Does Validity Measure Response Affect CPT Group Outcomes in Veterans with PTSD?
Does Validity Measure Response Affect CPT Group Outcomes in Veterans with PTSD?
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有效性测量反应是否会影响患有 PTSD 退伍军人的 CPT 小组结果？
DOI：
10.1093/milmed/usz385
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发表时间：
2020
影响因子：
1.2
通讯作者：
King-Casas,Brooks
中科院分区：
文献类型：
--
作者：
Williams,MWright;Graham,David;Sciarrino,NicoleA;Estey,Matt;McCurry,KatherineL;Chiu,Pearl;King-Casas,Brooks
关于治疗前评估努力和症状夸大对退伍军人从事创伤集中治疗的治疗结果的影响的研究缺乏，阻碍了提供这些治疗的治疗师。研究表明，多方法评估退伍军人创伤后应激障碍（PTSD）的症状夸大，包括努力和症状效度测试，是可取的。症状夸大也被认为是“呼救”，与创伤后应激障碍和抑郁症状的增加有关。最近，研究已经确定了复原力是PTSD和抑郁症状严重程度的调节因子，也是PTSD患者治疗反应的重要预测因子。因此，重要的是检查症状夸大、恢复力和治疗结果的交集，以确定评估努力和症状夸大是否会损害治疗反应。材料和方法我们从心理健康诊所和张贴在大型退伍军人医疗中心的传单中招募了年龄在18-50岁之间的退伍军人，他们曾在持久自由行动/伊拉克自由行动/新黎明行动（OEF/OIF/OND）时期服役。如果退伍军人通过临床医生管理的评估被诊断患有创伤后应激障碍，他们就符合纳入标准。61名退伍军人同意参加并自行选择认知处理治疗（CPT）组或照常治疗。我们提供自我选择，因为低招募率推迟了治疗开始日期，并与以退伍军人为中心的护理理念相一致。在治疗前后对退伍军人进行评估，以确定评估努力和症状夸大评分对PTSD和抑郁症状和恢复力的影响。本研究探讨了评估努力失败和症状夸大是否与创伤后应激障碍退伍军人接受CPT的心理治疗结果受损有关。我们假设，与提供良好努力和真实反应的退伍军人相比，努力和症状夸大相一致的反应模式会导致PTSD和抑郁症状结果测量的治疗前和治疗后得分更高（即更严重），恢复力更低。采用双变量相关分析、方差分析和卡方分析对假设进行评估。结果退伍军人治疗前创伤后应激障碍和抑郁症状的得分较高，其反应模式与评估努力不足和症状夸大相一致；这些退伍军人在弹性方面的得分也较低。在治疗后，在创伤后应激障碍和抑郁症状的测量和是否完成治疗方面，表现良好和失败的退伍军人之间没有差异。在努力测试失败的患者中，治疗后的恢复力得分仍然明显较低。结论效度测试分数显示努力程度较低和症状夸大的PTSD退伍军人的复原力可能较差，但仍然可以完成CPT组治疗，并且与治疗前表现出良好评估努力和真实症状报告的退伍军人相比，从治疗中获益的比率相当。这些发现也挑战了治疗前评估努力失败和症状夸大准确预测以创伤为重点的心理治疗努力不足的假设。
IntroductionThere is a dearth of research on the impact of pre-treatment assessment effort and symptom exaggeration on the treatment outcomes of Veterans engaging in trauma-focused therapy, handicapping therapists providing these treatments. Research suggests a multi-method approach for assessing symptom exaggeration in Veterans with posttraumatic stress disorder (PTSD), which includes effort and symptom validity tests, is preferable. Symptom exaggeration has also been considered a “cry for help,” associated with increased PTSD and depressive symptoms. Recently, research has identified resilience as a moderator of PTSD and depressive symptom severity and an important predictor of treatment response among individuals with PTSD. Thus, it is important to examine the intersection of symptom exaggeration, resilience, and treatment outcome to determine whether assessment effort and symptom exaggeration compromise treatment response.Materials and MethodsWe recruited Veterans, aged 18–50 who served during the Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) era, from mental health clinics and fliers posted in a large Veterans Affairs Medical Center. Veterans met inclusion criteria if they were diagnosed with PTSD via a clinician-administered assessment. Sixty-one Veterans consented to participate and self-selected into a cognitive processing therapy (CPT) group or treatment-as-usual. We offered self-selection because low recruitment rates delayed treatment start dates and were consistent with a Veteran-centered care philosophy. Veterans were assessed before and after treatment to determine the impact of assessment effort and symptom exaggeration scores on measures of PTSD and depressive symptoms and resilience. This study examined whether assessment effort failure and symptom exaggeration were associated with compromised psychotherapy outcomes in Veterans with PTSD undergoing CPT group. We hypothesized that a pattern of responding consistent with both effort and symptom exaggeration would result in higher (ie, more severe) pre- and post-treatment scores on PTSD and depressive symptom outcome measures and lower resiliency when compared to Veterans providing good effort and genuine responding. Hypotheses were evaluated using bivariate correlation analyses, analysis of variance, and chi-square analyses.ResultsPre-treatment scores on measures of PTSD and depressive symptoms were higher among Veterans whose pattern of responding was consistent with poor assessment effort and symptom exaggeration; these Veterans also scored lower on a measure of resiliency. At post-treatment, there were no differences between Veterans displaying good and failed effort testing on measures of PTSD and depressive symptoms or in whether they completed treatment. Post-treatment resiliency scores remained significantly lower in those with failed effort testing.ConclusionThese results suggest that Veterans with PTSD whose validity testing scores are indicative of poor effort and symptom exaggeration may be less resilient but may still complete a CPT group treatment and benefit from treatment at a rate comparable to Veterans who evidence good assessment effort and genuine symptom reporting pre-treatment. These findings also challenge the assumption that pre-treatment assessment effort failure and symptom exaggeration accurately predict poor effort in trauma-focused psychotherapy.
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影响因子：
7.4
作者：
Connor, KM;Davidson, JRT
通讯作者：
Davidson, JRT
影响因子：
2.6
作者：
Bush, SS;Ruff, RM;Silver, CH
通讯作者：
Silver, CH
使用 MMPI-2 症状有效性量表检测退伍军人的症状夸大：混合组验证。
影响因子：
3.6
作者：
D. Tolin;M. Steenkamp;B. Marx;B. Litz
通讯作者：
B. Litz
米勒法医症状评估测试（M-Fast）
影响因子：
2.1
作者：
Holly A. Miller
通讯作者：
Holly A. Miller
创伤后应激障碍和急性应激障碍
DOI：
10.1093/med:psych/9780195174113.003.0027
发表时间：
2012
影响因子：
3.6
作者：
C. Lareau
通讯作者：
C. Lareau