Sleep-directed hypnosis as a complement to CPT in treating PTSD

描述(由申请人提供)：这项提案旨在测试睡眠指导催眠的有效性，作为现有经验支持的心理社会干预的补充，认知处理疗法(CPT)在患有创伤后应激障碍的人际暴力幸存者的样本中。此外，这项建议寻求确定治疗中导致症状改善、更大功能领域的改善以及与健康相关的问题的作用机制。为此，将进行多方法、多模式的评估，包括对精神病学、心理学和心理生理学领域的日常和间歇性监测。具体地说，40名受试者将被随机分配到催眠+持续睡眠疗法(HiCPT)或症状监测延迟治疗组(SMDT)，该组旨在控制监测的效果、时间的流逝，并作为评估睡眠、创伤后应激障碍症状和日常压力之间的基本时间关系的一种手段。利用半微生物设计，对照条件将被交叉到主动治疗，允许在研究中重复。整个治疗样本(N=40)将与最近仅接受严格CPT治疗的类似创伤幸存者的样本(N=50)进行比较，该治疗通过最近结束的NIH资助的大规模临床试验在同一地点进行，使用相同的措施。这项研究的参与者将接受一系列访谈和自我报告措施，包括1。)临床医生使用创伤后应激障碍量表，2。)DSM-IV轴I障碍的结构化临床访谈，3。)标准化创伤面谈，4)创伤后应激障碍诊断量表，5)贝克抑郁量表-II，6。Pennebaker Limbic Landuigness清单，7)SF-36健康调查，8。)生活质量问卷，9。)社会适应量表、匹兹堡睡眠质量指数和失眠严重程度指数。此外，生理指标将被用来评估睡眠障碍和过度觉醒之间的关系，以及随着时间的推移生理反应的变化。还将进行精神运动警戒任务，以测试是否存在睡眠剥夺(即以反应时间衡量的“困倦”)以及相关的时间变化。受试者将通过使用每日日记监测症状和日常压力源，并在治疗前、治疗后和三个月随访点接受正式评估。进行这项拟议的研究将对在遭受创伤的人群中使用一种新的方法--增加催眠--来补救睡眠障碍(PTSD最常见的症状，也是最难治疗的症状之一)具有重要的意义。同时，这项建议旨在阐明催眠的作用机制，催眠是一种研究较少的补充治疗元素，在创伤文献中几乎没有经验支持。 公共卫生相关性：创伤后应激障碍(PTSD)通常被认为是慢性的和持久的表现，通常与跨越多个功能领域的衰弱损害有关，从而造成高水平的社会成本(Kessler，2000)，睡眠障碍被确定为PTSD发展的早期预测因素(Korn，et al，2002)，是17种PTSD症状中最常见的(Green，1993)，被认为是最难治疗的(Krakow，Hollifield等人，2001；Cooper and Clum，；Zayfert和DeViva，2004年)，并被确定为创伤后应激障碍症状与躯体化和功能障碍之间的中介(Clum，Nishith&Resick，2001；Mellman等人，1995；Mohr等人，2003)。因此，在创伤人群中对睡眠障碍进行特定的补救可能会导致总体创伤后应激障碍症状的大幅减少，从而减少心理社会损害、与健康相关的关切和社会费用。

DESCRIPTION (provided by applicant): This proposal seeks to test the efficacy of sleep-directed hypnosis as a complement to an existing empirically supported psychosocial intervention, Cognitive Processing Therapy (CPT) in sample of survivors of interpersonal violence suffering from PTSD. Further, this proposal seeks to identify mechanisms of action in the therapy that lead to symptom modification, improvement in larger domains of functioning, and health-related concerns. Towards this end, a multi-method, multimodal assessment will be administered including daily and intermittent monitoring across psychiatric, psychological, and psychophysiological domains. Specifically, forty subjects will be randomly assigned to either a hypnosis + CPT (hypCPT) condition or to a symptom monitoring, delayed treatment group (SMDT) designed to control for the effects of monitoring, the passage of time, and as a means to assess the basic temporal relationship between sleep, PTSD symptoms and daily stress. Utilizing a semicrossover design, the control condition will be crossed over to the active treatment, allowing for a replication within the study. The entire treated sample (N = 40) will be compared to a sample (N = 50) of similar trauma survivors who have recently been treated with a strict CPT only, manualized therapy through the course of a recently concluded NIH-funded large scale clinical trial conducted at the same site and using the same measures. Participants in this study will be administered a battery of interviews and self-report measures including the 1.) Clinician Administered PTSD Scale, 2.) Structured Clinical Interview for DSM-IV Axis I Disorders, 3.) Standardized Trauma Interview, 4.) PTSD Diagnostic Scale, 5) Beck Depression Inventory - II, 6.) Pennebaker Inventory of Limbic Landuigness, 7.) The SF-36 Health Survey, 8.) Quality of Life Inventory, 9.) Social Adjustment Scale, 10) Pittsburgh Sleep Quality Index, and the 11) Insomnia Severity Index. In addition, physiological indices will be used to assess the relationship between sleep impairment and hyperarousal as well as changes over time in physiological reactivity. A Psychomotor Vigilance Task will also be administered to test for the presence of sleep deprivation (i.e. "sleepiness" as measured by reaction time) as well as related changes over time. Subjects will monitor symptoms and daily stressors through the use of daily diaries as well as undergo formal assessments at pre-treatment, post- treatment and three month follow-up points. Conducting the proposed study will have important implications on remediating sleep impairment (the most often reported symptom of PTSD and one of the most refractory to treatment) utilizing a novel approach, the addition of hypnosis, within a traumatized population. Concurrently this proposal aims to illuminate the mechanisms of action in hypnosis, an understudied complementary treatment element with virtually no empirical support in the trauma literature. Public Health Relevance: Posttraumatic Stress Disorder (PTSD) is commonly considered to be chronic and enduring in presentation and is typically associated with debilitating impairment across multiple domains of functioning with a resultant high level of societal cost (Kessler, 2000) Sleep impairment is identified as an early predictor of the development of PTSD (Koren, et al, 2002), is the most often reported of the 17 PTSD symptoms (Green, 1993), is considered one of the most refractory to treatment (Krakow, Hollifield, et al, 2001; Cooper and Clum, 1989; Zayfert and DeViva, 2004), and is identified as a mediator between PTSD symptoms and somatization and functional disability (Clum, Nishith, & Resick, 2001; Mellman et al, 1995; Mohr et al., 2003). Thus the specific remediation of sleep impairment within a trauma population could result in substantial decreases in overall PTSD symptomatology which would then result in reduced psychosocial impairment, health-related concerns, and societal expense.