Mindfulness-Based Stress Reduction for Posttraumatic Stress Disorder Among Veterans A Randomized Clinical Trial
Mindfulness-Based Stress Reduction for Posttraumatic Stress Disorder Among Veterans A Randomized Clinical Trial
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DOI：
10.1001/jama.2015.8361
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发表时间：
2015-08-04
影响因子：
120.7
通讯作者：
Lim, Kelvin O.
中科院分区：
文献类型：
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作者：
Polusny, Melissa A.;Erbes, Christopher R.;Lim, Kelvin O.
重要性正念为基础的干预措施可能是可以接受的退伍军人谁有穷人坚持现有的证据为基础的治疗创伤后应激障碍（PTSD）目的比较正念为基础的压力减少与目前为中心的团体治疗创伤后应激障碍。设计，设置，和参与者随机临床试验的116名退伍军人与创伤后应激障碍招募在明尼阿波利斯退伍军人事务医疗中心从2012年3月，2013年12月在治疗前、治疗中、治疗后和2个月随访时评估结果。干预研究对象被随机分配接受正念减压治疗（n = 58），共9次（8周2.5小时的小组会议和一天的静修）专注于教导患者以不评判的，接受的方式关注当下;或以现在为中心的团体治疗（n = 58），一种积极控制的条件，包括9个每周1.5小时的小组会议，集中在当前的生活问题。主要结果和措施的主要结果，随着时间的推移，PTSD症状严重程度的变化，进行了评估，使用PTSD检查表在基线和第3、6、9和17周时（范围：17-85;评分越高表明严重程度越大;降低10分或更多被认为是最小的临床重要差异）。次要结果包括PTSD诊断和症状严重程度，由独立评估者使用临床医生管理的PTSD量表沿着评估，以及抑郁症状、生活质量、结果：在治疗过程中，正念减压组的参与者在自我报告的PTSD症状严重程度方面表现出更大的改善（以现在为中心的小组治疗组的平均PTSD量表评分从63.6分变化到55.7分，而以现在为中心的小组治疗组的平均PTSD量表评分从58.8分变化到55.8分;组间差异为4.95; 95% CI为1.92-7.99; P = 0.002）和2个月随访时（平均评分分别从63.6变为54.4 vs 58.8变为56.0;差异为6.44; 95%CI，3.34-9.53，P <0.001）。尽管正念减压组的参与者在自我报告的PTSD症状严重程度方面更有可能表现出临床显著的改善，（48.9% vs 28.1%，以现在为中心的团体治疗;差异为20.9%; 95% CI，2.2%-39.5%; P = .03）2个月随访时，他们不再有可能失去创伤后应激障碍诊断（分别为53.3%和47.3%;差异为6.0%; 95% CI为-14.1%至26.2%; P = .55）。结论和相关性在患有创伤后应激障碍的退伍军人中，与以现在为中心的团体治疗相比，导致创伤后应激障碍症状严重程度的大幅下降。然而，平均改善的幅度表明效果不大。
IMPORTANCE Mindfulness-based interventions may be acceptable to veterans who have poor adherence to existing evidence-based treatments for posttraumatic stress disorder (PTSD).OBJECTIVE To compare mindfulness-based stress reduction with present-centered group therapy for treatment of PTSD.DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 116 veterans with PTSD recruited at the Minneapolis Veterans Affairs Medical Center from March 2012 to December 2013. Outcomes were assessed before, during, and after treatment and at 2-month follow-up. Data collection was completed on April 22, 2014.INTERVENTIONS Participants were randomly assigned to receive mindfulness-based stress reduction therapy (n = 58), consisting of 9 sessions (8 weekly 2.5-hour group sessions and a daylong retreat) focused on teaching patients to attend to the present moment in a nonjudgmental, accepting manner; or present-centered group therapy (n = 58), an active-control condition consisting of 9 weekly 1.5-hour group sessions focused on current life problems.MAIN OUTCOMES AND MEASURES The primary outcome, change in PTSD symptom severity over time, was assessed using the PTSD Checklist (range, 17-85; higher scores indicate greater severity; reduction of 10 or more considered a minimal clinically important difference) at baseline and weeks 3, 6, 9, and 17. Secondary outcomes included PTSD diagnosis and symptom severity assessed by independent evaluators using the Clinician-Administered PTSD Scale along with improvements in depressive symptoms, quality of life, and mindfulness.RESULTS Participants in the mindfulness-based stress reduction group demonstrated greater improvement in self-reported PTSD symptom severity during treatment (change in mean PTSD Checklist scores from 63.6 to 55.7 vs 58.8 to 55.8 with present-centered group therapy; between-group difference, 4.95; 95% CI, 1.92-7.99; P = .002) and at 2-month follow-up (change in mean scores from 63.6 to 54.4 vs 58.8 to 56.0, respectively; difference, 6.44; 95% CI, 3.34-9.53, P < .001). Although participants in the mindfulness-based stress reduction group were more likely to showclinically significant improvement in self-reported PTSD symptom severity (48.9% vs 28.1% with present-centered group therapy; difference, 20.9%; 95% CI, 2.2%-39.5%; P = .03) at 2-month follow-up, theywere no more likely to have loss of PTSD diagnosis (53.3% vs 47.3%, respectively; difference, 6.0%; 95% CI, -14.1% to 26.2%; P = .55).CONCLUSIONS AND RELEVANCE Among veterans with PTSD, mindfulness-based stress reduction therapy, compared with present-centered group therapy, resulted in a greater decrease in PTSD symptom severity. However, the magnitude of the average improvement suggests a modest effect.