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

书面暴露疗法 (WET) 作为一种针对同时发生药物使用障碍和创伤后应激障碍 (PTSD) 的退伍军人的短暂创伤治疗

• 批准号: 10482493
• 负责人: Sarah Meshberg-Cohen
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10482493
• 关键词: Address; Aftercare; Alcohol consumption; Alcohols; Arousal; Autonomic nervous system; Back; Biological Markers; Buprenorphine; Client satisfaction; Clinic; Clinical; Clinical Trials; Cognitive; Data; Diagnosis; Distress; Dose; Dropout; Drug usage; Frequencies; Goals; Intervention; Light; Measures; Mental Depression; Mental Health; Moods; Outcome; Outpatients; Participant; Pharmaceutical Preparations; Physiological; Pilot Projects; Post-Traumatic Stress Disorders; Provider; Psychotherapy; Questionnaires; Randomized; Randomized Clinical Trials; Relapse; Reporting; Research Design; Rest; Severities; Standardization; Stress; Substance Use Disorder; Symptoms; Time; TimeLine; Training; Trauma; Treatment Efficacy; Treatment outcome; United States Department of Veterans Affairs; Veterans; Woman; Writing; acceptability and feasibility; addiction; base; comorbidity; cost efficient; dual diagnosis; efficacy evaluation; evidence base; follow-up; heart rate variability; improved; improved outcome; medical specialties; physical conditioning; post-traumatic symptoms; programs; reduce symptoms; satisfaction; substance use; suicide rate; symptomatic improvement; traditional therapy; trauma exposure; trauma symptom; treatment as usual; treatment comparison; treatment program

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.

在治疗过程中，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的退伍军人。SUD退伍军人中的共病PTSD有助于 与治疗效果差有关，并与整体精神和身体健康状况较差有关。虽然成瘾 传统上，创伤后应激障碍的治疗方案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SUD治疗的保留和合并症的结果。 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受过创伤培训，因此 不提供创伤后应激障碍治疗因此，尽管退伍军人事务部（VA）优先考虑 管理有效的循证心理治疗创伤后应激障碍，只有一小部分退伍军人与 SUD接受这种治疗。书面暴露疗法（WET）是一种以创伤为中心的简短干预， 有效治疗PTSD。与传统疗法相比，WET有几个优点;它可以在5个疗程中进行， 与其他创伤后应激障碍治疗相比， 提供最低的治疗师培训要求，使其具有成本效益，因此是理想的 在忙碌SUD门诊中进行给药干预。先前的一项研究表明， 可行和有效的减少创伤后应激障碍症状的妇女在住宅SUD治疗。在最近的一 接受性和可行性试点研究，SUD治疗寻求退伍军人（N=12）与共患PTSD， 随机分为WET+常规治疗（TAU）组或TAU+中性书写条件组。结果 表明这种基于书写的干预是可行和可接受的。WET与更大的 基线后8周随访时PTSD症状减少， 与对照组相比，随访时使用酒精和药物的天数。 拟议的研究是一项在SUD专科诊所内进行的随机临床试验，旨在评估TAU是否 加上WET在PTSD和成瘾结果方面上级于TAU， 在治疗上的优势这项拟议中的研究还将检查自主神经唤醒的生物标志物， 心率变异性（HRV），以确定它是否可能是一个潜在的客观措施， 治疗效果新的证据表明，高频HRV可能对SUD和PTSD敏感 症状改善和压力与物质之间联系的可能机制 使用. [This这项研究将检查HRV和治疗结果之间的关系。我们亦会研究 HRV评分随时间的变化是否与治疗结果（PTSD症状和治疗天数）相关 物质使用）。 该项目的具体目标是检查TAU的WET增强是否：a）改善创伤 与TAU相比，接受门诊SUD治疗的SUD和PTSD退伍军人的症状 中性书写控制;和B）与对照组相比， TAU具有中立的写入控制。寻求SUD治疗并同时出现创伤后应激障碍的退伍军人将 被随机分配到WET + TAU或TAU加上中性主题写作条件。措施 创伤症状、痛苦和情绪将在每次书写时收集，静息心率变异性和 基线、治疗后（约6周）、8周和12周时的额外评估 基线评估。主要结果将是创伤症状，物质使用和HRV的变化。如果结果 证明有前途，他们将支持WET作为一个有效的简报，成本效益，易于传播，辅助 目前对患有创伤后应激障碍共病的退伍军人进行SUD治疗。