Cognitive-Behavior Treatment for Victims of Mass Violenc

大规模暴力可以说是影响最多人心理健康的最严重的灾难形式，因此，解决大规模暴力受害者的心理健康需求是一项重大的公共卫生挑战。有必要向受大规模暴力影响的大量个人提供有效和早期的创伤后应激障碍治疗。此外，由于没有对大规模暴力和灾难幸存者的创伤后应激障碍进行精神健康治疗的随机对照试验，因此没有可以推荐的具体循证程序来满足这一人群的特殊需求。由于灾害发生后资源往往稀缺，有效的干预措施是有效的、可行的、迅速可用的，并尽可能有效地提供给最大比例的受灾个人。在治疗其他创伤情况下的创伤后应激障碍方面，有相当多的证据表明，认知行为疗法(CBT)程序在减少创伤后应激障碍症状方面取得了实质性的成功。总体而言，现有证据表明，在患有创伤后应激障碍的患者中，使用CBT的两个组成部分--长期暴露(PE)和应激接种训练(SIT)--具有理论和经验上的合理性。现有研究的一个实际限制是，它们仅限于单独管理的治疗环境，通常需要在专门的精神卫生保健环境中提供8至12次治疗。这些疗法的劳动密集性是在大规模暴力事件的背景下向数千名患有创伤后应激障碍的人提供治疗的重大障碍。这个项目的主要目的是评估一种简明的、以初级保健为基础的CBT模式，旨在为创伤后应激障碍患者提供有效的自我管理技能。这种干预的基本原理是，在单一治疗过程中有适当和密集的治疗师投入，并有系统地辅以随后自我指导的基于网络的信息和日常家庭作业活动的指导，因大规模暴力而患上创伤后应激障碍的初级护理患者可以从已证明在减少创伤后应激障碍症状方面有效的策略中受益。五角大楼9/11袭击的幸存者将被随机分配到PE、SIT或支持性咨询对照组。患者的依从性和症状将在网络上进行监测。患者将在治疗后6个月和12个月进行随访。

Mass violence is arguably the most severe form of disaster affecting the mental health of the largest number of people, thus addressing the mental health needs of victims of mass violence is a major public health challenge. There is a need for delivering effective and early treatments for PTSD to the large number of affected individuals by mass violence. In addition, since there are no randomized controlled trials of mental health treatments for PTSD in survivors of mass violence and disasters, there are no specific evidence-based procedures that can be recommended to meet the special needs of this population. Because resources are often scarce in the aftermath of disasters, a useful intervention is one that is effective, feasible, rapidly available, and efficiently delivered to the largest proportion of affected individuals possible. In terms of treating PTSD in other trauma contexts, there is considerable evidence that cognitive-behavioral therapy (CBT) procedures have substantial success in reducing the array of PTSD symptoms. Overall, the available evidence points to the theoretical and empirical justification for using Prolonged Exposure (PE) and Stress Inoculation Training (SIT), two components of CBT, with patients presenting with PTSD. A practical limitation of available studies is that they are limited to individually administered therapy contexts that typically require between 8 and 12 sessions delivered in a specialty mental health care- setting. The labor-intensive nature of these therapies represents a significant obstacle to provision of therapy to thousands of individuals suffering PTSD in the context of mass violence events. The major aim of this project is to evaluate an abbreviated, primary care-based format of CBT that aims to provide effective self-management skills to individuals with PTSD. The rationale underpinning this intervention is that with appropriate and intensive therapist input during a single session of therapy, supplemented systematically with subsequent self- directed web-based information and guidance for daily homework activity, primary care patients with PTSD stemming from mass violence can benefit from the strategies that have demonstrated efficacy in reducing PTSD symptoms. Survivors of the Pentagon attack on 9/11 will be randomly assigned to PE, SIT, or a supportive counseling control group. Patients' compliance and symptoms will be monitored on the web. Patients will be followed 6 and 12 months post-treatment.