A treatment development study of a cognitive and mindfulness-based therapy for adolescents with co-occurring post-traumatic stress and substance use disorder
A treatment development study of a cognitive and mindfulness-based therapy for adolescents with co-occurring post-traumatic stress and substance use disorder
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DOI：
10.1111/papt.12143
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发表时间：
2018-03-01
影响因子：
3.4
通讯作者：
Padilla，Auralyd
中科院分区：
文献类型：
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作者：
Fortuna，Lisa R.;Porche，Michelle V.;Padilla，Auralyd
目的在创伤后应激障碍(PTSD)青少年中使用物质是很常见的。我们的目标是开发和研究一种综合治疗青少年共生障碍的方法。设计这是一项针对患有创伤后应激、抑郁和药物使用的青少年的治疗开发和开放先导性试验研究，使用认知治疗(CT)和意识治疗相结合的方法。方法通过描述性统计和配对样本测试，使用标准化测量方法评估从基线到治疗结束的创伤后应激障碍症状、抑郁和药物使用频率的变化，并通过尿药筛查进行验证。我们还检查了安全性、临床结果的预测因素和治疗保留。结果37名青少年参与了这项研究；62%的青少年根据保留至少6周的治疗定义为研究完成者。从基线到治疗结束，创伤后应激障碍和抑郁症状有显著改善，反映出中等效果，这与创伤相关认知的变化有关。大麻的使用减少了，这是最常用的物质。结论初步结果表明，综合治疗青少年创伤后应激障碍、抑郁和药物使用的可行性、安全性和潜在的临床效果。尽管在患有创伤后应激障碍和共生疾病的青少年中，治疗保留不良和临床结果差的风险很高，但保留时间与其他青少年治疗临床试验研究的结果相当。我们讨论了继续研究这种基于正念的CT治疗患有共生精神障碍的青少年的理由。实践者指出，患有创伤后应激障碍和药物使用的青少年在接受CT和正念双重诊断方法后，在创伤后应激障碍和抑郁症状严重程度方面取得了显著的改善。用于双重诊断的综合手动治疗显示出在患有创伤后应激障碍的青少年中减少大麻使用的前景。创伤相关认知的变化有可能改善有药物使用问题的青少年的创伤后应激障碍和抑郁症状。
ObjectiveSubstance use is common among adolescents with post‐traumatic stress disorder (PTSD). We aimed to develop and study an integrated treatment for adolescents with co‐occurring disorders.DesignThis is a therapy development and open pilot trial study of a manualized therapy for adolescents with post‐traumatic stress, depression, and substance use that uses a combination of cognitive therapy (CT) and mindfulness.MethodsDescriptive statistics and paired samplet‐tests were calculated to assess for changes in PTSD symptoms, depression, and substance use frequency from baseline to end of treatment using standardized measures and validated by urine drug screens. We also examined for safety, predictors of clinical outcomes, and treatment retention.ResultsThirty‐seven adolescents participated in the study; 62% were study completers as defined by retention for at least 6 weeks of treatment. There were significant improvements in PTSD and depression symptoms from baseline to end of treatment, reflecting medium effect sizes, and which was associated with changes in trauma‐associated cognitions. There was a reduction in cannabis use, which was the most commonly used substance.ConclusionsPreliminary results suggest feasibility, safety, and potential clinical effectiveness of an integrated therapy for adolescents with PTSD, depression, and substance use. Retention was comparable to other therapy clinical trial studies of adolescents despite the high risk for poor treatment retention and poor clinical outcomes among adolescents with PTSD and co‐occurring disorders. We discuss the rationale for continued research of this mindfulness‐based CT for adolescents with co‐occurring disorders.Practitioner pointsAdolescents with co‐occurring PTSD and substance use achieved meaningful improvement in PTSD and depression symptom severity after receiving a CT and mindfulness dual diagnosis approach.An integrated manualized therapy for dual diagnosis shows promise for reducing cannabis use in adolescents with PTSD.Changes in trauma‐related cognitions have the potential to improve PTSD and depression symptoms in adolescents with substance use problems.