BEHAVIORAL ACTIVATION AND THERAPEUTIC EXPOSURE FOR POSTTRAUMATIC STRESS DISORDER: A NONINFERIORITY TRIAL OF TREATMENT DELIVERED IN PERSON VERSUS HOME-BASED TELEHEALTH
BEHAVIORAL ACTIVATION AND THERAPEUTIC EXPOSURE FOR POSTTRAUMATIC STRESS DISORDER: A NONINFERIORITY TRIAL OF TREATMENT DELIVERED IN PERSON VERSUS HOME-BASED TELEHEALTH
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DOI：
10.1002/da.22476
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发表时间：
2016-05-01
影响因子：
7.4
通讯作者：
Tuerk, Peter W.
中科院分区：
文献类型：
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作者：
Acierno, Ron;Gros, Daniel F.;Tuerk, Peter W.
患有创伤后应激障碍 (PTSD) 和重度抑郁症 (MD) 等精神健康问题重返社会的退伍军人报告称，在提供传统心理治疗服务方面存在重大障碍（例如耻辱、旅行时间和费用）。因此，需要替代的治疗方法。家庭远程医疗 (HBT) 就是这样的选择之一；然而，这种交付模式尚未在充分有力的试验中与针对 PTSD 的面对面临床护理进行比较。本研究旨在比较 PTSD 和 MD 的循证心理治疗的相对非劣效性，特别是通过 HBT 与亲自实施的行为激活和治疗暴露 (BA-TE) 进行临床治疗时的相对非劣效性。方法采用非劣效性分析的重复测量（即基线、治疗后、3、6 个月随访）随机对照设计来比较 BA-TE 的 PTSD 和 MD 症状改善情况通过 HBT 与在诊所条件下亲自进行的比较。参与者是 232 名被诊断患有完全标准或预定义阈值下 PTSD 的退伍军人。结果 HBT 提供的 BA-TE 后的 PTSD 和 MD 症状改善与治疗后以及 3 个月和 12 个月随访时亲自提供的 BA-TE 的改善相当。结论 可以通过 HBT 安全有效地提供针对 PTSD 和抑郁症的循证心理治疗，其临床结果与亲自提供的基于临床的护理相当。因此，HBT 解决了与后勤和耻辱相关的护理障碍。
ObjectiveCombat veterans returning to society with impairing mental health conditions such as PTSD and major depression (MD) report significant barriers to care related to aspects of traditional psychotherapy service delivery (e.g., stigma, travel time, and cost). Hence, alternate treatment delivery methods are needed. Home-based telehealth (HBT) is one such option; however, this delivery mode has not been compared to in person, clinic-based care for PTSD in adequately powered trials. The present study was designed to compare relative noninferiority of evidence-based psychotherapies for PTSD and MD, specifically Behavioral Activation and Therapeutic Exposure (BA-TE), when delivered via HBT versus in person, in clinic delivery.MethodA repeated measures (i.e., baseline, posttreatment, 3-, 6-month follow-up) randomized controlled design powered for noninferiority analyses was used to compare PTSD and MD symptom improvement in response to BA-TE delivered via HBT versus in person, in clinic conditions. Participants were 232 veterans diagnosed with full criteria or predefined subthreshold PTSD.ResultsPTSD and MD symptom improvement following BA-TE delivered by HBT was comparable to that of BA-TE delivered in person at posttreatment and at 3- and 12-month follow-up.ConclusionEvidence-based psychotherapy for PTSD and depression can be safely and effectively delivered via HBT with clinical outcomes paralleling those of clinic-based care delivered in person. HBT, thereby, addresses barriers to care related to both logistics and stigma.