A randomized controlled trial of 7-day intensive and standard weekly cognitive therapy for PTSD and emotion-focused supportive therapy.
A randomized controlled trial of 7-day intensive and standard weekly cognitive therapy for PTSD and emotion-focused supportive therapy.
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DOI：
10.1176/appi.ajp.2013.13040552
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发表时间：
2014-03
期刊：
影响因子：
--
通讯作者：
Clark DM
中科院分区：
文献类型：
--
作者：
Ehlers A;Hackmann A;Grey N;Wild J;Liness S;Albert I;Deale A;Stott R;Clark DM
创伤后应激障碍（PTSD）的心理治疗通常在几个月内每周进行一次或两次。目前还不清楚它们是否能在较短的时间内成功交付。这项临床试验有两个目标，一个是研究为期7天的强化认知疗法对PTSD的可接受性和有效性，另一个是通过比较强化和标准的每周认知疗法与同样可信的替代疗法来研究认知疗法是否具有特定的治疗效果。慢性PTSD患者（N=121）被随机分配到为期7天的强化或标准3个月的每周PTSD认知治疗，3个月的每周情绪集中的支持治疗，或14周的等待名单条件。主要结果是PTSD症状和诊断由独立评估者和自我报告评估。次要结局为残疾、焦虑、抑郁和生活质量。在初始评估、6周和14周（治疗后/等待）时进行测量。对于接受治疗的组，还在3周时进行测量，并在随机化后27周和40周进行随访。所有分析均为意向治疗。在治疗后/等待评估时，强化认知治疗组、标准认知治疗组、支持治疗组和等待治疗组分别有73%、77%、43%和7%的患者从PTSD中恢复。所有治疗均耐受良好，在所有结局指标上均上级等待名单，但支持性治疗和等待名单在生活质量上无差异。对于主要结局，残疾和广泛焦虑，强化和标准认知治疗优于支持治疗上级。强化认知治疗可以更快地减轻症状，并且与标准认知治疗的总体结局相当。在一周多一点的时间内密集提供的PTSD认知疗法与在3个月内提供的认知疗法一样有效。两者均具有特异性疗效，且上级优于支持疗法。PTSD的强化认知治疗是一种可行的和有前途的替代传统的每周治疗。
Psychological treatments for posttraumatic stress disorder (PTSD) are usually delivered once or twice weekly over several months. It is unclear whether they can be successfully delivered over a shorter period of time. This clinical trial had two goals, to investigate the acceptability and efficacy of a 7-day intensive version of cognitive therapy for PTSD, and to investigate whether cognitive therapy has specific treatment effects by comparing intensive and standard weekly cognitive therapy with an equally credible alternative treatment. Patients with chronic PTSD (N=121) were randomly allocated to 7-day intensive or standard 3-month weekly cognitive therapy for PTSD, 3-month weekly emotion-focused supportive therapy, or a 14-week waitlist condition. Primary outcomes were PTSD symptoms and diagnosis as assessed by independent assessors and self-report. Secondary outcomes were disability, anxiety, depression, and quality of life. Measures were taken at initial assessment, 6 weeks and 14 weeks (post-treatment/wait). For groups receiving treatment, measures were also taken at 3 weeks, and follow-ups at 27 and 40 weeks after randomization. All analyses were intent-to-treat. At post-treatment/wait assessment, 73%, 77%, 43%, 7% of the intensive cognitive therapy, standard cognitive therapy, supportive therapy, and waitlist groups, respectively, had recovered from PTSD. All treatments were well tolerated and were superior to waitlist on all outcome measures, with the exception of no difference between supportive therapy and waitlist on quality of life. For primary outcomes, disability and general anxiety, intensive and standard cognitive therapy were superior to supportive therapy. Intensive cognitive therapy achieved faster symptom reduction and comparable overall outcomes to standard cognitive therapy. Cognitive therapy for PTSD delivered intensively over little more than a week is as effective as cognitive therapy delivered over 3 months. Both had specific effects and were superior to supportive therapy. Intensive cognitive therapy for PTSD is a feasible and promising alternative to traditional weekly treatment.
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影响因子：
12.8
作者：
Ehlers, Anke;Bisson, Jonathan;Clark, David M.;Creamer, Mark;Pilling, Steven;Richards, David;Schnurr, Paula P.;Turner, Stuart;Yule, William
通讯作者：
Yule, William
影响因子：
4.1
作者：
Ehlers, A;Clark, DM;Fennell, M
通讯作者：
Fennell, M
影响因子：
--
作者：
Duffy, Michael;Gillespie, Kate;Clark, David M.
通讯作者：
Clark, David M.
影响因子：
1.8
作者：
Blackburn, Ivy-Marie;James, Ian A.;Reichelt, F. Katharina
通讯作者：
Reichelt, F. Katharina
影响因子：
5
作者：
Hendriks L;de Kleine R;van Rees M;Bult C;van Minnen A
通讯作者：
van Minnen A