A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder
A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder
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DOI：
10.1001/archpsyc.60.10.1024
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发表时间：
2003-10-01
影响因子：
--
通讯作者：
Mayou, R
中科院分区：
文献类型：
--
作者：
Ehlers, A;Clark, DM;Mayou, R
背景：目前尚不清楚创伤事件发生后应提供哪些心理帮助。同样，对于识别哪些人在没有干预的情况下不太可能从早期创伤后症状中恢复的最佳方法也缺乏明确性。目的：确定在创伤事件发生后最初几个月内给予认知疗法或自助小册子是否比重复评估更有效地预防慢性创伤后应激障碍（PTSD）。设计：随机对照试验。患者：在事故发生后最初几个月内患有 PTSD 并符合症状标准的机动车事故幸存者 (n=97)。在一项针对可比人群的大型自然主义前瞻性研究中预测了持续性 PTSD。背景：从当地事故和急诊科的参与者中招募患者。干预措施：患者完成了为期 3 周的自我监测阶段。自我监测未康复的患者 (n=85) 被随机分配接受认知治疗 (n=28)、基于认知行为治疗原则的自助小册子 (n=8) 或重复评估 (n=29)。 主要结果指标：由自我报告和不知道患者分配情况的独立评估者评估 PTSD 症状。主要评估在 3 个月（治疗后，n=80）和 9 个月（随访，n=79）时进行。结果：12%（n=12）的患者通过自我监测康复。认知疗法比自助手册或重复评估更能有效减少创伤后应激障碍、抑郁、焦虑和残疾症状。随访时，与接受自助手册的患者（17 [61%]；比值比，12.9；95% 置信区间，3.1-53.1）或重复评估患者（16 [55%]；比值比，10.3；95% 置信区间，2.5-41.7）相比，认知治疗患者较少（3 [11%]）患有 PTSD。没有迹象表明自助手册优于重复评估。在随访时的高终态功能和治疗请求这两项指标上，自助组的结果比重复评估组更差。 结论：认知治疗是治疗新发 PTSD 的有效干预措施。自助手册没有效果。初始症状评分升高和自我监测未能改善相结合，可以有效地识别出一组患有早期 PTSD 症状的患者，这些患者如果不进行干预就不太可能康复。
Background: It is unclear what psychological help should be offered in the aftermath of traumatic events. Similarly, there is a lack of clarity about the best way of identifying people who are unlikely to, recover from early posttraumatic symptoms without intervention.Objective: To determine whether cognitive therapy or a self-help booklet given in the initial months after a traumatic event is more effective in preventing chronic posttraumatic stress disorder (PTSD) than repeated assessments.Design: Randomized controlled trial.Patients: Motor vehicle accident survivors (n=97) who had PTSD in the initial months after the accident and met symptom criteria that had predicted persistent PTSD in a large naturalistic prospective study of a comparable population.Setting: Patients were recruited from attendees at local accident and emergency departments.Interventions: Patients completed a 3-week self-monitoring phase. Those who did not recover with self-monitoring (n=85) were randomly assigned to receive cognitive therapy (n=28), a self-help booklet based on principles of cognitive behavioral therapy (n=8), or repeated assessments (n=29).Main Outcome Measures: Symptoms of PTSD as assessed by self-report and independent assessors unaware of the patient's allocation. Main assessments were at 3 months (posttreatment, n=80) and 9 months (follow-up, n=79).Results: Twelve percent (n=12) of patients recovered with self-monitoring. Cognitive therapy was more effective in reducing symptoms of PTSD, depression, anxiety, and disability than the self-help booklet or repeated assessments. At follow-up, fewer cognitive therapy patients (3 [11%]) had PTSD compared with those receiving the self-help booklet (17 [61%]; odds ratio, 12.9; 95% confidence interval, 3.1-53.1) or repeated assessments (16 [55%]; odds ratio, 10.3; 95% confidence interval, 2.5-41.7). There was no indication that the self-help booklet was superior to repeated assessments. On 2 measures, high end-state functioning at follow-up and request for treatment, the outcome for the self-help group was worse than for the repeated assessments group.Conclusions: Cognitive therapy is an effective intervention for recent-onset PTSD. A self-help booklet was not effective. The combination of an elevated initial symptom score and failure to improve with self-monitoring was effective in identifying a group of patients with early PTSD symptoms who were unlikely to recover without intervention.