Trauma-Focused Exposure Therapy for Chronic Posttraumatic Stress Disorder in Alcohol and Drug Dependent Patients: A Randomized Controlled Trial
Trauma-Focused Exposure Therapy for Chronic Posttraumatic Stress Disorder in Alcohol and Drug Dependent Patients: A Randomized Controlled Trial
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DOI：
10.1037/adb0000201
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发表时间：
2016-11-01
影响因子：
3.4
通讯作者：
Stasiewicz, Paul R.
中科院分区：
文献类型：
--
作者：
Coffey, Scott F.;Schumacher, Julie A.;Stasiewicz, Paul R.
为了测试一种改良版的延长暴露疗法（mPE）是否能有效治疗同时患有创伤后应激障碍（PTSD）和物质依赖的个体的PTSD，进行了一项疗效试验。在该试验中，患有PTSD的物质依赖治疗寻求者（N = 126，男性 = 54.0%，白人 = 79.4%）被随机分配到mPE组、mPE + 以创伤为重点的动机强化疗程组（mPE + MET - PTSD）或基于健康信息的对照组（HLS）。所有参与者都遭受过多次创伤；符合《精神疾病诊断与统计手册》第四版（DSM - IV）PTSD标准A的报告创伤中位数为8次。治疗包括9 - 12次每次60分钟的个体治疗疗程以及常规的物质滥用治疗。参与者在基线、治疗结束时以及治疗后3个月和6个月接受评估。mPE组和mPE + MET - PTSD组在PTSD治疗结果上都显著优于对照组。mPE + MET - PTSD组和mPE组在治疗结束时、3个月或6个月随访时的PTSD症状方面没有差异。各小组之间的物质使用结果没有差异，所有小组在随访时的戒酒天数达到85.7% - 97.9%。就创伤症状的临床显著改善而言，75.8%的mPE参与者、60.0%的mPE + MET - PTSD参与者以及44.4%的HLS参与者在治疗结束时经历了临床显著改善。结果表明，无论是否有MET - PTSD疗程，mPE都能有效治疗同时患有PTSD和物质依赖的患者的PTSD。此外，mPE疗程时长可能更适合标准临床实践，并且具有中等效应量。
To test whether a modified version of prolonged exposure (mPE) can effectively treat posttraumatic stress disorder (PTSD) in individuals with co-occurring PTSD and substance dependence, an efficacy trial was conducted in which substance dependent treatment-seekers with PTSD (N = 126, male = 54.0%, White = 79.4%) were randomly assigned to mPE, mPE + trauma-focused motivational enhancement session (mPE + MET-PTSD), or a health information-based control condition (HLS). All participants were multiply traumatized; the median number of reported traumas that satisfied DSM-IV Criterion A for PTSD was 8. Treatment consisted of 9-12 60-min individual therapy sessions plus substance abuse treatment-as-usual. Participants were assessed at baseline, end-of-treatment, and at 3- and 6-months posttreatment. Both the mPE and mPE + MET-PTSD conditions achieved significantly better PTSD outcome than the control condition. The mPE + MET-PTSD and mPE conditions did not differ from one another on PTSD symptoms at end of treatment, 3-, or 6-month follow-up. Substance use outcomes did not differ between groups with all groups achieving 85.7%-97.9% days abstinent at follow-up. In regard to clinically significant improvement in trauma symptoms, 75.8% of the mPE participants, 60.0% of the mPE + MET-PTSD participants, and 44.4% of the HLS participants experienced clinically significant improvement at the end-of-treatment. Results indicate mPE, with or without an MET-PTSD session, can effectively treat PTSD in patients with co-occurring PTSD and substance dependence. In addition, mPE session lengths may better suit standard clinical practice and are associated with medium effect sizes.