Davis Lori L, Whetsell Charles, Hamner Mark B, Carmody James, Rothbaum Barbara O, Allen Rebecca S, Al Bartolucci A B P P, Southwick Steven M, Bremner J Douglas
Psychiatr Res Clin Pract. 2019 Oct 1;1(2):39-48. doi: 10.1176/appi.prcp.20180002. Epub 2018 Sep 13.
Posttraumatic stress disorder (PTSD) is often difficult to treat, and many patients do not achieve full remission. Complementary and integrative health approaches, such as mindfulness meditation, are intended to be integrated with evidence-based treatment. This study examined the efficacy of mindfulness-based stress reduction (MBSR) in the treatment of PTSD in U.S. military veterans.
Veterans with a diagnosis of PTSD (N=214) were randomly assigned to either 90-minute group MBSR or present-centered group therapy (PCGT) for eight weeks. Follow-up assessments were obtained at baseline and weeks 3, 6, 9 (primary endpoint), and 16.
Both the MBSR and PCGT groups achieved significant improvement in PTSD as measured by the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV), with no statistically significant differences between groups. However, compared with PCGT, the MBSR group showed a statistically significant improvement in PTSD on the self-reported PTSD Checklist for DSM-IV over the nine weeks. This difference was not maintained posttreatment, at week 16. Strengths of the study include its large sample size, multisite design, active control group, single-blind outcome ratings, fidelity monitoring, large minority representation, and randomized approach. The study was limited by its high attrition rate and low representation of women.
Both MBSR and PCGT appear to have beneficial effects in treating PTSD in veterans, with greater improvement observed in self-reported PTSD symptoms in the MBSR group. No differences between groups were observed on the CAPS-IV scale.
创伤后应激障碍（PTSD）往往难以治疗，许多患者无法实现完全缓解。补充和综合健康方法，如正念冥想，旨在与循证治疗相结合。本研究考察了基于正念的减压疗法（MBSR）对美国退伍军人创伤后应激障碍的治疗效果。
214名被诊断为创伤后应激障碍的退伍军人被随机分为两组，一组接受为期八周的90分钟团体MBSR治疗，另一组接受以当下为中心的团体治疗（PCGT）。在基线、第3周、第6周、第9周（主要终点）和第16周进行随访评估。
根据《精神疾病诊断与统计手册》第四版临床医生管理的创伤后应激障碍量表（CAPS-IV）测量，MBSR组和PCGT组的创伤后应激障碍均有显著改善，两组之间无统计学显著差异。然而，与PCGT组相比，MBSR组在九周内自我报告的《精神疾病诊断与统计手册》第四版创伤后应激障碍检查表上的创伤后应激障碍有统计学显著改善。在第16周的治疗后，这种差异没有持续存在。该研究的优势包括样本量大、多地点设计、活性对照组、单盲结果评分、保真度监测、少数族裔代表性高和随机方法。该研究的局限性在于其高失访率和女性代表性低。
MBSR和PCGT在治疗退伍军人创伤后应激障碍方面似乎都有有益效果，MBSR组自我报告的创伤后应激障碍症状改善更大。在CAPS-IV量表上未观察到组间差异。
