Mastroleo Nadine R, Possemato Kyle, King Paul R, Balderrama-Durbin Christina, Crinnin Charlotte, Cigrang Jeff, Read Jennifer P, Borsari Brian, Maisto Stephen A, Rauch Sheila A M
Binghamton University (SUNY), Department of Psychology, PO Box 6000 Binghamton, NY 13902.
VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210.
Prof Psychol Res Pr. 2023 Feb;54(1):70-82. doi: 10.1037/pro0000489. Epub 2022 Nov 7.
There is a need for integrated treatment approaches that address heavy alcohol use and posttraumatic stress disorder (PTSD) concurrently among Veterans as interactions between heavy drinking and PTSD are frequent. Veteran engagement in specialty mental health services after referral is limited with poorer outcomes following empirically-supported, exposure-based PTSD treatments that do not explicitly address alcohol use. The current project aimed to incorporate two evidenced-based interventions: Brief Motivational Intervention (BMI) with Prolonged Exposure for Primary Care (PE-PC) for Veterans with heavy drinking and PTSD. Delphi methodology was applied to adapt an intervention protocol using subject matter expert (SME) feedback to guide the refinement of a preliminary treatment manual. The newly developed brief intervention (PC-TIME) was then tested in an open trial (n=9) to gather Veteran participant feedback to modify the treatment manual.Two rounds of SME feedback resulted in 80% agreement that manual content was "acceptable as-is" across all intervention domains. The resulting protocol is a five-session, integrated intervention with session 1 primarily focused on alcohol use reduction and sessions 2-5 consisting of narrative exposure and in-vivo exercises for PTSD symptoms with brief alcohol use check-ins. Open trial results indicated high Veteran acceptance of PC-TIME structure and content, and reductions in heavy drinking and PTSD symptoms. Preliminary data suggest PC-TIME to be a promising approach for treatment of heavy alcohol use and PTSD. A pilot randomized controlled trial is necessary to demonstrate the intervention's efficacy with Veterans in a PC setting.
由于重度饮酒与创伤后应激障碍（PTSD）之间的相互作用频繁，因此需要采用综合治疗方法，同时解决退伍军人中的重度饮酒问题和创伤后应激障碍。转诊后，退伍军人参与专科心理健康服务的情况有限，在未明确解决饮酒问题的基于实证的、暴露疗法的创伤后应激障碍治疗中，治疗效果较差。当前项目旨在纳入两种循证干预措施：针对有重度饮酒和创伤后应激障碍的退伍军人的简短动机干预（BMI）与初级保健延长暴露疗法（PE-PC）。应用德尔菲法，利用主题专家（SME）的反馈来调整干预方案，以指导对初步治疗手册的完善。然后，在一项开放试验（n=9）中对新开发的简短干预措施（PC-TIME）进行测试，以收集退伍军人参与者的反馈，从而修改治疗手册。经过两轮主题专家反馈，80%的人一致认为手册内容在所有干预领域“原样即可接受”。最终形成的方案是一个五阶段的综合干预措施，第1阶段主要侧重于减少饮酒，第2至5阶段包括叙事暴露和针对创伤后应激障碍症状的现场练习，并对饮酒情况进行简短检查。开放试验结果表明，退伍军人对PC-TIME的结构和内容接受度很高，重度饮酒和创伤后应激障碍症状有所减轻。初步数据表明，PC-TIME是治疗重度饮酒和创伤后应激障碍的一种有前景的方法。有必要进行一项试点随机对照试验，以证明该干预措施在初级保健环境中对退伍军人的疗效。
