Skills Training /Exposure in Childhood Abuse PTSD

描述（由申请人提供）：创伤后应激障碍（PTSD）是一种

Description (provided by applicant): Post-traumatic Stress Disorder (PTSD) is a debilitating and often chronic anxiety disorder with serious psychiatric comorbidity. The lifetime prevalence of PTSD is estimated at 10 percent among women and 5 percent for men. The most frequent trauma associated with PTSD among women is childhood abuse. PTSD related to childhood abuse is associated with substantial disturbance in emotion regulation and interpersonal functioning. There is significant functional impairment among childhood abuse survivors with PTSD such as poor work and relationship histories, problems in parenting, and high risk for revictimization in the form of physical assault, sexual assault and domestic violence. Not surprisingly, this population is significantly over-represented in mental health services. Treatment research for this group of PTSD patients is urgently needed. The principal investigator, supported by NIMH funds, has developed a treatment that directly and vigorously addresses three distinct problem domains in PTSD related to childhood abuse: emotion management problems, interpersonal problems, and PTSD. The treatment, organized into two phases, provides 8 sessions of skills training in affect and interpersonal regulation (STAIR) followed by 8 sessions of a modified version of prolonged exposure (MPE). Results of a randomized controlled trial found significant improvement in all three targeted areas. The primary aim of the proposed study is to determine whether this two-component treatment is superior to treatments utilizing only one of the treatment components. Studies of PTSD related to adult-onset traumas have found that combination treatments do not provide any benefit superior to their components. However, the problem-specific nature of the interventions as well the sequential rather than simultaneous implementation of the treatment components, suggest that this combination treatment may produce better outcomes than comparable single-component treatments. One hundred and fifty (150) women with PTSD related to childhood abuse will be randomly assigned to one of three active treatments: STAIR/MPE, an MPE treatment condition, and a STAIR treatment condition. The primary outcome variables will target the three problem domains: affect management, interpersonal functioning and PTSD symptoms. We will also assess the feasibility of each treatment as measured by dropout rates and the presence of adverse effects as measured by symptom worsening over the course of treatment.