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创伤后应激障碍老兵与未接受过 PTSD 治疗老兵的加速康复治疗比较。

Comparison of Accelerated Resolution Therapy for PTSD Between Veterans With and Without Prior PTSD Treatment.

机构信息

College of Public Health, University of South Florida, Tampa, FL 33612, USA.

Minnesota State University-Mankato, Mankato, MN 56001, USA.

出版信息

Mil Med. 2023 Mar 20;188(3-4):e621-e629. doi: 10.1093/milmed/usab335.

Abstract

INTRODUCTION

Post-traumatic stress disorder (PTSD) is a psychiatric disorder commonly caused by a traumatic event(s) and prevalent among service members and veterans. Accelerated Resolution Therapy (ART) is an emerging "mind-body" psychotherapy for PTSD that is generally briefer and less expensive than current first-line treatments, such as cognitive processing therapy (CPT) and prolonged exposure (PE) therapy. This study examined the results of ART for treatment of military-related PTSD, with stratification by prior PTSD treatment types, including service members/veterans with reported residual PTSD symptoms following receipt of first-line recommended psychotherapy.

MATERIALS AND METHODS

Four groups were constructed and compared based on self-reported prior PTSD treatment history: treatment-naïve (n = 33), pharmacotherapy only (n = 40), first-line psychotherapy (CPT and/or PE) (n = 33), and other psychotherapy (n = 42). Participants were assessed for PTSD symptoms at baseline, post-treatment, and 6-month follow-up using the 17-item Military PTSD Checklist (PCL-M), as well as assessment of depressive, anxiety, and sleep symptoms. The study was approved by the Institutional Review Board at University of South Florida.

RESULTS

Among 148 veterans/service members who enrolled and started treatment with ART, 106 (71.6%) completed treatment in a mean of 3.5 treatment sessions, and 55 (51.9%) provided 6-month follow-up data. Mean age was 43.8 years, 95% were male, and 84% were of white race. Within-group standardized effect sizes for pre-to-post changes in PTSD scores (PCL-M) were large at 1.48, 1.11, 1.88, and 1.03 for the treatment-naïve, pharmacotherapy only, first-line psychotherapy, and other psychotherapy groups, respectively. Among treatment completers, the clinically significant treatment response rate (reduction of ≥10 points on the PCL-M) was highest in the treatment-naïve (83%) and first-line psychotherapy (88%) groups. Similar significant symptom reductions were observed for measures of depression and anxiety, and favorable treatment effects were generally sustained at 6-month follow-up.

CONCLUSION

In a brief treatment period, ART appears to result in substantial reductions in symptoms of PTSD among veterans, including those with residual PTSD symptoms after prior treatment with first-line psychotherapies endorsed by the U.S. Department of Defense and Veterans Affairs. These results suggest that ART be considered as a potential first-line treatment modality for veterans with PTSD.

摘要

简介

创伤后应激障碍(PTSD)是一种常见的由创伤事件引起的精神障碍,在军人和退伍军人中较为普遍。加速解决治疗(ART)是一种新兴的“身心”心理疗法,用于治疗 PTSD,通常比目前的一线治疗方法(如认知加工疗法(CPT)和延长暴露(PE)疗法)更简短、更经济。本研究通过分层比较,考察了 ART 治疗与军事相关 PTSD 的结果,分层因素包括先前的 PTSD 治疗类型,包括接受美国国防部和退伍军人事务部推荐的一线心理治疗后仍有 PTSD 症状的军人/退伍军人。

材料和方法

根据自我报告的先前 PTSD 治疗史,构建并比较了 4 个组:治疗初治组(n=33)、仅药物治疗组(n=40)、一线心理治疗组(CPT 和/或 PE)(n=33)和其他心理治疗组(n=42)。参与者在基线、治疗后和 6 个月随访时使用 17 项军人 PTSD 清单(PCL-M)评估 PTSD 症状,以及评估抑郁、焦虑和睡眠症状。该研究得到了南佛罗里达大学机构审查委员会的批准。

结果

在 148 名参加并开始接受 ART 治疗的退伍军人/军人中,有 106 人(71.6%)在平均 3.5 次治疗后完成了治疗,有 55 人(51.9%)提供了 6 个月的随访数据。平均年龄为 43.8 岁,95%为男性,84%为白人。PTSD 评分(PCL-M)从治疗前到治疗后的组内标准化效应大小分别为 1.48、1.11、1.88 和 1.03,对于治疗初治组、仅药物治疗组、一线心理治疗组和其他心理治疗组。在治疗完成者中,治疗初治组(83%)和一线心理治疗组(88%)的临床显著治疗反应率(PCL-M 降低≥10 分)最高。对于抑郁和焦虑的测量,也观察到了类似的显著症状减轻,并且在 6 个月的随访中,治疗效果普遍持续。

结论

在一个简短的治疗期间,ART 似乎导致退伍军人 PTSD 症状的显著减轻,包括那些在接受美国国防部和退伍军人事务部推荐的一线心理治疗后仍有 PTSD 症状的退伍军人。这些结果表明,ART 应被视为 PTSD 退伍军人的一种潜在一线治疗模式。

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