Cognitive-Behavior Therapy for Khmer Refugees: A Randomized Controlled Trial

描述（由申请人提供）：拟议的项目代表了我们对柬埔寨创伤后应激障碍难民的治疗发展的下一步，这些难民对药物和支持性心理治疗反应不完全。最初的治疗开发得到了首席研究员K奖的支持（K23, MH066253）。这将是首席研究员的第一个独立的R-01，因此符合NIH新研究员指定的指导方针。最近的一项调查发现，社区环境中超过50%的柬埔寨人符合PTSD标准，另一项调查显示，即使经过多年的治疗，包括充分的精神药理学试验和支持性治疗，专科诊所中超过50%的柬埔寨患者仍然符合PTSD标准。尽管有充分的证据表明CBT在英语人群中治疗创伤后应激障碍的疗效，但在难民人群中只有五项治疗效果的对照研究。这五项研究中有三项是由我们小组进行的（两项针对柬埔寨难民，一项针对越南难民）。在美国，除了我们对柬埔寨和越南难民进行的三项研究外，还没有关于CBT治疗少数群体创伤后应激障碍疗效的研究。在我们的初步研究中，我们完成了美国国立卫生研究院定义的心理社会治疗发展阶段。基于对柬埔寨难民的广泛研究，我们开发了一种手动治疗方法。在柬埔寨难民中，该治疗在一项小型随机对照试验（RCT）中进行试点，与候补名单进行比较，然后在一项中型随机对照试验中，也与候补名单进行比较。在一个小型试点中，也是一个比较候补名单的随机对照试验，对患有治疗难治性创伤后应激障碍的越南难民证明了疗效。在这些研究中，我们发现手动治疗是被广泛接受和有效的（具有大效应量），通过标准化的评估措施，如临床医生管理的PTSD量表（CAPS）进行评估。拟议的拨款将使我们能够在早期研究的基础上，通过进行下一个合乎逻辑的实证调查，进一步调查我们的手动CBT干预对患有治疗难治性创伤后应激障碍的柬埔寨难民的疗效：将我们的手动治疗与另一种积极治疗条件进行比较。

DESCRIPTION (provided by applicant): The proposed project represents the next step in treatment development of our manualized, culturally sensitive cognitive-behavior therapy for Cambodian refugees with PTSD who have had an incomplete response to medications and supportive psychotherapy. The initial treatment development was supported by a K award to the principal investigator (K23, MH066253). This will be the principal investigator's first independent R-01, hence meeting the NIH guidelines for new investigator designation. One recent survey found that over 50% of Cambodians in a community setting met PTSD criteria, and another survey, that over 50% of Cambodian patients in a specialty clinic still met PTSD criteria, even after years of treatment, including adequate trials of psychopharmacology and supportive therapy. Despite the ample evidence of the efficacy of CBT for the treatment of PTSD among English-speaking groups, there are only five controlled studies of treatment efficacy among refugee populations. Three of those five studies were conducted by our group (two among Cambodian refugees, one among Vietnamese refugees). There is no study of the efficacy of CBT for treating PTSD in a minority group in the United States, other than our three studies of Cambodian and Vietnamese refugees. In our preliminary study, we completed NIH-defined stages of psychosocial treatment development. Based on extensive research among Cambodian refugees, we developed a manualized treatment. Among Cambodian refugees, the treatment was piloted in a small randomized controlled trial (RCT), comparing to waitlist, and then, in a medium-sized RCT, also comparing to waitlist. In a small pilot, also a RCT comparing to waitlist, efficacy was demonstrated for Vietnamese refugees with treatment-resistant PTSD. In these studies, we found the manualized treatment to be well accepted and efficacious (with large effect sizes), as assessed by standardized assessment measures, such as the Clinician-Administered PTSD Scale (CAPS). The proposed grant would allow us to further investigate the efficacy of our manualized CBT intervention for Cambodian refugees with treatment-resistant PTSD, building on our earlier studies, by conducting the next logical step of empirical investigation: a comparison of our manualized treatment to another active treatment condition.