Psychotherapies for Chronic Posttraumatic Stress Disorder

慢性创伤后应激障碍的心理治疗

• 批准号: 8041035
• 负责人: JOHN C MARKOWITZ
• 金额: $ 63.69万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8041035
• 关键词: Address; Affective; Anxiety; Anxiety Disorders; Aphorisms; Behavioral; Chronic; Cognitive Therapy; Communities; Complex; Controlled Study; DSM-IV; Data; Diagnosis; Disease; Disease remission; Elements; Evaluation; Exposure to; Foundations; Hybrids; Impairment; Inferior; Intervention; Length; Major Depressive Disorder; Measures; Mediating; Mediator of activation protein; Medicine; Memory; Mental disorders; Modeling; Mood Disorders; Neurobiology; Outcome; Patients; Pharmaceutical Preparations; Phase; Pilot Projects; Post-Traumatic Stress Disorders; Process; Psychotherapy; Public Health; Published Comment; Quality of life; Randomized Clinical Trials; Randomized Controlled Trials; Recovery; Relaxation; Relaxation Therapy; Research; Role; Sample Size; Selective Serotonin Reuptake Inhibitor; Social Adjustment; Social Functioning; Stimulus; Symptoms; Techniques; Testing; Time Study; Trauma; Withdrawal; active method; alternative treatment; base; control trial; depressive symptoms; design; efficacy testing; experience; follow-up; improved; interest; neglect; psychoeducation; psychosocial; response; skills; social; theories; treatment effect

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) is a prevalent, debilitating psychiatric disorder. Only two types of treatment have shown efficacy for chronic PTSD in replicated research: exposure-based cognitive behavioral therapies (CBT) and serotonin reuptake inhibitors. Cognitive behavioral therapies, which focus on re-exposure to traumatic memories and reminders to promote processing, have strong theoretical and empirical foundations. Yet multiple studies also document a central role for social and interpersonal processes in recovery after trauma. PTSD treatment research has not attempted to test these mechanisms. Interpersonal Psychotherapy (IPT), a well established, efficacious treatment for mood disorders, differs in theory and technique from CBT despite equal efficacy. Our pilot study found IPT to have great promise for PTSD, warranting a controlled trial. Unlike CBT treatments for PTSD, IPT targets interpersonal functioning, encouraging neither re-experiencing of traumatic memories nor out-of-session exposure to reminders of the trauma. Although exposure-based treatments are generally considered superior for anxiety disorders, PTSD is a hybrid disorder with features of both affective and anxiety disorders. IPT is thus a plausible alternative treatment approach to PTSD. Our group conjoins experience in randomized clinical trials (RCTs), in IPT and PE research, in psychosocial treatments for PTSD, and in cultural approaches to psychotherapy. We propose to test the efficacy of IPT for PTSD under controlled conditions. A 14-week RCT will compare IPT adapted for PTSD (IPT-PTSD), Prolonged Exposure (PE) therapy as a reference treatment, and Relaxation therapy (R) as a control treatment for 165 patients with chronic PTSD. Independent evaluators will assess outcomes. Responders will enter a three-month observational follow-up phase to assess persistence of treatment benefits. This design has been recently recommended in medicine to test new drugs being introduced for conditions with already established treatments. This state-of-the-art design will allow clinicians to interpret results with practicality. It presents a relatively rare and nearly ideal opportunity to study psychotherapy mechanisms by contrasting two very different treatments. The study will explore hypotheses about treatment mechanism by studying the timing of exposure-related change and interpersonal change in the two active treatments. In response to helpful comments from reviewers, we have standardized lengths of treatment, bolstered statistical analyses, and increased sample size among other adjustments for this final submission.

描述（由申请人提供）：创伤后应激障碍（PTSD）是一种普遍存在的、使人衰弱的精神疾病。在重复研究中，只有两种治疗方法显示出对慢性 PTSD 的疗效：基于暴露的认知行为疗法 (CBT) 和血清素再摄取抑制剂。认知行为疗法的重点是重新接触创伤记忆和提醒以促进处理，具有坚实的理论和经验基础。然而多项研究也证明了社会和人际过程在创伤后恢复中的核心作用。创伤后应激障碍（PTSD）治疗研究并未尝试测试这些机制。人际心理治疗 (IPT) 是一种成熟、有效的情绪障碍治疗方法，尽管疗效相同，但在理论和技术上与 CBT 不同。我们的试点研究发现，IPT 对于治疗 PTSD 有很大希望，值得进行对照试验。与针对 PTSD 的 CBT 治疗不同，IPT 的目标是人际功能，既不鼓励重新体验创伤记忆，也不鼓励在治疗结束后暴露于创伤提醒。虽然基于暴露的治疗通常被认为对于焦虑症更有效，但创伤后应激障碍是一种混合障碍，具有情感障碍和焦虑障碍的特征。因此，IPT 是 PTSD 的一种可行的替代治疗方法。我们的团队结合了随机临床试验 (RCT)、IPT 和 PE 研究、PTSD 心理社会治疗以及心理治疗文化方法方面的经验。我们建议在受控条件下测试 IPT 对 PTSD 的疗效。一项为期 14 周的随机对照试验将比较适用于 PTSD 的 IPT（IPT-PTSD）、作为参考治疗的延长暴露（PE）疗法以及作为对照治疗的放松疗法（R），对 165 名慢性 PTSD 患者进行比较。独立评估员将评估结果。应答者将进入为期三个月的观察随访阶段，以评估治疗效果的持久性。这种设计最近被推荐用于医学领域，以测试针对已有治疗方法引入的新药。这种最先进的设计将使临床医生能够实用地解释结果。它提供了一个相对罕见且近乎理想的机会，通过对比两种截然不同的治疗方法来研究心理治疗机制。该研究将通过研究两种主动治疗中与暴露相关的变化和人际关系变化的时间来探索有关治疗机制的假设。为了回应审稿人的有用评论，我们对最终提交的治疗时间进行了标准化，加强了统计分析，并增加了样本量等调整。