Cognitive-Behavior Treatment for Victims of Mass Violenc

大规模暴力可以说是影响最大多数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。有必要为大量受大规模暴力影响的个体提供有效的创伤后应激障碍早期治疗。此外，由于没有针对大规模暴力和灾难幸存者的创伤后应激障碍心理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。由于灾后资源往往匮乏，因此有效、可行、可迅速获得并高效地向尽可能多的受灾人口提供的干预措施是有用的。在治疗其他创伤背景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）在减少一系列创伤后应激障碍症状方面取得了实质性的成功。总的来说，现有的证据表明，对于患有PTSD的患者，使用CBT的两个组成部分——延长暴露（PE）和应激接种训练（SIT）是有理论和经验依据的。现有研究的一个实际限制是，它们仅限于个体管理的治疗环境，通常需要在专业精神卫生保健环境中进行8到12次治疗。这些疗法的劳动密集型性质是为成千上万在大规模暴力事件背景下遭受创伤后应激障碍的个体提供治疗的一个重大障碍。这个项目的主要目的是评估一种简短的、基于初级保健的CBT形式，旨在为PTSD患者提供有效的自我管理技能。支持这种干预的基本原理是，在单次治疗期间，通过适当和密集的治疗师输入，系统地补充随后的自我指导的网络信息和日常作业活动指导，源于大规模暴力的创伤后应激障碍的初级保健患者可以从已证明有效的减轻创伤后应激障碍症状的策略中受益。9/11五角大楼袭击的幸存者将被随机分配到PE， SIT或支持性咨询控制组。患者的依从性和症状将在网上监测。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.