TREATMENT OF PTSD IN FEMALE SEXUAL ABUSE SURVIVORS

一个小的，但越来越多的文献表明，认知行为疗法， (CBT)是强奸或战区创伤幸存者的有效治疗方法 创伤后应激障碍（PTSD），但没有 发表的研究测试CBT在创伤后应激障碍患者谁已暴露于 童年性虐待。此外，先前的CBT治疗结果 研究没有监测其对心理生理和 已知与创伤后应激障碍有关的神经生物学异常。解决 针对这两个问题，提出了一项随机临床试验， 评估CBT在患有继发于儿童性行为的PTSD的女性样本中的应用 虐待该项目的具体目标是：1）实施认知- 行为治疗方案; 2）提供全面，纵向 评估创伤后应激障碍症状，同时出现的精神问题， 心理生理反应和神经激素水平;以及3）测试 关于CBT的即时和长期有效性的假设， 与支持性咨询（SC）和等待名单对照比较。 84例儿童期性行为继发PTSD的女性门诊患者 滥用将被随机分配到两个活性治疗组之一， CBT或SC，或等待列表控制组。所有的女人都会 最初和14次治疗后（或在 等待名单对照组的情况下，九周后）使用结构化 访谈和自我报告问卷。此外，标准 用于评估PTSD的心理生理学测量（心率、皮肤 电导和面部肌电图）和心血管的补充措施 反应性（心输出量、射血前期和总外周血 抗性）将在治疗后立即获得 在暴露于创伤无关和创伤相关的被动和主动时， 应对任务24小时无尿皮质醇肾上腺素 去甲肾上腺素，以及甲状腺激素概况，也将是 测定了两个积极治疗组将接受相同的评估 完成治疗后6个月， 治疗3个月后进行心理评估。我们假设 CBT比SC和等待名单更有效：1）减少PTSD 症状; 2）减少心理生理反应的幅度 实验室压力源; 3）正常化神经激素水平;和4） 减少抑郁、分离和其他焦虑症状。除了其 作为一项治疗结果研究的临床价值，该项目应创造一个 有机会测试一些关于 PTSD的精神病理学和病理生理学。

A small but growing literature suggests that cognitive-behavioral therapy (CBT) is an effective treatment for survivors of rape or war-zone trauma who develop posttraumatic stress disorder (PTSD), but there are no published studies testing CBT in PTSD patients who have been exposed to childhood sexual abuse. Furthermore, previous CBT treatment outcome studies have not monitored its effect on psychophysiological and neurobiological abnormalities known to be associated with PTSD. To address both of these issues, a randomized clinical trial is proposed that will evaluate CBT in a sample of women with PTSD secondary to childhood sexual abuse. The specific aims of this project are: 1) to implement a cognitive- behavioral treatment program; 2) to provide comprehensive, longitudinal assessment of PTSD symptoms, co-occurring psychiatric problems, psychophysiological reactivity, and neurohormonal levels; and 3) to test hypotheses concerning the immediate and long-term effectiveness of CBT in comparison to supportive counseling (SC) and wait-list controls. Eighty-four female outpatients with PTSD secondary to childhood sexual abuse will be randomly assigned to one of the two active-treatment groups, CBT or SC, or to a wait-list control group. All of the women will be assessed initially and after fourteen sessions of treatment (or in the case of the wait-list control group, after nine weeks) using structured interviews and self-report questionnaires. In addition, both the standard psychophysiological measures for assessing PTSD (heart rate, skin conductance, and facial EMG) and supplementary measures of cardiovascular reactivity (cardiac output, pre-ejection period, and total peripheral resistance) will be obtained initially and immediately following treatment upon exposure to trauma-unrelated and trauma-related passive- and active- coping tasks. Twenty-four hour urinary-free cortisol, epinephrine, and norepinephrine, as well as thyroid hormone profiles, will also be measured. The two active-treatment groups will undergo the same assessment six months after completing treatment and will receive an interim psychometric assessment three months after treatment. We hypothesize that CBT will be more effective than both SC and wait-list: 1) in reducing PTSD symptoms; 2) in decreasing the magnitude of psychophysiological responses to laboratory stressors; 3) in normalizing neurohormonal levels; and 4) in reducing depressive, dissociative, and other anxiety symptoms. Besides its clinical value as a treatment outcome study, this project should create an opportunity to test a number of theoretical questions regarding the psychopathology and pathophysiology of PTSD.