Sturt J, Rogers R, Armour C, Cameron D, De Rijk L, Fiorentino F, Forbes T, Glen C, Grealish A, Kreft J, Meye de Souza I, Spikol E, Tzouvara V, Greenberg N
Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
Research Centre for Stress, Trauma, and Related Conditions (STARC), School of Psychology, Queens University Belfast, Belfast, Northern Ireland.
Pilot Feasibility Stud. 2023 Oct 13;9(1):175. doi: 10.1186/s40814-023-01396-x.
Post-traumatic stress disorder (PTSD) occurs more commonly in military veterans than the general population. Whilst current therapies are effective, up to half of veterans commencing treatment do not complete it. Reconsolidation of Traumatic Memories (RTM) protocol is a novel, easy to train, talking therapy with promising findings. We examine the feasibility of undertaking an efficacy trial of RTM in veterans.
A parallel group, single-centre randomised controlled feasibility trial with a post-completion qualitative interview study. Sixty military veterans were randomised 2:1 to RTM (n = 35) or Trauma Focussed Cognitive Behaviour Therapy (CBT) (n = 25). We aimed to determine the rate of recruitment and retention, understand reasons for attrition, determine data quality and size of efficacy signal. We explored veterans' perceptions of experiences of joining the trial, the research procedures and therapy, and design improvements for future veteran studies. Military veterans with a diagnosis of PTSD or complex PTSD, and clinically significant symptoms, were recruited between January 2020 and June 2021. Primary outcome was feasibility using pre-determined progression criteria alongside PTSD symptoms, with depression, recovery, and rehabilitation as secondary outcomes. Data were collected at baseline, 6, 12, and 20 weeks. Interviews (n = 15) were conducted after 20 weeks. Both therapies were delivered by trained charity sector provider therapists.
Participants' mean age was 53 years, the mean baseline PTSD symptoms score assessed by the Post-traumatic Stress Checklist (PCL-5) was 57 (range 0-80). Fifty had complex PTSD and 39 had experienced ≥ 4 traumas. Data were analysed at 20 weeks for feasibility outcomes (n = 60) and mental health outcomes (n = 45). Seven of eight progression criteria were met. The RTM group experienced a mean 18-point reduction on the PCL-5. TFCBT group participants experienced a mean reduction of eight points. Forty-eight percent of the RTM group no longer met diagnostic criteria for PTSD compared to 16% in the TFCBT group. All veterans reported largely positive experiences of the therapy and research procedures and ways to improve them.
RTM therapy remains a promising psychological intervention for the treatment of PTSD, including complex PTSD, in military veterans. With specific strengthening, the research protocol is fit for purpose in delivering an efficacy trial.
ISRCTN registration no 10314773 on 01.10.2019. Full trial protocol: available on request or downloadable at ISRCTN reg. no. 10314773.
创伤后应激障碍（PTSD）在退伍军人中比在普通人群中更常见。虽然目前的治疗方法有效，但开始治疗的退伍军人中多达一半没有完成治疗。创伤记忆重新巩固（RTM）方案是一种新颖、易于培训的谈话疗法，有很有前景的研究结果。我们研究了在退伍军人中进行RTM疗效试验的可行性。
一项平行组、单中心随机对照可行性试验，并在试验结束后进行定性访谈研究。60名退伍军人按2:1随机分为RTM组（n = 35）或创伤聚焦认知行为疗法（CBT）组（n = 25）。我们旨在确定招募和保留率，了解退出原因，确定数据质量和疗效信号大小。我们探讨了退伍军人对参与试验、研究程序和治疗的体验的看法，以及对未来退伍军人研究的设计改进。2020年1月至2021年6月招募了诊断为PTSD或复杂性PTSD且有临床显著症状的退伍军人。主要结局是根据预先确定的进展标准以及PTSD症状评估的可行性，以抑郁、康复和恢复作为次要结局。在基线、第6、12和20周收集数据。20周后进行访谈（n = 15）。两种疗法均由受过培训的慈善部门提供治疗师实施。
参与者的平均年龄为53岁，通过创伤后应激清单（PCL-5）评估的平均基线PTSD症状评分为57分（范围0-80）。50人患有复杂性PTSD，39人经历过≥4次创伤。在20周时分析了可行性结局（n = 60）和心理健康结局（n = 45）的数据。八项进展标准中的七项得到满足。RTM组在PCL-5上平均降低了18分。TFCBT组参与者平均降低了8分。RTM组中48%的人不再符合PTSD的诊断标准，而TFCBT组为16%。所有退伍军人对治疗和研究程序以及改进方法都报告了大体积极的体验。
RTM疗法仍然是治疗退伍军人PTSD（包括复杂性PTSD）的一种有前景的心理干预方法。经过具体强化后，该研究方案适合进行疗效试验。
2019年10月1日ISRCTN注册号10314773。完整试验方案：可按需提供或在ISRCTN注册号10314773处下载。
