Randomized trial of trauma-focused group therapy for posttraumatic stress disorder - Results from a Department of Veterans Affairs Cooperative Study
Randomized trial of trauma-focused group therapy for posttraumatic stress disorder - Results from a Department of Veterans Affairs Cooperative Study
复制标题
DOI：
10.1001/archpsyc.60.5.481
复制
发表时间：
2003-05-01
影响因子：
--
通讯作者：
Bernardy, NC
中科院分区：
文献类型：
--
作者：
Schnurr, PP;Friedman, MJ;Bernardy, NC
背景：退伍军人事务部合作研究420是一项随机临床试验，研究了两种团体心理治疗方法治疗男性越战退伍军人创伤后应激障碍（PTSD）。方法：将360名越战退伍军人随机分为以创伤为中心的集体心理治疗组和以现在为中心的避免创伤为中心的比较治疗组。每组6人，每周治疗30周，随后每月进行5次强化治疗。创伤后应激障碍的严重程度是主要结果。其他指标包括其他精神症状、功能状态、生活质量、身体健康和服务利用情况。在治疗结束时（7个月）和加强期结束时（12个月）进行随访评估；325人参加了一项或两项评估。在18个月和24个月时对一部分参与者进行PTSD严重程度的额外随访。结果：虽然治疗后PTSD严重程度的评估和其他措施较基线有显著改善，但意向治疗分析发现治疗组之间在任何结果上没有总体差异。对接受适当剂量治疗的参与者的数据分析表明，以创伤为重点的群体治疗减少了逃避和麻木，并可能减少了创伤后应激障碍症状。以创伤为重点的治疗组的辍学率更高。两种治疗的平均改善程度都不大，尽管大约40%的参与者表现出显著的临床变化。结论：本研究未发现以创伤为中心的群体治疗的治疗效果。有效性和适当剂量之间的差异表明，在临床实践中，加强认知行为治疗的方法可能具有价值。
Background: Department of Veterans Affairs Cooperative Study 420 is a randomized clinical trial of 2 methods of group psychotherapy for treating post-traumatic stress disorder (PTSD) in male Vietnam veterans.Methods: Vietnam veterans (360 men) were randomly assigned to receive trauma-focused group psychotherapy or a present-centered comparison treatment that avoided trauma focus. Treatment was provided weekly to groups of 6 members for 30 weeks, followed by 5 monthly booster sessions. Severity of PTSD was, the primary outcome. Additional measures were other psychiatric symptoms, functional status, quality of life, physical health, and service utilization. Follow-up assessments were conducted at the end of treatment (7 months) and at the end of the booster sessions (12 months); 325 individuals participated in 1 or both assessments. Additional follow-up for PTSD severity was performed in a subset of participants at 18 and 24 months.Results: Although posttreatment assessments of PTSD severity and other measures were significantly improved from baseline, intention-to-treat analyses found no overall differences between therapy groups on Any outcome. Analyses of data from participants who received an adequate dose of treatment suggested that trauma-focused group therapy reduced avoidance and numbing and, possibly, PTSD symptoms. Dropout from treatment was higher in trauma-focused group treatment. Average improvement was modest in both treatments, although approximately 40% of participants showed clinically significant change.Conclusions: This study did not find a treatment effect for trauma-focused group therapy. The difference between the effectiveness and adequate dose findings suggests the possible value of methods to enhance the delivery of cognitive-behavioral treatments in clinical practice settings.