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Psychotherapies for Chronic Posttraumatic Stress Disorder

慢性创伤后应激障碍的心理治疗

基本信息

批准号：
8243546
负责人：
JOHN C MARKOWITZ
金额：
$ 52.53万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-04-01 至 2014-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8243546
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

项目摘要

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）是一种普遍的、使人衰弱的精神疾病。在重复的研究中，只有两种治疗方法对慢性创伤后应激障碍有效：基于暴露的认知行为疗法（CBT）和血清素再摄取抑制剂。认知行为疗法侧重于重新接触创伤记忆和提醒以促进处理，具有强大的理论和实证基础。然而，多项研究也证明了社会和人际关系过程在创伤后恢复中的核心作用。创伤后应激障碍治疗研究并没有试图测试这些机制。人际心理治疗（IPT）是一种建立良好的、有效的情绪障碍治疗方法，尽管效果相同，但在理论和技术上与CBT不同。我们的初步研究发现，IPT治疗创伤后应激障碍有很大的希望，需要进行对照试验。与针对创伤后应激障碍的CBT治疗不同，IPT针对的是人际功能，既不鼓励重新体验创伤记忆，也不鼓励在治疗之外接触创伤的提醒。虽然基于暴露的治疗通常被认为对焦虑症更有效，但创伤后应激障碍是一种兼具情感障碍和焦虑症特征的混合型疾病。因此，IPT是一种可行的治疗创伤后应激障碍的替代方法。我们的团队结合了随机临床试验（rct）、IPT和PE研究、创伤后应激障碍的社会心理治疗以及心理治疗的文化方法等方面的经验。我们建议在控制条件下测试IPT治疗PTSD的疗效。一项为期14周的随机对照试验将对165名慢性创伤后应激障碍患者进行IPT治疗（IPT-PTSD）、延长暴露治疗（PE）作为对照治疗和放松治疗(R)作为对照治疗。独立评估人员将评估结果。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。这种设计最近在医学上被推荐用于测试针对已有治疗方法的疾病引入的新药。这种最先进的设计将允许临床医生用实用性来解释结果。通过对比两种非常不同的治疗方法，它提供了一个相对罕见的、近乎理想的机会来研究心理治疗机制。本研究将通过研究两种积极治疗中暴露相关变化和人际关系变化的时间来探索治疗机制的假设。为了回应审稿人提出的有益意见，我们对处理长度进行了标准化，加强了统计分析，并在最终提交的其他调整中增加了样本量。