The Comparative Effectiveness of Cognitive Processing Therapy for Male Veterans Treated in a VHA Posttraumatic Stress Disorder Residential Rehabilitation Program
The Comparative Effectiveness of Cognitive Processing Therapy for Male Veterans Treated in a VHA Posttraumatic Stress Disorder Residential Rehabilitation Program
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DOI：
10.1037/a0024466
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发表时间：
2011-10-01
影响因子：
5.9
通讯作者：
Kimerling, Rachel
中科院分区：
文献类型：
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作者：
Alvarez, Jennifer;McLean, Caitlin;Kimerling, Rachel
目的：在退伍军人健康管理局 (VHA) 创伤后应激障碍 (PTSD) 住院康复计划中，探讨团体认知处理疗法 (CPT) 相对于以创伤为中心的照常团体治疗 (TAU) 的有效性。方法：参与者是同一项目中接受 CPT（n = 104）或 TAU（n = 93；在实施 CPT 之前）治疗的 2 组男性患者。使用 PTSD 检查表（PCL；Weathers、Litz、Herman、Huska 和 Keane，1993）和其他症状和功能测量方法对队列进行比较治疗前和治疗后的变化。少数族裔占样本的 41%，平均年龄为 52 岁 (SD = 9.22)。 CPT 组明显更年轻，并且不太可能获得 PTSD 的残疾福利；然而，这些变量与结果无关。结果：控制摄入症状水平和队列差异的协方差分析显示，在 PCL 上，CPT 参与者在出院时的症状改善程度高于 TAU 参与者，F(3, 193) = 15.32，p < .001，b = 6.25，95% CI [3.06, 9.44] 和其他指标。此外，接受 CPT 治疗的患者在出院时被分类为“康复”或“改善”的人数显着增加，chi(2)(1, N = 197) = 4.93，p = .032。结论：仍有改进的空间，因为即使在住院计划中接受 CPT 治疗后，仍有大量退伍军人继续出现明显的症状。然而，与实施 CPT 之前进行的治疗相比，CPT 似乎能显着改善症状。在 VHA 环境中实施这种经验支持的治疗既可行又可持续，并且可能改善对患有军事相关 PTSD 的男性退伍军人的护理。
Objective: To examine the effectiveness of group cognitive processing therapy (CPT) relative to trauma-focused group treatment as usual (TAU) in the context of a Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) residential rehabilitation program. Method: Participants were 2 cohorts of male patients in the same program treated with either CPT (n = 104) or TAU (n = 93; prior to the implementation of CPT). Cohorts were compared on changes from pre- to posttreatment using the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and other measures of symptoms and functioning. Minorities represented 41% of the sample, and the mean age was 52 years (SD = 9.22). The CPT group was significantly younger and less likely to receive disability benefits for PTSD; however, these variables were not related to outcome. Results: Analyses of covariance controlling for intake symptom levels and cohort differences revealed that CPT participants evidenced more symptom improvement at discharge than TAU participants on the PCL, F(3, 193) = 15.32, p < .001, b = 6.25, 95% CI [3.06, 9.44], and other measures. In addition, significantly more patients treated with CPT were classified as "recovered" or "improved" at discharge, chi(2)(1, N = 197) = 4.93, p = .032. Conclusions: There is still room for improvement, as substantial numbers of veterans continue to experience significant symptoms even after treatment with CPT in a residential program. However, CPT appears to produce significantly more symptom improvement than treatment conducted before the implementation of CPT. The implementation of this empirically supported treatment in VHA settings is both feasible and sustainable and is likely to improve care for male veterans with military-related PTSD.