Held Philip, Zalta Alyson K, Smith Dale L, Bagley Jenna M, Steigerwald Victoria L, Boley Randy A, Miller Michelle, Brennan Michael B, Van Horn Rebecca, Pollack Mark H
Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA.
Department of Psychological Science, University of California, Irvine, CA, USA.
Eur J Psychotraumatol. 2020 Aug 12;11(1):1789324. doi: 10.1080/20008198.2020.1789324.
Intensive treatment programmes (ITPs) have shown promise for reducing PTSD and depression symptoms. It is still unknown whether treatment gains are maintained following completion.
This study examined whether veterans were able to maintain treatment gains for up to 12 months after an ITP for PTSD and whether reductions in negative posttrauma cognitions predicted treatment gain maintenance.
209 veterans (62.7% male, mean age = 40.86 years) completed a 3-week, CPT-based ITP for PTSD. Participants' PTSD (PCL-5) and depression (PHQ-9) symptoms were assessed at pre-treatment, post-treatment, and at 3-, 6-, and 12-month follow-up timepoints.
Despite small symptom increases from post-treatment to 3-month follow-up, significant and clinically meaningful reductions in PTSD and depression symptoms were reported from intake to 12 months follow-up (averaging >18 points on the PCL-5 and >6 points on the PHQ-9; = 1.28, and = 1.18, respectively). Greater reductions in negative posttrauma cognitions during treatment were associated with lower PTSD ( <.001) and depression ( =.005) severity at follow-up. Most veterans who completed the aftercare survey followed treatment recommendations and reported seeing a mental health provider at 3-, 6-, and 12-months post-treatment. Aftercare treatment did not significantly predict whether veterans maintained treatment gains at follow-up.
Overall maintenance of treatment gains long-term suggests veterans may be able to apply skills acquired during the ITP following treatment. These findings further support the feasibility and effectiveness of intensive, trauma-focused, evidence-based therapy delivery.
强化治疗方案（ITPs）已显示出减轻创伤后应激障碍（PTSD）和抑郁症状的前景。治疗结束后治疗效果能否维持仍不清楚。
本研究调查了退伍军人在接受PTSD强化治疗方案后长达12个月内能否维持治疗效果，以及创伤后消极认知的减少是否能预测治疗效果的维持。
209名退伍军人（62.7%为男性，平均年龄=40.86岁）完成了为期3周、基于认知处理疗法（CPT）的PTSD强化治疗方案。在治疗前、治疗后以及3个月、6个月和12个月的随访时间点评估参与者的PTSD（PCL-5）和抑郁（PHQ-9）症状。
尽管从治疗后到3个月随访症状略有增加，但从入组到12个月随访期间，PTSD和抑郁症状有显著且具有临床意义的减轻（PCL-5平均降低>18分，PHQ-9平均降低>6分；效应量分别为1.28和1.18）。治疗期间创伤后消极认知减少更多与随访时较低的PTSD严重程度（P<.001）和抑郁严重程度（P=.005）相关。大多数完成后续护理调查的退伍军人遵循了治疗建议，并报告在治疗后3个月、6个月和12个月时看了心理健康服务提供者。后续护理治疗并不能显著预测退伍军人在随访时是否维持治疗效果。
长期总体维持治疗效果表明退伍军人在治疗后可能能够应用在强化治疗方案中获得的技能。这些发现进一步支持了强化的、以创伤为重点的循证治疗的可行性和有效性。
