A Multisite Randomized Controlled Trial of Mindfulness-Based Stress Reduction in the Treatment of Posttraumatic Stress Disorder.
A Multisite Randomized Controlled Trial of Mindfulness-Based Stress Reduction in the Treatment of Posttraumatic Stress Disorder.
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DOI：
10.1176/appi.prcp.20180002
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发表时间：
2019-10-01
影响因子：
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通讯作者：
Bremner JD
中科院分区：
文献类型：
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作者：
Davis LL;Whetsell C;Hamner MB;Carmody J;Rothbaum BO;Allen RS;Al Bartolucci ABPP;Southwick SM;Bremner JD
创伤后应激障碍（PTSD）通常难以治疗，许多患者无法完全缓解。补充和综合健康方法，如正念冥想，旨在与循证治疗相结合。本研究考察了正念减压（MBSR）在治疗美国退伍军人创伤后应激障碍中的效果。诊断为PTSD的退伍军人（N=214）被随机分配到90分钟MBSR组或以当前为中心的小组治疗（PCGT），为期8周。在基线和第3,6,9周（主要终点）和第16周进行随访评估。根据临床医师管理的PTSD量表DSM - IV (CAPS - IV)， MBSR组和PCGT组在PTSD方面均有显著改善，两组间无统计学差异。然而，与PCGT相比，在九周内，MBSR组在自我报告的DSM - IV PTSD检查表上显示出显著的改善。在治疗后第16周，这种差异没有保持。该研究的优势包括其大样本量、多站点设计、主动对照组、单盲结果评分、保真度监测、大量少数群体代表性和随机方法。这项研究受到高流失率和低女性代表性的限制。正念减压疗法和PCGT疗法在治疗退伍军人创伤后应激障碍方面似乎都有有益的效果，正念减压疗法组在自我报告的创伤后应激障碍症状方面有更大的改善。在CAPS - IV量表上，两组间没有观察到差异。
Posttraumatic stress disorder (PTSD) is often difficult to treat, and many patients do not achieve full remission. Complementary and integrative health approaches, such as mindfulness meditation, are intended to be integrated with evidence‐based treatment. This study examined the efficacy of mindfulness‐based stress reduction (MBSR) in the treatment of PTSD in U.S. military veterans. Veterans with a diagnosis of PTSD (N=214) were randomly assigned to either 90‐minute group MBSR or present‐centered group therapy (PCGT) for eight weeks. Follow‐up assessments were obtained at baseline and weeks 3, 6, 9 (primary endpoint), and 16. Both the MBSR and PCGT groups achieved significant improvement in PTSD as measured by the Clinician‐Administered PTSD Scale for DSM‐IV (CAPS‐IV), with no statistically significant differences between groups. However, compared with PCGT, the MBSR group showed a statistically significant improvement in PTSD on the self‐reported PTSD Checklist for DSM‐IV over the nine weeks. This difference was not maintained posttreatment, at week 16. Strengths of the study include its large sample size, multisite design, active control group, single‐blind outcome ratings, fidelity monitoring, large minority representation, and randomized approach. The study was limited by its high attrition rate and low representation of women. Both MBSR and PCGT appear to have beneficial effects in treating PTSD in veterans, with greater improvement observed in self‐reported PTSD symptoms in the MBSR group. No differences between groups were observed on the CAPS‐IV scale.