一项针对女性退伍军人的在线、教练辅助的自我管理 PTSD 干预措施的随机试验。
A randomized trial of an online, coach-assisted self-management PTSD intervention tailored for women veterans.
机构信息
Health Services Research & Development Center of Innovation.
Geriatric Research Education and Clinical Center.
出版信息
J Consult Clin Psychol. 2021 Feb;89(2):134-142. doi: 10.1037/ccp0000556.
OBJECTIVE
Scalable, efficiently delivered treatments are needed to address the needs of women Veterans with PTSD. This randomized clinical trial compared an online, coach-assisted cognitive behavioral intervention tailored for women Veterans with PTSD to phone monitoring only.
METHOD
Women Veterans who met diagnostic criteria for PTSD were randomized to an 8-week web-based intervention, called DElivery of Self TRaining and Education for Stressful Situations (DESTRESS)-Women Veterans version (WV), or to phone monitoring only (N = 102). DESTRESS-WV consisted of online sessions and 15-min weekly phone calls from a study coach. Phone monitoring included 15-min weekly phone calls from a study coach to offer general support. PTSD symptom severity (PTSD Symptom-Checklist-Version 5 [PCL-5]) was evaluated pre and posttreatment, and at 3 and 6 months posttreatment.
RESULTS
More participants completed phone monitoring than DESTRESS-WV (96% vs. 76%, p = 0.01), although treatment satisfaction was significantly greater in the DESTRESS-WV condition. We failed to confirm the superiority of DESTRESS-WV in intent-to-treat slope changes in PTSD symptom severity. Both treatments were associated with significant reductions in PTSD symptom severity over time. However, post hoc analyses of treatment completers and of those with baseline PCL ≥ 33 revealed that the DESTRESS-WV group had greater improvement in PTSD symptom severity relative to phone monitoring with significant differences at the 3-month follow-up assessment.
CONCLUSIONS
Both DESTRESS-WV and phone monitoring resulted in significant improvements in women Veterans' PTSD symptoms. DESTRESS-WV may be an appropriate care model for women Veterans who can engage in the demands of the treatment and have higher baseline symptoms. Future research should explore characteristics of and the methods of reliably identifying women Veterans who are most likely to benefit. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
目的
需要可扩展且高效的治疗方法来满足患有 PTSD 的女性退伍军人的需求。本随机临床试验比较了一种针对 PTSD 女性退伍军人的在线、教练辅助认知行为干预与仅电话监测。
方法
符合 PTSD 诊断标准的女性退伍军人被随机分配到 8 周的基于网络的干预中，称为针对女性退伍军人的自我训练和应对压力情况的交付（DESTRESS）-退伍军人版（WV），或仅接受电话监测（N = 102）。DESTRESS-WV 包括在线课程和每周 15 分钟的研究教练电话。电话监测包括每周 15 分钟的研究教练电话，提供一般支持。在治疗前、治疗后以及治疗后 3 个月和 6 个月评估 PTSD 症状严重程度（PCL-5 版本 PTSD 症状清单）。
结果
完成电话监测的参与者多于 DESTRESS-WV（96%对 76%，p = 0.01），尽管 DESTRESS-WV 条件下的治疗满意度显著更高。我们未能确认 DESTRESS-WV 在 PTSD 症状严重程度的意向治疗斜率变化方面的优越性。两种治疗均随着时间的推移与 PTSD 症状严重程度的显著降低相关。然而，对于治疗完成者和基线 PCL≥33 的患者的事后分析显示，与电话监测相比，DESTRESS-WV 组 PTSD 症状严重程度的改善更大，在 3 个月随访评估时存在显著差异。
结论
DESTRESS-WV 和电话监测均使女性退伍军人的 PTSD 症状得到显著改善。对于能够参与治疗要求且具有更高基线症状的女性退伍军人，DESTRESS-WV 可能是一种合适的护理模式。未来的研究应该探索最有可能受益的女性退伍军人的特征和可靠识别方法。
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