Are 60-Minute Prolonged Exposure Sessions With 20-Minute Imaginal Exposure to Traumatic Memories Sufficient to Successfully Treat PTSD? A Randomized Noninferiority Clinical Trial
Are 60-Minute Prolonged Exposure Sessions With 20-Minute Imaginal Exposure to Traumatic Memories Sufficient to Successfully Treat PTSD? A Randomized Noninferiority Clinical Trial
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DOI：
10.1016/j.beth.2014.12.002
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发表时间：
2015-05-01
期刊：
影响因子：
3.7
通讯作者：
Foa, Edna B.
中科院分区：
文献类型：
--
作者：
Nacasch, Nitsa;Huppert, Jonathan D.;Foa, Edna B.
该研究旨在确定包含 20 分钟想象暴露 (IE) 的 60 分钟长时间暴露 (PE) 疗程在治疗创伤后应激障碍 (PTSD) 方面是否不劣于包含 40 分钟 IE 的标准 90 分钟疗程，并探讨治疗结果与疗程内和疗程间习惯化以及消极认知变化的关系。 39 名患有慢性 PTSD 的成年退伍军人被随机分配接受 90 分钟 (n = 19) 或 60 分钟 (n = 20) 的体育训练。 PTSD 症状由一位不知情的独立评估员在治疗前后以及 6 个月的随访时进行评估。在治疗前后评估抑郁和消极认知的自我报告。两种情况下的参与者的 PTSD 症状均显着减轻。研究发现，60 分钟疗程在减少 PTSD 症状方面并不劣于 90 分钟疗程，因为 PTSD 症状量表访谈中条件差异的 95% 置信区间上限（治疗后：6.00；随访：6.77）低于预定义的非劣效界值 (7.00)。接受较短疗程的参与者在疗程内和疗程间的习惯性比接受较长疗程的参与者要少，但在消极认知的减少方面没有发现组间差异。目前的研究结果表明，60 分钟体育课程的结果与 90 分钟体育课程的结果没有差异。此外，创伤相关认知的改变和治疗期间的习惯化都是PE的潜在机制。
The study aims to determine whether 60-minute sessions of prolonged exposure (PE) that include 20 minutes of imaginal exposure (IE) are noninferior to the standard 90-minute sessions that include 40 minutes of IE in treating posttraumatic stress disorder (PTSD) and to explore the relationship of treatment outcome to within- and between-session habituation and change in negative cognitions. Thirty-nine adult veterans with chronic PTSD were randomly assigned to 90-minute (n = 19) or 60-minute (n = 20) sessions of PE. PTSD symptoms were assessed by an unaware independent evaluator before and after treatment and at 6-month follow-up. Self-reports of depression and negative cognitions were assessed before and after treatment. Participants in both conditions showed significant reductions in PTSD symptoms. Sixty-minute sessions were found to be noninferior to 90-minute sessions in reducing PTSD symptoms, as the upper bound of the 95% confidence interval for the difference between conditions in the PTSD Symptom Scale Interview (posttreatment: 6.00; follow-up: 6.77) was below the predefined noninferiority margin (7.00). Participants receiving shorter sessions showed less within- and between-session habituation than those receiving longer sessions, but no group differences in reductions in negative cognitions were found. The current findings indicate that the outcomes of 60-minute sessions of PE do not differ from those of 90-minute sessions. In addition, change in trauma-related cognitions and between-session habituation are both potential mechanisms of PE.