Veterans Affairs Center for Clinical Management Research VA Ann Arbor Health Care System; University of Michigan.
Emory University; Atlanta VA Medical Center.
Behav Ther. 2020 Jan;51(1):85-98. doi: 10.1016/j.beth.2019.05.003. Epub 2019 May 18.
Evidence-based treatments for posttraumatic stress disorder (PTSD) often produce significant symptom reduction within eight sessions. However, some patients take longer to respond and a better understanding of predictors of later response can help guide treatment. In the current study, the cohort consisted of all VA patients with a PTSD diagnosis who received at least eight sessions of documented evidence-based treatment within a 6-month period in FY16-FY17 and had at least two PTSD symptom assessments. We examined the proportion of patients who achieved meaningful change (defined as at least 50% reduction in self-reported PTSD symptoms), both within the first eight sessions and subsequently. Fourteen percent of patients achieved meaningful change within eight sessions and 10% subsequently. Symptom change within the first eight sessions was highly predictive of subsequent change. Those who experienced at least 20% symptom reduction by session eight were twice as likely to subsequently achieve meaningful change as compared with all patients who continued treatment. Patients receiving service-connected disability compensation were less likely and White patients more likely to achieve meaningful change. Without some degree of symptom reduction by session eight, patients are unlikely to achieve meaningful change if treatment is not enhanced or changed.
创伤后应激障碍（PTSD）的循证治疗通常在八次疗程内产生显著的症状减轻。然而，有些患者需要更长的时间来反应，更好地了解后期反应的预测因素可以帮助指导治疗。在当前的研究中，队列包括所有在 FY16-FY17 期间接受至少八次记录在案的循证治疗且至少有两次 PTSD 症状评估的 PTSD 诊断的 VA 患者。我们检查了在头 8 次治疗中以及随后达到有意义变化（定义为自我报告的 PTSD 症状至少减少 50%）的患者比例。14%的患者在头 8 次治疗中达到有意义的变化，10%的患者随后达到有意义的变化。头 8 次治疗中的症状变化高度预测随后的变化。与所有继续治疗的患者相比，那些在第 8 次治疗时至少有 20%症状减轻的患者随后达到有意义的变化的可能性是其两倍。接受服务关联残疾补偿的患者不太可能，而白人患者更有可能达到有意义的变化。如果不通过第 8 次治疗达到一定程度的症状减轻，那么如果不增强或改变治疗，患者就不太可能达到有意义的变化。
