Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
South Texas Veterans Health Care System, San Antonio, Texas, USA.
J Trauma Stress. 2023 Dec;36(6):1126-1137. doi: 10.1002/jts.22982. Epub 2023 Oct 26.
Cognitive processing therapy (CPT) is an effective treatment for posttraumatic stress disorder (PTSD); however, some patients do not improve to the same extent as others. It is important to understand potential factors that can be modified for better patient outcomes. This clinical trial implemented a three-arm, equipoise-stratified randomization design to allow for the accommodation of patient preference before randomization to one of three CPT treatment modalities: in-home, in-office, or telehealth. This study examined whether satisfaction with the modality, perceived stigma, expectations of therapy, and credibility of the therapist differed between modalities and whether these factors impacted treatment outcomes. We hypothesized that the contributions of these variables would depend upon whether participants opted out of any treatment arms and that these factors would predict treatment outcomes. Participants who endorsed less perceived stigma demonstrated larger reductions in PTSD symptom severity than those with similar levels of perceived stigma in the telehealth and in-office conditions, η = .12-.18. Participants who endorsed lower satisfaction with their treatment modality and were assigned to the in-home condition experienced larger PTSD symptom reductions than those with similar dissatisfaction in the telehealth and in-office conditions, η = .20. The results show the robustness of evidence-based therapies for PTSD given that dissatisfaction did not impede treatment success. In addition, they demonstrate that it is important for clinicians to address stigma before initiating evidence-based therapies for PTSD. Strategies to address these factors are discussed.
认知加工疗法（CPT）是一种治疗创伤后应激障碍（PTSD）的有效方法；然而，并非所有患者都能得到相同程度的改善。了解可以改善患者预后的潜在因素非常重要。本临床试验采用三臂、均衡分层随机设计，允许患者在随机分配到三种 CPT 治疗方式（家庭治疗、门诊治疗或远程医疗）之前选择自己偏好的治疗方式。本研究旨在探讨患者对治疗方式的满意度、感知耻辱感、对治疗的期望以及对治疗师的信任度在不同治疗方式之间是否存在差异，以及这些因素是否会影响治疗结果。我们假设这些变量的贡献取决于参与者是否选择退出任何治疗方式，并且这些因素将预测治疗结果。在远程医疗和门诊治疗条件下，感知耻辱感较低的患者比具有相似感知耻辱感的患者 PTSD 症状严重程度的减轻幅度更大，η 值为.12-.18。对治疗方式满意度较低且被分配到家庭治疗条件的患者比在远程医疗和门诊治疗条件下具有相似不满的患者 PTSD 症状减轻幅度更大，η 值为.20。结果表明，基于证据的 PTSD 治疗方法具有很强的稳健性，因为不满并没有阻碍治疗的成功。此外，结果还表明，临床医生在开始 PTSD 的基于证据的治疗前，解决耻辱感问题非常重要。讨论了针对这些因素的策略。
