Implementation of an Evidence-Based PTSD Treatment in Public Sector Settings

在公共部门环境中实施循证 PTSD 治疗

• 批准号: 8661051
• 负责人: Marylene Cloitre
• 金额: $ 118.52万
• 依托单位: PALO ALTO VETERANS INSTIT FOR RESEARCH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8661051
• 关键词: Address; Adherence; Administrator; Adoption; Affective; Aftercare; Ambulatory Care Facilities; Biological Markers; Boston; Characteristics; Child Abuse; Chronic; Chronic Disease; Client satisfaction; Clinic; Clinical; Cognitive Therapy; Collection; Communities; Comorbidity; DSM-IV; Data; Diagnosis; Disease remission; Domestic Violence; Dropout; Effectiveness; Emotions; Enrollment; Environment; Equipment and supply inventories; Event; Evidence based program; Evidence based treatment; Exposure to; Focus Groups; Future; General Population; Genetic; Impairment; Individual; Interpersonal Violence; Intervention; Investigation; Life; Measures; Mental Health; Mental Health Services; Military Personnel; New York; Online Systems; Ontario; Outcome; Participant; Patients; Pilot Projects; Population; Population Heterogeneity; Post-Traumatic Stress Disorders; Prevalence; Process; Protocols documentation; Provider; Public Sector; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recording of previous events; Regulation; Reporting; Research Design; Research Infrastructure; Resources; Sampling; Scientist; Self Efficacy; Self-Injurious Behavior; Sequential Treatment; Services; Severities; Severity of illness; Site; Substance abuse problem; Suicide; Symptoms; Technology; Training; Trauma; Treatment outcome; Variant; Woman; Work; clinical care; clinical material; clinically significant; design; effective therapy; efficacy trial; emotion regulation; evidence base; experience; flexibility; follow-up; high risk; innovation; mood regulation; negative mood; primary outcome; randomized trial; response; secondary outcome; sexual assault; skills training; social; therapy development; treatment as usual; uptake; web site

DESCRIPTION (provided by applicant): PTSD among women is a particularly pernicious and chronic disorder associated with significant psychiatric comorbidity, high rates of suicidality, substance abuse, self-injury and multiple traumatization including repeated sexual assault and domestic violence. Public-sector mental health services are the disproportionate recipient of traumatized women with between 62% to 98% of treatment seeking women reporting a history of trauma and of those, up to 40% carry a diagnosis of PTSD with various comorbidities. Over 40 single-site randomized trials of cognitive-behavioral therapy for PTSD have been conducted. However, to date, there are only two large-sample randomized clinical trials which have evaluated the effectiveness of such treatments in the community and both of them concerned military populations. This application proposes to evaluate the effectiveness of an evidence-based PTSD treatment in the context of a collaborative partnership of four public mental health clinics serving diverse populations. The intervention is a two module, sequential treatment (STAIR/MPE) in which the first module emphasizes present-focused skills training in affective an interpersonal regulation (STAIR) for day-to-day life difficulties and the second module incorporates past-focused work on the processing of the trauma, using a modified version of prolonged exposure (MPE). This cognitive behavioral treatment was specifically designed to treat high risk, multiply traumatized women with chronic PTSD and has been demonstrated to provide significant and clinically substantial relief from PTSD as well as improvement in emotion management and interpersonal functioning. We will assess the effectiveness of STAIR/MPE compared to Treatment as Usual (TAU) in the context of every day clinical care. The study is a randomized, controlled repeated measures intent-to-treat design to assess STAIR/MPE as compared to TAU at post-treatment and three and six-month follow-up. Four sites (Western Ontario, Boston, New York and Atlanta), each situated within a large public sector mental health network, will enroll 88 treatment-seeking women with PTSD related to interpersonal violence yielding a total of 352 study participants. The primary outcome will be PTSD symptom severity. Secondary outcomes will be negative mood regulation self-efficacy, interpersonal problems and general level of psychiatric impairment (GAF scores). Exploratory aims include the examination of the relationship between variations in treatment implementation and treatment outcome as well as the influence of patient characteristics and other contextual (therapist and organization) variables likely to impact implementation. We will also introduce web-based technology as a resource intended to strengthen clinical networks and maintain use of study materials after the trial has ended.

描述（由申请人提供）：女性创伤后应激障碍（PTSD）是一种特别有害的慢性疾病，与严重的精神合并症、高自杀率、药物滥用、自残和多重创伤（包括反复性侵犯和家庭暴力）相关。公共部门的心理健康服务是受创伤女性的不成比例的接受者，62%至98%的寻求治疗的女性报告有创伤史，其中高达40%的人被诊断患有创伤后应激障碍（PTSD）并伴有各种合并症。已经进行了超过 40 项针对 PTSD 认知行为治疗的单中心随机试验。然而，迄今为止，只有两项大样本随机临床试验评估了此类治疗在社区中的有效性，并且都涉及军队人群。该申请旨在评估在四个为不同人群提供服务的公共心理健康诊所的合作伙伴关系的背景下基于证据的创伤后应激障碍（PTSD）治疗的有效性。干预是一个双模块顺序治疗（STAIR/MPE），其中第一个模块强调针对日常生活困难的情感和人际调节（STAIR）中针对当前的技能培训，第二个模块结合了针对过去的创伤处理的工作，使用修改版的长期暴露（MPE）。这种认知行为疗法专门用于治疗患有慢性创伤后应激障碍（PTSD）的高风险、多重创伤女性，并已被证明可以显着且临床上实质性地缓解创伤后应激障碍（PTSD），并改善情绪管理和人际功能。我们将在日常临床护理中评估 STAIR/MPE 与常规治疗 (TAU) 相比的有效性。该研究是一项随机、对照、重复测量意向治疗设计，旨在评估 STAIR/MPE 与 TAU 在治疗后以及三个月和六个月随访时的比较。四个地点（西安大略省、波士顿、纽约和亚特兰大）均位于大型公共部门心理健康网络内，将招募 88 名因人际暴力而患有 PTSD 寻求治疗的女性，总共 352 名研究参与者。主要结果是 PTSD 症状的严重程度。次要结果是负面情绪调节自我效能、人际关系问题和一般精神障碍水平（GAF 评分）。探索性目标包括检查治疗实施的变化和治疗结果之间的关系，以及患者特征和其他可能影响实施的背景（治疗师和组织）变量的影响。我们还将引入基于网络的技术作为一种资源，旨在加强临床网络并在试验结束后维持研究材料的使用。