Dissemination and Training Division, National Center for PTSD.
College of Staten Island, City University of New York; Yale School of Medicine.
Behav Ther. 2021 May;52(3):774-784. doi: 10.1016/j.beth.2020.10.001. Epub 2020 Oct 24.
In light of the well-established relationship between posttraumatic stress disorder (PTSD) and suicidal ideation (SI), there has been a push for treatments that simultaneously improve symptoms of PTSD and decrease SI. Using data from a randomized controlled hybrid implementation-effectiveness trial, the current study investigated the effectiveness of Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2016) on PTSD and SI. The patient sample (N = 188) was diverse in military and veteran status, gender, and comorbidity, and 73% of the sample endorsed SI at one or more points during CPT. Participants demonstrated significant improvement in SI over the course of CPT. Multilevel growth curve modeling revealed a significant association between PTSD symptom change and change in SI. Results from cross-lagged multilevel regressions indicated that PTSD symptoms predicted SI in the next session, yet SI in a given session did not predict PTSD symptoms in the next session. Potentially relevant clinical factors (i.e., military status, gender, depression diagnosis, baseline SI, study consultation condition) were not associated with the relationship between PTSD symptoms and SI. These results add to the burgeoning literature suggesting that evidence-based treatments for PTSD, like CPT, reduce suicidality in a range of individuals with PTSD, and that this reduction is predicted by improvements in PTSD symptoms.
鉴于创伤后应激障碍 (PTSD) 和自杀意念 (SI) 之间存在的既定关系，人们一直在努力寻找同时改善 PTSD 症状和降低 SI 的治疗方法。本研究利用一项随机对照混合实施效果试验的数据，调查了认知加工疗法 (CPT; Resick, Monson, & Chard, 2016) 对 PTSD 和 SI 的疗效。患者样本 (N=188) 在军人和退伍军人身份、性别和共病方面具有多样性，且 73%的样本在 CPT 的一个或多个时间点上表示存在 SI。参与者在 CPT 过程中表现出 SI 的显著改善。多层次增长曲线模型显示 PTSD 症状变化与 SI 变化之间存在显著关联。交叉滞后多层次回归的结果表明，PTSD 症状可预测下一次治疗中的 SI，但某次治疗中的 SI 并不能预测下一次治疗中的 PTSD 症状。潜在相关的临床因素（即军人身份、性别、抑郁诊断、基线 SI、研究咨询条件）与 PTSD 症状和 SI 之间的关系无关。这些结果增加了越来越多的文献，这些文献表明，像 CPT 这样的 PTSD 循证治疗方法可以降低 PTSD 患者的自杀率，而 PTSD 症状的改善可预测 SI 的降低。
