Written Exposure Therapy (WET) as a brief trauma treatment for Veterans with Co-occurring Substance Use Disorders and PTSD

在治疗中，创伤暴露和创伤后应激障碍(PTSD)的发生率很高。 寻找患有物质使用障碍(SUD)的退伍军人。有SUD贡献的退伍军人并发创伤后应激障碍 导致治疗结果不佳，并与整体心理和身体健康更差有关。虽然上瘾了 传统上，计划并不针对创伤后应激障碍，越来越多的证据表明，创伤治疗不仅 治疗创伤后应激障碍，但甚至可能改善合并疾病者的SUD治疗保留率和结果。 患有SUD的退伍军人通常在SUD专科诊所接受治疗，那里的工作人员没有接受过创伤方面的培训，因此 不要提供创伤后应激障碍治疗。因此，尽管退伍军人事务部(VA)将 对创伤后应激障碍进行有效的循证心理治疗，只有一小部分退伍军人患有 苏德接受这种治疗。书面暴露疗法(WEW)是一种简短的以创伤为重点的干预措施，表明 有效治疗创伤后应激障碍。与传统疗法相比，湿润疗法有几个优点；它可以在5个疗程内提供， 与其他创伤后应激障碍治疗相比，脱落率更低，患者满意度更高，而且很容易 提供最低限度的治疗师培训要求，使其具有成本效益，因此是理想的 在繁忙的SUD门诊部进行给药干预。之前的一项研究表明，书面接触是 在住宅区SUD治疗中减轻女性创伤后应激障碍症状是可行和有效的。在最近一次 可接受性和可行性初步研究，SUD寻求治疗的退伍军人(N=12)共患创伤后应激障碍 随机分为湿润加照常治疗(TAU)或TAU加中性书写条件。结果 说明这种书面干预是可行的和可以接受的。湿的与更大的 基线后8周随访时创伤后应激障碍症状的减少和平均数量的更大减少 与对照组相比，在随访时饮酒和吸毒的天数。 这项拟议的研究是一项在SUD专科诊所内进行的随机临床试验，以评估TAU是否 在创伤后应激障碍和成瘾结果方面，加湿优于通过中性话题写作增强的TAU 接受苏德治疗的退伍军人。这项拟议的研究还将检查自主神经唤醒的生物标记物， 心率变异性(HRV)，以确定它是否可能是一种潜在的客观衡量 治疗效果。新的证据表明，高频心率变异性可能对SUD和PTSD敏感 症状改善和应激与物质联系的可能机制 使用。[这项研究将检验HRV和治疗结果之间的关系。我们还将检查 HRV评分随时间的变化是否与治疗结果相关(创伤后应激障碍症状和天数 物质使用)。] 该项目的具体目标是检查TAU的湿性增强：a)是否改善创伤 与TAU相比，接受门诊SUD治疗的患有SUD和PTSD的退伍军人的症状 使用中性书写控制；以及b)与合并创伤后应激障碍的退伍军人相比，改善了SUD结果 带有中性书写控制的Tau。同时患有创伤后应激障碍的退伍军人寻求SUD治疗将 随机分为湿式+TAU组或TAU+中性话题写作组。衡量标准 创伤症状、痛苦和情绪将在每一次写作中收集，休息的HRV和 在基线、治疗后(约6周)、8周和12周后进行额外评估- 基线评估。主要结果将是创伤症状、药物使用和心率变异性的变化。如果结果 事实证明，他们将支持WEW作为一种有效的简短、经济高效、易于传播、附属于 目前对患有创伤后应激障碍的退伍军人的SUD治疗。

There are high rates of trauma exposure and posttraumatic stress disorder (PTSD) among treatment- seeking veterans with substance use disorders (SUD). Comorbid PTSD among veterans with SUD contributes to poor treatment outcomes and is associated with worse overall mental and physical health. While addiction programs traditionally do not address PTSD, increasing evidence suggests that trauma treatments not only treat PTSD, but may even improve SUD treatment retention and outcomes among those with comorbidity. Veterans with SUD are usually treated in SUD specialty clinics, where staff are not trained in trauma, and thus do not offer PTSD treatment. So, although the Department of Veterans Affairs (VA) prioritizes the administration of effective evidence-based psychotherapies for PTSD, only a small percentage of veterans with SUD receive this treatment. Written exposure therapy (WET) is a brief trauma-focused intervention shown to effectively treat PTSD. WET has several advantages over traditional therapies; it can be delivered in 5 sessions, has lower dropout compared to other PTSD treatments, has high patient satisfaction, and can be easily delivered with minimal therapist training requirements making it cost efficient and therefore an ideal intervention for administration in a busy outpatient SUD clinic. A previous study suggested written exposure is feasible and effective in decreasing symptoms of PTSD among women in residential SUD treatment. In a recent acceptability and feasibility pilot study, SUD treatment-seeking veterans (N=12) with comorbid PTSD were randomized to WET plus treatment as usual (TAU) or TAU augmented by a neutral writing condition. Results showed this writing-based intervention was feasible and acceptable. WET was associated with a greater decrease in PTSD symptoms at 8-week post-baseline follow-up and a greater decrease in the average number of days of alcohol and drug use at follow-up compared to controls. The proposed study is a randomized clinical trial within a SUD specialty clinic to evaluate whether TAU plus WET is superior to TAU augmented by neutral topic writing on both PTSD and addiction outcomes for veterans in SUD treatment. The proposed study will also examine a biological marker of autonomic arousal, heart rate variability (HRV), in order to determine whether it might be a potential objective measure of treatment efficacy. Emerging evidence suggests high-frequency HRV may be sensitive to SUD and PTSD symptom improvement and a possible mechanism underlying the connection between stress and substance use. [This study will examine the association between HRV and treatment outcomes. We will also examine whether change in HRV scores over time correlates with treatment outcomes (PTSD symptoms and days of substance use).] The specific aims of the project are to examine whether WET augmentation of TAU: a) improves trauma symptoms for veterans with SUD and PTSD who are receiving outpatient SUD treatment compared to TAU with a neutral writing control; and b) improves SUD outcomes for veterans with comorbid PTSD compared to TAU with a neutral writing control. Veterans seeking SUD treatment who present with co-occurring PTSD will be randomized to either WET plus TAU or TAU augmented by a neutral topic writing condition. Measures of trauma symptoms, distress, and mood will be collected at each writing session, with resting HRV and additional assessments at baseline, at post-treatment (approximately 6-weeks), 8-weeks, and 12-weeks post- baseline assessment. Main outcomes will be change in trauma symptoms, substance use, and HRV. If results prove promising, they will support WET as an effective brief, cost efficient, easy to disseminate, adjunct to current SUD treatment for veterans with comorbid PTSD.