A Randomized Controlled Trial of Cognitive-behavioral Therapy for the Treatment of PTSD in the Context of Chronic Whiplash
A Randomized Controlled Trial of Cognitive-behavioral Therapy for the Treatment of PTSD in the Context of Chronic Whiplash
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DOI：
10.1097/ajp.0b013e318243e16b
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发表时间：
2012-11-01
影响因子：
2.9
通讯作者：
Sterling, Michele
中科院分区：
文献类型：
--
作者：
Dunne, Rachael Louise;Kenardy, Justin;Sterling, Michele
目的：挥鞭样损伤相关性疾病（WAD）是常见的，涉及身体和心理损伤。研究表明，持续的创伤后应激症状与较差的功能恢复和物理治疗结果有关。以创伤为中心的认知行为疗法（TF-CBT）在慢性疼痛样本中显示出中等有效性。然而，迄今为止，在WAD中还没有临床试验。因此，本研究将报告TF-CBT在符合当前慢性WAD和创伤后应激障碍（PTSD）标准的个体中的有效性。方法：26名参与者被随机分配到TF-CBT或等待名单对照组，并在治疗后和6个月随访时使用结构化临床访谈，自我报告问卷，结果：TF-CBT组与评估后的等待名单相比，PTSD症状临床显著减少，随访时进一步增加。创伤后应激障碍的治疗也与临床显着改善颈部残疾，身体，情绪和社会功能和生理反应的创伤cues，而有限的变化被发现在感觉疼痛thresholds.Discussion：这项研究提供了支持TF-CBT的有效性，以针对创伤后应激障碍的症状在慢性WAD。PTSD的治疗导致颈部残疾和生活质量的改善以及冷痛阈值的变化，这一发现突出了WAD和PTSD背后复杂且相互关联的机制。临床意义的研究结果和未来的研究方向进行了讨论。
Objectives: Whiplash-associated disorders (WAD) are common and involve both physical and psychological impairments. Research has shown that persistent posttraumatic stress symptoms are associated with poorer functional recovery and physical therapy outcomes. Trauma-focused cognitive-behavioral therapy (TF-CBT) has shown moderate effectiveness in chronic pain samples. However, to date, there have been no clinical trials within WAD. Thus, this study will report on the effectiveness of TF-CBT in individuals meeting the criteria for current chronic WAD and posttraumatic stress disorder (PTSD).Method: Twenty-six participants were randomly assigned to either TF-CBT or a waitlist control, and treatment effects were evaluated at posttreatment and 6-month follow-up using a structured clinical interview, self-report questionnaires, and measures of physiological arousal and sensory pain thresholds.Results: Clinically significant reductions in PTSD symptoms were found in the TF-CBT group compared with the waitlist at post-assessment, with further gains noted at the follow-up. The treatment of PTSD was also associated with clinically significant improvements in neck disability, physical, emotional, and social functioning and physiological reactivity to trauma cues, whereas limited changes were found in sensory pain thresholds.Discussion: This study provides support for the effectiveness of TF-CBT to target PTSD symptoms within chronic WAD. The finding that treatment of PTSD resulted in improvements in neck disability and quality of life and changes in cold pain thresholds highlights the complex and interrelating mechanisms that underlie both WAD and PTSD. Clinical implications of the findings and future research directions are discussed.