Divergent experiences of U.S. veterans who did and did not complete trauma-focused therapies for PTSD: A national qualitative study of treatment dropout.
Divergent experiences of U.S. veterans who did and did not complete trauma-focused therapies for PTSD: A national qualitative study of treatment dropout.
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DOI：
10.1016/j.brat.2022.104123
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发表时间：
2022-07
影响因子：
4.1
通讯作者：
Polusny, Melissa A.
中科院分区：
文献类型：
--
作者：
Kehle-Forbes, Shannon M.;Ackland, Princess E.;Spoont, Michele R.;Meis, Laura A.;Orazem, Robert J.;Lyon, Alexandra;Valenstein-Mah, Helen R.;Schnurr, Paula P.;Zickmund, Susan L.;Foa, Edna B.;Chard, Kathleen M.;Alpert, Elizabeth;Polusny, Melissa A.
长时间暴露(PE)和认知加工疗法(CPT)是治疗创伤后应激障碍(PTSD)的一线疗法，已在美国退伍军人健康管理局广泛传播。治疗未完成很常见，降低了临床疗效；然而，先前的工作未能确定与未完成相关的一致因素。半结构化访谈是对最近完成(n=60)或未完成(n=66)体育或CPT的退伍军人进行的全国样本。非完成者访谈集中于导致退伍军人决定退学的因素以及为完成PE/CPT所做的努力。完成者访谈的重点是完成治疗所面临的挑战和完成的促进者。使用混合演绎/归纳方法对成绩单进行编码；使用恒定比较来确定完成者和非完成者之间的差异。完成者和非完成者在接受特定治疗的治疗师支持的程度、治疗师在治疗提供方面的灵活性、护理团队提供的鼓励和社会支持的类型、他们对症状恶化的解释、对治疗对功能的感知影响以及应激源对他们治疗投入的影响等方面存在差异。针对特定治疗的治疗师支持、更以患者为中心和更灵活的治疗提供、充分利用全面护理团队以及解决功能问题是PE和CPT参与干预的潜在目标。
Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are first-line treatments for posttraumatic stress disorder (PTSD) and have been disseminated throughout the U.S. Veterans Health Administration. Treatment non-completion is common and lessens clinical effectiveness; however, prior work has failed to identify factors consistently associated with non-completion. Semi-structured interviews were conducted with a national sample of veterans who recently completed (n = 60) or did not complete (n = 66) PE or CPT. Non-completer interviews focused on factors that contributed to veterans’ decisions to drop out and efforts undertaken to complete PE/CPT. Completer interviews focused on challenges faced in completing treatment and facilitators of completion. Transcripts were coded using a mixed deductive/inductive approach; constant comparison was used to identify differences between completers and non-completers. Completers and non-completers differed in the extent of treatment-specific therapist support received, therapists’ flexibility in treatment delivery, the type of encouragement offered by the care team and social supports, their interpretation of symptom worsening, the perceived impact of treatment on functioning, and the impact of stressors on their treatment engagement. Treatment-specific therapist support, more patient-centered and flexible treatment delivery, leveraging the full care team, and addressing functional concerns are potential targets for PE and CPT engagement interventions.
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影响因子：
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