Veterans' perspectives on initiating evidence-based psychotherapy for posttraumatic stress disorder.
Veterans' perspectives on initiating evidence-based psychotherapy for posttraumatic stress disorder.
复制标题
DOI：
10.1037/tra0000035
复制
发表时间：
2015-11-01
期刊：
影响因子：
--
通讯作者：
Stanley, Melinda A
中科院分区：
文献类型：
--
作者：
Hundt, Natalie E;Mott, Juliette M;Stanley, Melinda A
针对创伤后应激障碍 (PTSD) 的循证心理治疗 (EBP) 可有效减轻症状并提高生活质量。尽管 EBP 很有效，但很少有退伍军人接受 EBP。为了调查退伍军人针对 PTSD 开始 EBP 的经历，我们对那些完成了至少 8 次长期暴露 (PE) 或认知加工治疗 (CPT) 疗程的退伍军人进行了定性访谈。退伍军人报告从治疗师、精神科医生和其他退伍军人那里了解了 EBP。矛盾心理和延迟 EBP 启动很常见。障碍包括担心 EBP 会加重症状、相信避免治疗是有帮助的、不相信治疗原理（尤其是对于 PE），以及不太常见的缺乏对 EBP 的了解。促进因素包括感觉“需要谈论它”、之前的治疗增加了对处理 EBP 能力的信心、对 EBP 治疗师的事先了解、促进接受的提供者行为、其他退伍军人的鼓励以及对症状缓解的渴望。尽管PE退伍军人更有可能对治疗原理表示怀疑，但PE和CPT之间的障碍和促进因素几乎没有差异。这些结果强调了退伍军人社区中关于 EBP 的“口碑”以及识别可能促进 EBP 启动的提供者行为的重要性。
Evidence-based psychotherapies (EBP) for posttraumatic stress disorder (PTSD) are effective at reducing symptoms and improving quality of life. Despite their effectiveness, few veterans receive EBP. To examine veterans' experiences initiating EBP for PTSD, we conducted qualitative interviews with those who completed at least 8 sessions of prolonged exposure (PE) or cognitive processing therapy (CPT). Veterans reported learning about EBP from therapists, psychiatrists, and other veterans. Ambivalence and delaying EBP initiation were common. Barriers included fears that EBP would increase symptoms, beliefs that avoidance was helpful, disbelief of the therapy rationale, particularly for PE, and less commonly, lack of knowledge about EBP. Facilitators included feeling a "need to talk about it," prior treatment that increased confidence in the ability to handle EBP, prior knowledge of the EBP therapist, provider behaviors that facilitated buy-in, encouragement from other veterans, and desperation for symptom relief. There were few differences in barriers and facilitators between PE and CPT, although veterans in PE were more likely to express skepticism of the therapy rationale. These results highlight the importance of "word of mouth" about EBP among the veteran community and identifying provider behaviors that may promote EBP initiation.