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退伍军人事务部医疗保健系统中书面暴露疗法治疗创伤后应激障碍的效果。

Effectiveness of written exposure therapy for posttraumatic stress disorder in the Department of Veterans Affairs Healthcare System.

机构信息

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center.

National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System.

出版信息

Psychol Trauma. 2023 Jul;15(5):748-756. doi: 10.1037/tra0001148. Epub 2021 Oct 28.

Abstract

OBJECTIVE

Written Exposure Therapy (WET) for posttraumatic stress disorder (PTSD) has been shown to be efficacious in clinical trials; however, research is needed to determine WET's effectiveness in clinical practice settings. Additionally, research is needed to understand whether patient characteristics or treatment delivery format moderate outcomes.

METHOD

Patient outcomes ( = 277) were assessed as part of a multisite training and implementation program in the Department of Veterans Affairs (VA). During treatment, patients completed self-report measures of PTSD, depression, and functional impairment. Patient characteristics (i.e., demographics, psychiatric comorbidity, trauma type) and treatment delivery format (i.e., telehealth vs. in-person) were assessed as treatment moderators.

RESULTS

Intent-to-treat analyses indicated that WET was effective in reducing PTSD symptoms ( = .84), depression symptoms ( = .47), and functional impairment ( = .36) during treatment. Approximately one quarter of patients dropped out of treatment prematurely. No moderators of PTSD treatment outcome were observed; however, telehealth delivery was associated with lower dropout.

CONCLUSIONS

WET was an effective approach across a range of patient characteristics in this sample of veterans with PTSD. WET was also effective whether delivered in-person or via telehealth. WET is a promising treatment option for veteran patients in VA clinical care settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

摘要

目的

创伤后应激障碍(PTSD)的书面暴露疗法(WET)已在临床试验中被证明是有效的;然而,需要研究来确定 WET 在临床实践环境中的效果。此外,需要研究了解患者特征或治疗提供方式是否调节结果。

方法

作为退伍军人事务部(VA)多地点培训和实施计划的一部分,评估了患者的结果(n=277)。在治疗过程中,患者完成了 PTSD、抑郁和功能障碍的自我报告评估。评估了患者特征(即人口统计学、精神共病、创伤类型)和治疗提供方式(即远程医疗与面对面)作为治疗调节剂。

结果

意向治疗分析表明,WET 在治疗过程中有效降低了 PTSD 症状( =.84)、抑郁症状( =.47)和功能障碍( =.36)。大约四分之一的患者提前退出了治疗。未观察到 PTSD 治疗结果的调节剂;然而,远程医疗的提供与较低的脱落率有关。

结论

在 PTSD 退伍军人的这个样本中,WET 是一种针对各种患者特征的有效方法。无论是面对面还是通过远程医疗提供,WET 都同样有效。WET 是 VA 临床护理环境中退伍军人患者的一种有前途的治疗选择。(PsycInfo 数据库记录(c)2023 APA,保留所有权利)。

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