CBT for PTSD Among Public-Sector Consumers

描述（由申请人提供）：这是对R21提案的修订，旨在为患有PTSD和严重精神疾病（SMI）的公共部门消费者开发创伤后应激障碍（PTSD）的多组分认知行为治疗（CBT）计划。数据显示，在公共部门接受治疗的重度精神分裂症患者（如精神分裂症）中，创伤受害（高达98%）和创伤后应激障碍（高达43%）非常普遍。在普通人群中，创伤后应激障碍与医疗和其他服务的使用率几乎是最高的，因此可能是最昂贵的精神障碍之一。有证据还表明，PTSD患者往往得不到充分的心理健康服务。因此，创伤显然对公众健康有显著影响。尽管人们越来越意识到创伤经历对在国家资助的精神卫生系统中接受治疗的人的重大影响，但对于这些患有创伤后应激障碍和重度精神障碍的消费者的有效干预措施，却明显缺乏经验数据。事实上，虽然已经为其他创伤群体（例如，男性退伍军人、女性强奸受害者）开发了有效的社会心理治疗方法，但很少努力将这些治疗方法用于在国家资助的大型精神卫生系统中接受治疗的人。因此，迫切需要开发和评估适当的治疗方法，专门针对这一人群在这种实践环境中使用。该提案的具体目标是：(1)在公共部门患有PTSD和重度精神障碍的消费者中制定一个全面的PTSD治疗计划和治疗手册，采用现有的CBT干预措施（教育、暴露疗法、社交技能培训）来治疗PTSD，(2)培训公共部门治疗师使用该治疗手册，并评估治疗师的能力和遵守手册的情况。(3)对患有PTSD和SM的公共部门消费者进行试点研究！为了评估四个领域的结果变量——创伤后应激障碍症状、社会功能、其他精神疾病症状（如精神病）以及治疗的可信度和满意度。本提案响应了NIMH在2010年健康人（目标18 9和18 10）中描述的目标，以及衔接科学与服务报告中关于研究有希望的干预措施和服务环境特征的必要性的建议（建议10）。

DESCRIPTION (provided by applicant): This is a revision of an R21 proposal to develop a multi-component cognitive behavioral treatment (CBT) program for posttraumatic stress disorder (PTSD) among public sector consumers with PTSD and severe mental illness (SMI). Data show that trauma victimization (up to 98%) and PTSD (up to 43%) are highly prevalent among persons with SMI (e g, schizophrenia) who are treated within the public sector. Among the general population PTSD is associated with nearly the highest rate of medical and other service use, and therefore may be one of the costliest mental disorders. Evidence also shows that individuals with PTSD tend to receive inadequate mental health services. Thus, it is clear that trauma has a prominent impact on the public health. Despite a growing awareness of the significant impact of traumatic experiences on persons treated within state-funded mental health systems, there is a striking lack of empirical data regarding effective interventions for these consumers with PTSD and SMI. In fact, although effective psychosocial treatments have been developed for other traumatized groups (e.g., male combat veterans, female rape victims), little effort has been made to adapt these treatments for persons who are treated within large state-funded mental health systems. Thus, there is a pressing need for the development and evaluation of appropriate treatments designed specifically for use with this population in this of practice setting. The specific aims of this proposal are to (1) develop a comprehensive treatment program and treatment manual for PTSD among public sector consumers with PTSD and SMI, adapting existing components of CBT interventions (education, exposure therapy, social skills training) for PTSD, (2) train public sector therapists in the use of this treatment manual and evaluate therapist competence and adherence to following the manual, and (3) conduct a pilot study with public sector consumers with PTSD and SM! in order to evaluate outcome variables that fall into four domains-- PTSD symptoms, social functioning, symptoms of other psychiatric conditions (e g, psychosis), and treatment credibility and satisfaction. This proposal is responsive to the NIMH objectives described in Healthy People 2010 (Objectives 18 9 and 18 10) and the Bridging Science and Service report recommendation regarding the need for research that characterizes promising interventions and service settings (recommendation #10).