Treatment of comorbid sleep disorders and posttraumatic stress disorder in U.S. active duty military personnel: A pilot randomized clinical trial.
Treatment of comorbid sleep disorders and posttraumatic stress disorder in U.S. active duty military personnel: A pilot randomized clinical trial.
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美国现役军人共病睡眠障碍和创伤后应激障碍的治疗：一项试点随机临床试验。
DOI：
10.1002/jts.22939
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发表时间：
2023
影响因子：
3.3
通讯作者：
中科院分区：
文献类型：
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作者：
Taylor,DanielJ;Pruiksma,KristiE;Mintz,Jim;Slavish,DanicaC;Wardle-Pinkston,Sophie;Dietch,JessicaR;Dondanville,KatherineA;Young-McCaughan,Stacey;Nicholson,KarinL;Litz,BrettT;Keane,TerenceM;Peterson,AlanL;Resick,PatriciaA;
创伤后应激障碍（PTSD）患者常出现失眠和噩梦。它们与更差的心理和身体健康以及更差的PTSD治疗结果有关。此外，他们对PTSD治疗有抵抗力，而PTSD治疗通常不能解决睡眠障碍。失眠和噩梦的认知行为疗法（CBT‐I&N）和PTSD的认知加工疗法（CPT）是一线治疗方法，但指导所有三种疾病患者治疗的证据有限。目前的研究将美国军事人员（N= 93）随机分配到三种条件之一：CPT之前交付的CBT-I&N，CPT之后交付的CBT-I & N，或单独使用CPT;所有组都接受了18次会议。在各组中，参与者表现出显著改善的PTSD症状。由于招募和保留方面的挑战，研究提前终止，因此回答最初预期的研究问题的效力不足。尽管如此，仍观察到了统计学结果和相关的有临床意义的变化。与单独接受CPT的参与者相比，接受CBT-I &N和CPT的参与者，无论顺序如何，在PTSD症状方面表现出更大的改善，d=-0.36;失眠，d=-0.77;睡眠效率，d= 0.62;噩梦，d=-0.53。与在CPT之前接受CBT-I &N的参与者相比，在CPT之后接受CBT-I &N的参与者表现出PTSD症状的更大改善，d= 0.48，睡眠效率d=-0.44。这项初步研究表明，与单独治疗PTSD相比，治疗共病的失眠、噩梦和PTSD症状在改善所有三个问题方面具有临床意义的优势。
Insomnia and nightmares are common in patients with posttraumatic stress disorder (PTSD). They are associated with worse psychological and physical health and worse PTSD treatment outcomes. In addition, they are resistant to PTSD treatments, which do not typically address sleep disorders. Cognitive behavioral therapy for insomnia and nightmares (CBT‐I&N) and cognitive processing therapy (CPT) for PTSD are first‐line treatments, but limited evidence exists guiding the treatment of individuals with all three disorders. The current study randomized U.S. military personnel (N= 93) to one of three conditions: CBT‐I&N delivered before CPT, CBT‐I&N delivered after CPT, or CPT alone; all groups received 18 sessions. Across groups, participants demonstrated significantly improved PTSD symptoms. Because the study was terminated prematurely due to challenges with recruitment and retention, it was underpowered to answer the initially intended research questions. Nonetheless, statistical findings and relevant clinically meaningful changes were observed. Compared to participants who received CPT alone, those who received CBT‐I&N and CPT, regardless of sequencing, demonstrated larger improvements in PTSD symptoms,d= −0.36; insomnia,d= −0.77; sleep efficiency,d= 0.62; and nightmares,d= −.53. Compared to participants who received CBT‐I&N delivered before CPT, those who received CBT‐I&N delivered after CPT demonstrated larger improvements in PTSD symptoms,d= 0.48, and sleep efficiency,d= −0.44. This pilot study suggests that treating comorbid insomnia, nightmares, and PTSD symptoms results in clinically meaningful advantages in improvement for all three concerns compared to treating PTSD alone.