Augmenting Prolonged Exposure therapy for PTSD with intranasal oxytocin: A randomized, placebo-controlled pilot trial
Augmenting Prolonged Exposure therapy for PTSD with intranasal oxytocin: A randomized, placebo-controlled pilot trial
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DOI：
10.1016/j.jpsychires.2017.12.014
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发表时间：
2018-03-01
影响因子：
4.8
通讯作者：
Back, Sudie E.
中科院分区：
文献类型：
--
作者：
Flanagan, Julianne C.;Sippel, Lauren M.;Back, Sudie E.
创伤后应激障碍(PTSD)是一种慢性、衰弱的疾病，长期暴露(PE)治疗是非常有效的。然而，对于一些人来说，过早辍学和创伤后应激障碍症状仍然是障碍。神经肽催产素具有以下作用：1)亲社会的认知和行为，理论上可以促进积极的工作联盟；2)消亡学习，这是成功的体育治疗的核心作用机制。尽管有强有力的理论基础，但到目前为止，还没有研究将PTSD的循证心理治疗与催产素相结合。这项随机、安慰剂对照、双盲试验研究了使用催产素增强PE的可行性、安全性和初步疗效。参与者是17名患有不同指征创伤的人。参与者在每周一次的体育治疗前45分钟自行鼻腔注射催产素(40IU)或配套的安慰剂。安慰剂组发生1起不良事件，3名患者退出(17.6%；2名催产素组和1名安慰剂组)。催产素组术中创伤后应激障碍和抑郁症状较少，工作联盟评分较高，但差异无统计学意义。虽然是初步的，但研究结果支持催产素联合PE的可行性。要确定催产素是否能改善PE治疗结果，并检查可能的机制，如加速消退性学习、增强早期反应和防止过早辍学，有必要进行足够有力的研究。NCT03238924。
Posttraumatic stress disorder (PTSD) is a chronic, debilitating condition for which Prolonged Exposure (PE) therapy is highly efficacious. However, for some individuals, premature dropout and residual PTSD symptoms remain obstacles. The neuropeptide oxytocin is a promising candidate to enhance PE due to its ability to enhance 1) prosocial cognition and behavior, which are theorized to promote positive working alliance, and 2) extinction learning, which is the central mechanism of action underlying successful PE treatment. Despite a robust theoretical rationale, no studies to date have combined evidence-based psychotherapy for PTSD with oxytocin. This randomized, placebo-controlled, double-blind pilot trial examined the feasibility, safety, and preliminary efficacy of augmenting PE with' oxytocin. Participants were 17 individuals with diverse index traumas. Participants self-administered intranasal oxytocin (40 IU) or matching placebo 45 min prior to each weekly PE therapy session. One adverse event occurred in the placebo group and three individuals dropped out (17.6%; 2 oxytocin group and 1 placebo group). The oxytocin group demonstrated lower PTSD and depression symptoms during PE, and had higher working alliance scores, although these differences did not reach statistical significance. Although preliminary, the findings support the feasibility of oxytocin combined with PE. Adequately powered studies are necessary to determine whether oxytocin enhances PE treatment outcomes and to examine potential mechanisms, such as accelerating extinction learning, enhancing early response, and preventing premature dropout. NCT03238924.