现了时间与治疗条件的显著交互作用，表明接受 PE 的参与者在症状减轻方面的获益更大，而且自我报告的 PTSD 症状的反弹也更大。与 PTSD 症状不同，从治疗前到随访时，抑郁症状既没有变化，也不受治疗条件的调节。对于在每次治疗时评估的自我报告 PTSD 和抑郁症状，时间显著预测了整个心理治疗过程中的症状减轻。
PE 和 RT 对老年人是耐受良好、可行且有效的，但在随访时治疗效果无法维持。
clinicaltrials.gov 标识符：NCT00539279。
