VA Puget Sound Health Care System, Tacoma, Washington, USA.
Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA.
J Trauma Stress. 2019 Oct;32(5):784-790. doi: 10.1002/jts.22427. Epub 2019 Aug 20.
Active duty military service members have high dropout rates for trauma-focused treatment in both clinical practice and research settings. Measuring patients' intent to complete (ITC) and intent to attend (ITA) treatment have been suggested as methods to reduce dropout, but no studies have examined the effectiveness of such measures. In an attempt to reduce high dropout rates, measures of ITC and ITA were included in a randomized controlled trial evaluating prolonged exposure (PE) and virtual reality exposure (VRE) in active duty soldiers with posttraumatic stress disorder (PTSD). Participants (N = 108) were randomized to either PE or VRE, and the last 49 to enroll were administered a measure of ITC at enrollment and a measure of ITA at the end of every session. A score of 7 or below triggered a problem-solving discussion with the individual's therapist. The results revealed that the ITA assessment predicted treatment dropout after controlling for mental health stigma, PTSD symptoms, and age, odds ratio (OR) = 0.24, p = .023. Additionally, participants who completed the ITA assessment were less likely to drop out than those who were not administered the ITA, OR = 0.29 p = .002. The ITC did not predict treatment dropout OR = 0.98, p = .402. These findings suggest that assessing ITA throughout trauma-focused therapy may reduce treatment dropout rather than solely measuring ITC prior to starting psychotherapy. Based on these preliminary findings, future research should randomize the measurement of ITA in clinical trials to evaluate its impact on treatment dropout.
现役军人在临床实践和研究环境中接受创伤为重点的治疗时，辍学率很高。有人提出，衡量患者完成治疗的意愿（ITC）和参加治疗的意愿（ITA）是减少辍学的方法，但没有研究检验过这些措施的有效性。为了降低高辍学率，在一项评估现役 PTSD 士兵接受延长暴露（PE）和虚拟现实暴露（VRE）的随机对照试验中，纳入了 ITC 和 ITA 的测量。参与者（N = 108）被随机分配到 PE 或 VRE 组，最后 49 名入组者在入组时接受 ITC 测量，在每次治疗结束时接受 ITA 测量。得分 7 或以下者会触发与个体治疗师的解决问题讨论。结果表明，在控制心理健康耻辱感、PTSD 症状和年龄后，ITA 评估预测了治疗辍学，优势比（OR）=0.24，p=0.023。此外，完成 ITA 评估的参与者比未接受 ITA 评估的参与者更不可能辍学，OR=0.29，p=0.002。ITC 并未预测治疗辍学，OR=0.98，p=0.402。这些发现表明，在创伤为重点的治疗过程中评估 ITA 可能会降低治疗辍学率，而不仅仅是在开始心理治疗之前测量 ITC。基于这些初步发现，未来的研究应该在临床试验中随机测量 ITA，以评估其对治疗辍学的影响。
