Behavior Treatment for Chronic PTSD

描述(申请人提供)：创伤后应激障碍(PTSD)是一种严重的慢性焦虑症，伴随着创伤经历(例如，战斗、身体和性侵犯)，以再次经历、情绪麻木、回避、高度觉醒和严重的社会功能障碍为特征。这是一种终生流行率，在普通人群中高达14%，在退伍军人中超过30%。密集暴露疗法减少了慢性创伤后应激障碍的特征(如侵入性、生理反应性)和许多相关的普遍焦虑，目前被认为是心理社会治疗的选择。然而，暴露疗法并不能减少创伤后应激障碍的“消极”症状(如回避、技能缺陷、社交孤立、人际关系困难、愤怒控制)。创伤管理疗法(TMT)是一种针对慢性战斗相关创伤后应激障碍的多成分行为疗法，它结合了患者教育、暴露疗法、社交技能培训(包括情绪管理)和系统的家庭作业，解决了临床综合征的各个方面。初步证据表明，总的来说，在退伍军人管理局内接受治疗的退伍军人中，TMT在广泛的PTSD症状方面都有广泛的改善。这一应用是TMT疗效评估的下一步。具体地说，该项目是一项前瞻性随机研究，比较了TMT和暴露疗法仅用于治疗退伍军人中的慢性创伤后应激障碍。将从华盛顿特区的退伍军人医学中心招募48名受试者。治疗将持续17周(积极治疗阶段)；受试者将再接受12个月的跟踪治疗(随访阶段)，以确定治疗的四个功能领域的长期效果：(1)核心创伤后应激障碍症状；(2)社会和情感功能；(3)其他精神疾病的症状(例如抑郁症)；以及(4)治疗的可信度和满意度。本申请是根据R21(探索性/开发性补助金)机制提交的。

DESCRIPTION (provided by applicant): Post-traumatic stress disorder (PTSD), a severe and chronic anxiety disorder that follows traumatic experiences (e.g., combat, physical, and sexual assault), is characterized by acute symptoms of re-experiencing, emotional numbing, avoidance, hyperarousal, and severe impairment in social functioning. There is lifetime prevalence, as high as 14% in the general population and over 30% among combat veterans. Intensive exposure therapy reduces the hallmark features of chronic PTSD (e.g., intrusions, physiological reactivity) and much of the associated general anxiety, and currently is considered the psychosocial treatment of choice. However, exposure therapy does not reduce the "negative" symptoms of PTSD (e.g., avoidance, skill deficits, social isolation, interpersonal difficulties, anger control). Trauma Management Therapy (TMT), a multi-component behavioral treatment for chronic combat-related PTSD addresses all aspects of the clinical syndrome, using a combination of patient education, exposure therapy, social skills training (including emotional management) and systematic homework assignments. Preliminary evidence shows that overall TMT results in broad improvement across the wide spectrum of PTSD symptoms in veterans treated within the VA. This application is the next step in the evaluation of the efficacy of TMT. Specifically, this project is a prospective randomized study comparing TMT to Exposure Therapy only for treatment of chronic PTSD in combat veterans within the VA. Forty-eight subjects will be recruited from VA Medical Centers in Washington, D.C. Treatment will be administered over a 17-week period (active treatment phase); and subjects will be followed for an additional 12-months (follow-up phase) to ascertain long-term effects of treatment across four domains of functioning: (1) core PTSD symptoms; (2) social and emotional function; (3) symptoms of other psychiatric conditions (e.g., depression); and (4) treatment credibility and satisfaction. This application is submitted under the R21 (Exploratory/Developmental Grants) Mechanism.