Effectiveness of National Implementation of Prolonged Exposure Therapy in Veterans Affairs Care
Effectiveness of National Implementation of Prolonged Exposure Therapy in Veterans Affairs Care
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DOI：
10.1001/jamapsychiatry.2013.36
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发表时间：
2013-09-01
期刊：
影响因子：
25.8
通讯作者：
Karlin, Bradley E.
中科院分区：
文献类型：
--
作者：
Eftekhari, Afsoon;Ruzek, Josef I.;Karlin, Bradley E.
重要性创伤后应激障碍（PTSD）是一种普遍的，往往使人衰弱的条件，影响许多个人在一般人群和军事服务人员。从伊拉克和阿富汗返回的退伍军人以及其他时代的退伍军人都非常需要有效的创伤后应激障碍治疗。延长暴露（PE）治疗已被证明是非常有效的临床试验涉及妇女与非战斗创伤，但有有限的数据，其有效性在现实世界的临床实践设置和veterines.Objective评估的有效性，作为实施与创伤后应激障碍的退伍军人在一个大型的卫生保健系统。和参与者这项评估包括1931退伍军人治疗的804名临床医生参加退伍军人事务部（VA）体育培训计划。在完成了为期4天的体验式PE培训研讨会，临床医生实施PE（同时接受咨询）与至少2名退伍军人患者谁有PTSD.Main结局和措施的初步诊断PTSD和抑郁症状的变化进行了评估与PTSD检查表和贝克抑郁量表II，在基线和最后的治疗会话。使用多重和单次插补来估计在完成8个疗程前离开治疗的患者的后测评分。人口统计学预测的治疗dropouts.Results意向治疗分析表明，PE是有效的减少PTSD（前-后D=0.87）和抑郁症（前-后D=0.66）的症状，与以前的疗效试验中报道的效果大小。PTSD检查表阳性率从87.6%下降到46.2%。结论在所有战争时期的男性和女性退伍军人以及患有战斗相关和非战斗相关PTSD的退伍军人中，PTSD症状均获得了临床显著的减轻。结果还表明，体育是有效地减少抑郁症症状，即使抑郁症不是一个直接的目标的治疗。
IMPORTANCE Posttraumatic stress disorder (PTSD) is a pervasive and often debilitating condition that affects many individuals in the general population and military service members. Effective treatments for PTSD are greatly needed for both veterans returning from Iraq and Afghanistan and veterans of other eras. Prolonged exposure (PE) therapy has been shown to be highly efficacious in clinical trials involving women with noncombat trauma, but there are limited data on its effectiveness in real-world clinical practice settings and with veterans.OBJECTIVE To evaluate the effectiveness of PE as implemented with veterans with PTSD in a large health care system.DESIGN, SETTING, AND PARTICIPANTS This evaluation included 1931 veterans treated by 804 clinicians participating in the Department of Veterans Affairs (VA) PE Training Program. After completing a 4-day experiential PE training workshop, clinicians implemented PE (while receiving consultation) with a minimum of 2 veteran patients who had a primary diagnosis of PTSD.MAIN OUTCOMES AND MEASURES Changes in PTSD and depression symptoms were assessed with the PTSD Checklist and the Beck Depression Inventory II, measured at baseline and at the final treatment session. Multiple and single imputation were used to estimate the posttest scores of patients who left treatment before completing 8 sessions. Demographic predictors of treatment dropout were also examined.RESULTS Intent-to-treat analyses indicate that PE is effective in reducing symptoms of both PTSD (pre-post d=0.87) and depression (pre-post d=0.66), with effect sizes comparable to those reported in previous efficacy trials. The proportion of patients screening positive for PTSD on the PTSD Checklist decreased from 87.6% to 46.2%.CONCLUSIONS Clinically significant reductions in PTSD symptoms were achieved among male and female veterans of all war eras and veterans with combat-related and non-combat-related PTSD. Results also indicate that PE is effective in reducing depression symptoms, even though depression is not a direct target of the treatment.