Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston (Tanev, Federico, Goetter); the Department of Psychiatry, Massachusetts General Hospital, Boston (Tanev, Federico, Greenberg, Orr, Goetter, Pitman); and the Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, N.C. (Resick).
J Neuropsychiatry Clin Neurosci. 2020 Summer;32(3):286-293. doi: 10.1176/appi.neuropsych.19020032. Epub 2020 Jan 17.
Approximately 5%-20% of U.S. troops returning from Iraq and Afghanistan have posttraumatic stress disorder (PTSD), and another 11%-23% have traumatic brain injury (TBI). Cognitive-behavioral therapies (CBTs) are empirically validated treatment strategies for PTSD. However, cognitive limitations may interfere with an individual's ability to adhere to as well as benefit from such therapies. Comorbid TBI has not been systematically taken into consideration in PTSD outcome research or in treatment planning guidance. The authors hypothesized that poorer pretreatment cognitive abilities would be associated with poorer treatment outcomes from CBTs for PTSD.
This study was designed as a naturalistic examination of treatment as usual in an outpatient clinic that provides manualized CBTs for PTSD to military service members and veterans. Participants were 23 veterans, aged 18-50 years, with combat-related PTSD and a symptom duration of more than 1 year. Of these, 16 participants had mild TBI (mTBI). Predictor variables were well-normed objective tests of cognitive ability measured at baseline. Outcome variables were individual slopes of change of the PTSD Checklist for DSM-5 (PCL-5) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) over weeks of treatment, and of pretreatment-to-posttreatment change in PCL-5 and CAPS-5 (ΔPCL-5 and ΔCAPS-5, respectively).
Contrary to prediction, neither pretreatment cognitive performance nor the presence of comorbid mTBI predicted poorer response to CBTs for PTSD.
These results discourage any notion of excluding patients with PTSD and poorer cognitive ability from CBTs.
约 5%-20%从伊拉克和阿富汗返回的美军士兵患有创伤后应激障碍（PTSD），另有 11%-23%患有创伤性脑损伤（TBI）。认知行为疗法（CBT）是 PTSD 的经实证验证的治疗策略。然而，认知限制可能会干扰个人坚持和受益于这些疗法的能力。共病 TBI 在 PTSD 结果研究或治疗计划指导中并未被系统考虑。作者假设，较差的治疗前认知能力与 PTSD 的 CBT 治疗结果较差相关。
本研究旨在对门诊诊所的常规治疗进行自然观察，该诊所为军人和退伍军人提供 PTSD 的规范化 CBT。参与者为 23 名年龄在 18-50 岁之间、有与战斗相关的 PTSD 和超过 1 年症状持续时间的退伍军人。其中 16 名参与者患有轻度 TBI（mTBI）。预测变量为基线时测量的认知能力的正常良好的客观测试。结果变量为 PTSD 检查表 DSM-5（PCL-5）和 DSM-5 临床医生管理 PTSD 量表（CAPS-5）的个体变化斜率，以及 PCL-5 和 CAPS-5 的治疗前至治疗后变化（分别为ΔPCL-5 和ΔCAPS-5）。
与预测相反，治疗前的认知表现或共病 mTBI 均不能预测对 PTSD 的 CBT 反应较差。
这些结果不鼓励将认知能力较差且患有 PTSD 的患者排除在 CBT 之外。
