New York State Psychiatric Institute, New York.
Corresponding Author: Maja Bergman, PhD, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032 (
J Clin Psychiatry. 2023 Nov 22;85(1):23m14883. doi: 10.4088/JCP.23m14883.
Posttraumatic stress disorder (PTSD) is prevalent after surviving sudden cardiac arrest (SCA). SCA-induced PTSD is associated with increased mortality and cardiovascular risk, yet no psychotherapeutic treatment has been developed and tested for this population. Exposure therapy is standard treatment for PTSD, but its safety and efficacy remain unconfirmed for SCA survivors: current protocols do not address their specific disease course and have high attrition. Mindfulness-based interventions are typically well-tolerated and have shown promise in reducing PTSD symptoms from other traumas. This study sought to determine feasibility, safety, and preliminary efficacy of acceptance and mindfulness-based exposure therapy (AMBET), a novel SCA-specific psychotherapy protocol combining mindfulness and exposure-based interventions with cardiac focused psychoeducation to reduce symptoms and improve health behaviors in patients with post-SCA PTSD. We conducted an open feasibility pilot study from January 2021 to April 2022 with a small sample (N = 11) of SCA survivors meeting PTSD criteria. AMBET comprised eight 90-minute remotely delivered individual sessions. Clinical evaluators assessed PTSD symptoms using the Clinician-Administered PTSD Scale for (CAPS-5) at baseline, midpoint, posttreatment, and 3-month follow-up. Ten (91%) of 11 enrolled patients completed treatment. Satisfaction was high and patients reported no adverse events. PTSD symptoms significantly improved statistically (.001) and clinically with large effect sizes (1.34-2.21) and treatment gains sustained at 3-month follow-up. Posttreatment, 80% of completers (n=8) showed significant treatment response, 70% (n=7) with PTSD diagnostic remission. No patient reported symptom increases. This initial trial found AMBET feasible, safe, and potentially efficacious in reducing PTSD following SCA. These encouraging pilot results warrant further research. ClinicalTrials.gov identifier: NCT04596891.
创伤后应激障碍（PTSD）在经历突发性心脏骤停（SCA）后很常见。SCA 引起的 PTSD 与死亡率和心血管风险增加有关，但尚未针对该人群开发和测试任何心理治疗方法。暴露疗法是 PTSD 的标准治疗方法，但对于 SCA 幸存者的安全性和疗效仍未得到证实：目前的方案并未解决他们特定的疾病进程，且患者脱落率很高。基于正念的干预措施通常耐受性良好，并已显示出在减轻其他创伤引起的 PTSD 症状方面有一定效果。本研究旨在确定接受和正念为基础的暴露疗法（AMBET）的可行性、安全性和初步疗效，这是一种针对 SCA 的新型特定于心理疗法的方案，将正念和基于暴露的干预措施与心脏为中心的心理教育相结合，以减少 PTSD 症状并改善 SCA 后 PTSD 患者的健康行为。我们于 2021 年 1 月至 2022 年 4 月进行了一项开放可行性试点研究，纳入了符合 PTSD 标准的小样本（N=11）SCA 幸存者。AMBET 包括 8 次远程提供的每次 90 分钟的个体治疗。临床评估者使用临床医生管理的 PTSD 量表第五版（CAPS-5）在基线、中点、治疗后和 3 个月随访时评估 PTSD 症状。11 名入组患者中有 10 名（91%）完成了治疗。满意度很高，患者报告无不良事件。PTSD 症状显著改善（<.001），临床疗效显著（效应量 1.34-2.21），且治疗效果在 3 个月随访时仍维持。治疗后，8 名（80%）完成治疗的患者（n=8）表现出显著的治疗反应，7 名（70%）患者达到 PTSD 诊断缓解。无患者报告症状加重。这项初步试验发现 AMBET 在减少 SCA 后 PTSD 方面是可行、安全且可能有效的。这些令人鼓舞的初步结果值得进一步研究。临床试验.gov 标识符：NCT04596891。
