Evaluation of Web-Based CBT for Women Veterans with PTSD

曾在军队服役的女性在美国人口中是迅速增长的少数，也是增长最快的 退伍军人事务部(退伍军人事务部)的新用户群体不断增长。最近的研究表明，与 对于平民来说，女性退伍军人报告的创伤暴露比率显著更高，从而导致更高的创伤发生率。 创伤后应激障碍。尽管存在针对创伤后应激障碍的循证治疗，但大多数女性退伍军人对退伍军人的利用不足 关心。在提供治疗方面的一项创新有可能接触到这些妇女并使其参与进来，那就是使用 在互联网上进行治疗。已经开发了一些基于网络的创伤后应激障碍的CBT干预措施，并 已评估。然而，除了一项之外，所有这些评估都是在美国以外的地方进行的，是与平民一起进行的 人口。例外的是，“为有压力的情况提供自我训练和教育”(DESTRESSS)， 主要在男性服役人员和退伍军人身上进行测试；只有少数女性参加了 评估其疗效的两项临床试验。因此，关于它对这一人群的疗效的数据有限， 这表明有必要评估它是否会满足女性退伍军人的需求。此外，减轻压力 对于女性来说可能不是最佳选择，因为它不是针对退伍军人独特的创伤经历而设计的 和需求。例如，减压不包括关于人际关系创伤的心理教育，也不包括 解决女性退伍军人的社会支持和关系问题。为此，我们建议 与女性退伍军人和具有内容专业知识的临床医生进行定性研究，以获取他们的反馈 在减压时，根据反馈对程序进行修改，然后进行试点 随机临床试验(RCT)评估修订后的基于网络的电话辅助电话干预 仅支持。具体地说，在第一阶段，我们将对20名女性退伍军人进行半结构化访谈 创伤后应激障碍以及与4-6名专家一起了解他们对减压的印象。我们将做出改变 作为这项形成性工作的结果，减压，同样的女性退伍军人和专家提供者 重新面谈，以提供对所做更改的反馈。在第二阶段，我们将进行一项试点RCT，其中70 患有创伤后应激障碍的女性退伍军人被随机分配到干预或电话支持组。创伤后应激障碍的测量 将收集症状严重程度(主要结果)、抑郁和生活质量(次要结果)。 在基线、治疗后以及12周和24周的随访评估中。有关计划的信息 使用率、辍学率、患者满意度和可接受性也将被收集。这样做的长期目标是 研究方向是为患有创伤后应激障碍的女性退伍军人开发低成本、可获得的干预措施。发现 应该提高我们对女性退伍军人的反应和护理偏好的一般了解 为她们量身定做的治疗，以及为女性退伍军人提供创新的、基于网络的干预 患有创伤后应激障碍。

Women who have served in the military are a rapidly growing minority in the US population and the fastest growing group of new users in the Department of Veterans Affairs (VA). Recent studies suggest that compared to civilians, women Veterans report significantly higher rates of trauma exposure and consequent high rates of PTSD. Despite the existence of evidence-based treatments for PTSD, most women Veterans underutilize VA care. One innovation in treatment delivery that has the potential to reach and engage these women is use of the Internet to administer treatment. A few web-based CBT interventions for PTSD have been developed and evaluated. However, all but one of these evaluations was conducted outside of the US and with civilian populations. The exception, "Delivery of Self Training and Education for Stressful Situations" (DESTRESSS), has been primarily tested on male service members and Veterans; only a handful of women participated in the two clinical trials evaluating its efficacy. Thus, there are limited data on its efficacy for this population, suggesting the need to evaluate whether it will meet the needs of women Veterans. Moreover, DESTRESS may not be optimal for women as it was not designed to target women Veterans' unique trauma experiences and needs. For example, DESTRESS does not include psychoeducation on interpersonal traumas nor does it address social support and relationship concerns central to women Veterans. To this end, we propose to conduct qualitative research with women Veterans and clinicians with content expertise to elicit their feedback on DESTRESS, make modifications to the program based on this feedback, and then conduct a pilot randomized clinical trial (RCT) evaluating the revised web-based, phone-assisted intervention with phone support only. Specifically, in Phase I we will conduct semi-structured interviews with 20 women Veterans with PTSD as well as with 4-6 expert providers regarding their impressions of DESTRESS. Changes will be made to DESTRESS as a result of this formative work, and the same women Veterans and expert providers will be re-interviewed to provide feedback on the changes made. In Phase II, we will conduct a pilot RCT wherein 70 women Veterans with PTSD are randomized to the intervention or phone support only. Measures of PTSD symptom severity (primary outcome) and depression and quality of life (secondary outcomes) will be collected at baseline, post-treatment, and 12- and 24-week follow-up assessments. Information about program utilization, dropout, patient satisfaction, and acceptability will also be collected. The long-term objective of this line of research is to develop low cost, accessible interventions for women Veterans with PTSD. Findings should improve our general knowledge about women Veterans' responses and preferences for care regarding tailored treatments for them, as well as result in an innovative, web-based intervention for women Veterans with PTSD.