University of Memphis, Department of Psychology, Memphis, TN, USA.
University of Wyoming, Department of Psychology, Laramie, WY, USA.
J Anxiety Disord. 2021 May;80:102386. doi: 10.1016/j.janxdis.2021.102386. Epub 2021 Mar 22.
To examine moderators of change during group-based intervention for Posttraumatic Stress Disorder (PTSD), multilevel models were used to assess trajectories of symptom clusters in male veterans receiving trauma focused Group Cognitive Behavioral Treatment (gCBT; N = 84) or non-trauma focused Group Present Centered Therapy (gPCT; N = 91; Sloan et al., 2018). Separate models were conducted for symptom clusters in each intervention, examining pre-treatment PTSD symptoms, pre-treatment depression severity, age, index trauma, and outcome expectancies as potential moderators. Unconditioned growth models for both gCBT and gPCT showed reductions in intrusions, avoidance, negative cognitions/mood, and arousal/reactivity (all p < .001). Distinct moderators of recovery emerged for each treatment. Reductions in avoidance during gCBT were strongest at high levels of pre-treatment PTSD symptoms (low PTSD: p = .964, d = .05; high PTSD: p < .001, d = 1.31) whereas positive outcome expectancies enhanced reductions in cognitions/mood (low Expectancy: p = .120, d = .50; high Expectancy: p < .001, d = 1.13). For gPCT, high levels of pre-treatment depression symptoms negatively impacted change in both intrusion (low depression: p < .001, d = .96; high depression: p = .376, d = .22) and arousal/reactivity (low depression: p < .001, d = .95; high depression: p = .092, d = .39) symptoms. Results support the importance of examining trajectories of change and their moderators for specific treatments, particularly when contrasting trauma focused and non-trauma focused treatments.
为了研究基于团体的创伤后应激障碍（PTSD）干预中变化的调节因素，使用多层次模型评估了接受创伤聚焦团体认知行为治疗（gCBT；N=84）或非创伤聚焦团体当下中心治疗（gPCT；N=91；Sloan 等人，2018）的男性退伍军人的症状群轨迹。对于每种干预措施中的症状群，分别进行了单独的模型，考察了治疗前 PTSD 症状、治疗前抑郁严重程度、年龄、标志性创伤和结果预期作为潜在的调节因素。gCBT 和 gPCT 的无条件增长模型均显示侵入、回避、消极认知/情绪和唤醒/反应性降低（均 p<0.001）。每种治疗方法都出现了不同的恢复调节因素。gCBT 中回避的减少在高治疗前 PTSD 症状水平时最强（低 PTSD：p=0.964，d=0.05；高 PTSD：p<0.001，d=1.31），而积极的结果预期则增强了认知/情绪的减少（低期望：p=0.120，d=0.50；高期望：p<0.001，d=1.13）。对于 gPCT，治疗前抑郁症状的高水平对侵入（低抑郁：p<0.001，d=0.96；高抑郁：p=0.376，d=0.22）和唤醒/反应性（低抑郁：p<0.001，d=0.95；高抑郁：p=0.092，d=0.39）症状的变化都有负面影响。结果支持检查特定治疗方法变化轨迹及其调节因素的重要性，特别是在对比创伤聚焦和非创伤聚焦治疗时。
