The pattern of symptom change during prolonged exposure therapy and present-centered therapy for PTSD in active duty military personnel
The pattern of symptom change during prolonged exposure therapy and present-centered therapy for PTSD in active duty military personnel
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DOI：
10.1017/s0033291718002714
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发表时间：
2019-09-01
影响因子：
6.9
通讯作者：
Foa, Edna B.
中科院分区：
文献类型：
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作者：
Brown, Lily A.;Clapp, Joshua D.;Foa, Edna B.
背景很少有研究探讨创伤后应激障碍（PTSD）症状在长期暴露（PE）治疗中的变化模式。在这项研究中，我们的目的是了解模式的创伤后应激障碍症状的变化，在PE和目前为中心的治疗（PCT）。方法参与者是现役军人（N = 326，89.3%男性，61.2%白色，32.5岁），随机分配到间隔PE（S-PE; 10个疗程，8周），PCT（10个疗程，8周），或群众PE（M-PE; 10个疗程，2周）。使用潜在特征分析，我们确定了PTSD症状随时间变化的最佳类别数，并分析了基线和随访变量是否与类别成员关系相关。结果每种治疗分为五个类别，即快速反应者（7-17%）、急剧线性反应者（14-22%）、逐渐反应者（30-34%）、无反应者（27-33%）和症状加重（7-13%）类别。没有基线临床特征预测S-PE和M-PE的类别成员资格;在PCT中，更多的负面基线创伤认知预测了无应答者与逐渐应答者类别的成员资格。在S-PE和M-PE治疗后6个月内，类成员资格与PTSD、创伤认知和抑郁密切相关，但与PCT无关。结论：不同干预措施的治疗反应特征相似。总的来说，没有基线变量预测应答者类别。应答者状态是PE未来症状严重程度的强预测因子，而PCT应答与未来症状的相关性不强。
Background Few studies have investigated the patterns of posttraumatic stress disorder (PTSD) symptom change in prolonged exposure (PE) therapy. In this study, we aimed to understand the patterns of PTSD symptom change in both PE and present-centered therapy (PCT). Methods Participants were active duty military personnel (N = 326, 89.3% male, 61.2% white, 32.5 years old) randomized to spaced-PE (S-PE; 10 sessions over 8 weeks), PCT (10 sessions over 8 weeks), or massed-PE (M-PE; 10 sessions over 2 weeks). Using latent profile analysis, we determined the optimal number of PTSD symptom change classes over time and analyzed whether baseline and follow-up variables were associated with class membership. Results Five classes, namely rapid responder (7-17%), steep linear responder (14-22%), gradual responder (30-34%), non-responder (27-33%), and symptom exacerbation (7-13%) classes, characterized each treatment. No baseline clinical characteristics predicted class membership for S-PE and M-PE; in PCT, more negative baseline trauma cognitions predicted membership in the non-responder v. gradual responder class. Class membership was robustly associated with PTSD, trauma cognitions, and depression up to 6 months after treatment for both S-PE and M-PE but not for PCT. Conclusions Distinct profiles of treatment response emerged that were similar across interventions. By and large, no baseline variables predicted responder class. Responder status was a strong predictor of future symptom severity for PE, whereas response to PCT was not as strongly associated with future symptoms.