CBT for PTSD Among Public-Sector Consumers

描述（由申请人提供）：这是R21提案的修订版，旨在为患有创伤后应激障碍（PTSD）和严重精神疾病（SMI）的公共部门消费者制定多成分认知行为治疗（CBT）计划。数据显示，创伤受害（高达98%）和创伤后应激障碍（高达43%）是非常普遍的人与SMI（如精神分裂症）谁是在公共部门内治疗。在一般人群中，PTSD与医疗和其他服务使用率几乎最高相关，因此可能是最昂贵的精神疾病之一。证据还表明，PTSD患者往往没有得到足够的心理健康服务。因此，很明显，创伤对公众健康有着显著的影响。尽管人们越来越意识到创伤经历对国家资助的精神卫生系统内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缺乏经验数据。事实上，尽管已经为其他创伤群体开发了有效的心理社会治疗方法（例如，男性退伍军人、女性强奸受害者），但几乎没有作出努力，使这些治疗适合在大型国家资助的精神卫生系统接受治疗的人。因此，迫切需要开发和评估专门用于这一人群的适当治疗方法。该提案的具体目标是：（1）在患有PTSD和SMI的公共部门消费者中制定全面的PTSD治疗计划和治疗手册，调整CBT干预措施的现有组成部分（教育，暴露疗法，社交技能培训），（2）培训公共部门的治疗师使用本治疗手册，并评估治疗师的能力和遵守手册，以及（3）对患有PTSD和SM的公共部门消费者进行试点研究！为了评估结果变量，分为四个领域-创伤后应激障碍症状，社会功能，其他精神疾病的症状（如精神病），治疗的可信度和满意度。该提案响应了《2010年健康人群》（目标18 9和18 10）中描述的NIMH目标，以及《连接科学与服务》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).