Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, USA.
Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA.
Psychiatr Q. 2021 Jun;92(2):735-750. doi: 10.1007/s11126-020-09850-2. Epub 2020 Sep 22.
To compare the outcomes of Seeking Safety (SS) and cognitive processing therapy (CPT) in veterans with PTSD in a specialty clinic of an urban VA medical center. Retrospective chart review of electronic medical records was conducted for 420 veterans with PTSD who received treatment with either CPT (n = 227) or SS (n = 193) in group setting. 1) treatment completion rate, 2) self-reported PTSD symptom severity measured by PTSD checklist (PCL), and 3) additional mental health services received within 12 months after treatment. Data were analyzed for the 160 who had both a pre and post PCL documented in their charts. The final analysis sample included n = 94 for CPT and n = 66 for SS veterans with a mean age of 49.71[SD = 14] years, 24 women [15%]; mean baseline PCL score was 68.41 [9]. Significantly more veterans completed SS treatment (SS, 59 [89%] than CPT, 47 [50%] (p = <.001). However, PCL score decreases were significantly greater for patients who completed CPT treatment than those in SS (treatment x time interaction, 9.60 vs.4.98, respectively; difference, 4.62; t = 2.16; p = .02). The patients who received SS used significantly more mental health services of the PTSD clinical team than patients who completed CPT treatment (p = .01). The results of this study demonstrate the need for alternative approaches where dually diagnosed patients would not be delayed in their receipt of trauma-focused care - i.e., where treatment is initiated concurrently rather than sequentially to substance abuse treatment.
将 Seeking Safety（SS）和认知加工疗法（CPT）在城市退伍军人事务部医疗中心的专科诊所治疗 PTSD 退伍军人的结果进行比较。对在小组环境中接受 CPT（n=227）或 SS（n=193）治疗的 420 名 PTSD 退伍军人的电子病历进行回顾性图表审查。1）治疗完成率，2）通过 PTSD 检查表（PCL）自我报告的 PTSD 症状严重程度，3）治疗后 12 个月内接受的其他心理健康服务。对 160 名在图表中同时记录了 PCL 前后的患者进行了数据分析。最终分析样本包括 n=94 名接受 CPT 治疗的退伍军人和 n=66 名接受 SS 治疗的退伍军人，平均年龄为 49.71[SD=14]岁，24 名女性[15%]；平均基线 PCL 得分为 68.41[9]。完成 SS 治疗的退伍军人明显多于 CPT 治疗（SS，59[89%]比 CPT，47[50%]；p<.001）。然而，完成 CPT 治疗的患者的 PCL 评分下降明显大于 SS 治疗的患者（治疗×时间交互作用，分别为 9.60 与 4.98；差异，4.62；t=2.16；p=.02）。接受 SS 治疗的患者比接受 CPT 治疗的患者使用 PTSD 临床团队的心理健康服务明显更多（p=.01）。这项研究的结果表明，需要采用替代方法，使双重诊断患者不会在接受创伤聚焦治疗方面延迟——即同时而不是顺序开始治疗，而不是同时开始治疗。
