Mind Body Treatment for WTC Responders with Comorbid PTSD and Respiratory Illness

为患有创伤后应激障碍 (PTSD) 和呼吸系统疾病的 WTC 救援人员提供身心治疗

• 批准号: 8706140
• 负责人: EVELYN J BROMET
• 金额: $ 50.56万
• 依托单位: STATE UNIVERSITY NEW YORK STONY BROOK
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8706140
• 关键词: Mind; Body; Treatment; WTC; Responders

DESCRIPTION (provided by applicant): More than 30% of responders to the World Trade Center (WTC) disaster continue to experience significant medical and/or psychiatric problems in spite of the extensive clinical services offered by the WTC Health Programs. Moreover, 20% of these patients are burdened by both mental and physical illnesses. The two signature health sequelae of the WTC disaster, post-traumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) are highly comorbid. Psychiatric conditions, such as PTSD, exacerbate physical illness and increase treatment non-compliance, morbidity and mortality. The persistence of PTSD and LRS in WTC responders underscores the fact that our best efforts thus far are not sufficient, and, thus, new treatments are needed. To date, no behavioral intervention has been conducted with WTC responders to aid in the management of both PTSD and LRS. Mind-body treatments are cost-effective, efficacious treatments for comorbid mental-physical health problems in the short and long-term. The Relaxation Response Resiliency Program (3RP) is one of the leading and innovative mind-body treatments developed at Harvard by Dr. Herbert Benson and colleagues to reduce psychiatric and physical symptoms. Thus, we propose to adapt the 3RP to WTC responders and test its efficacy for simultaneously reducing PTSD and LRS in a randomized controlled trial. The aims of the current proposal are to (1) compare the effects of the 3RP versus a Health Enhancement Program on PTSD and LRS immediately post-intervention and at 3, and 6 months post intervention; (2) to evaluate the effects of the new interventions on medication usage, occupational and psychosocial functioning, and health service utilization through follow-ups; and, (3) to evaluate the effects of the 3RP versus the Health Enhancement Program on respiratory functioning (as assessed by spirometry), blood pressure, and pro-inflammatory markers immediately post-intervention and at 3 and 6 months post-intervention. We will use multimodal assessments including self-report, structured clinical interviews, daily in vivo electronic monitoring of medication use and skills practice, and biological immune and inflammation markers. We expect that the 3RP will not only simultaneously reduce PTSD and LRS but will facilitate improvements in functioning, proper medication use, and health service utilization. This treatment will also result in improved biological markers of stress and inflammation. Thus, we will be able to directly evaluate the impact of these biological markers on disease course and psychosocial changes. If this study confirms our predictions, it will be possible to implement the 3RP at other WTC-Health Program sites easily and inexpensively. Moreover, this study will be groundbreaking, as it is the first randomized clinical trial to evaluate the effects of a mind-body treatment on comorbid PTSD and respiratory illness.

描述（由申请人提供）：尽管世贸中心 (WTC) 健康计划提供了广泛的临床服务，但超过 30% 的世贸中心 (WTC) 灾难救援者仍然面临严重的医疗和/或精神问题。 此外，其中20%的患者同时患有精神和身体疾病。 世贸中心灾难的两个标志性健康后遗症，创伤后应激障碍（PTSD）和下呼吸道症状（LRS）是高度共病的。 创伤后应激障碍（PTSD）等精神疾病会加剧身体疾病，增加治疗不依从性、发病率和死亡率。 世贸中心响应者中持续存在的 PTSD 和 LRS 突显了这样一个事实，即我们迄今为止所做的最大努力还不够，因此需要新的治疗方法。 迄今为止，尚未对 WTC 响应人员进行行为干预来帮助管理 PTSD 和 LRS。 身心治疗是针对短期和长期共存身心健康问题的经济有效的治疗方法。 放松反应弹性计划 (3RP) 是哈佛大学 Herbert Benson 博士及其同事开发的领先创新身心疗法之一，旨在减轻精神和身体症状。 因此，我们建议将 3RP 应用于 WTC 应答者，并在随机对照试验中测试其同时减少 PTSD 和 LRS 的功效。 当前提案的目的是 (1) 比较 3RP 与健康增强计划在干预后立即以及干预后 3 个月和 6 个月对 PTSD 和 LRS 的影响； (2) 通过随访评估新干预措施对药物使用、职业和心理社会功能以及卫生服务利用的影响； (3) 评估效果 3RP 与健康增强计划在干预后立即以及干预后 3 个月和 6 个月时关于呼吸功能（通过肺活量测定法评估）、血压和促炎标志物的比较。 我们将使用多模式评估，包括自我报告、结构化临床访谈、药物使用和技能实践的日常体内电子监测以及生物免疫和炎症标记物。 我们预计 3RP 不仅会同时减少 PTSD 和 LRS，而且将促进功能、正确药物使用和卫生服务利用的改善。 这种治疗也将改善 压力和炎症的生物标记。 因此，我们将能够直接评估这些生物标志物对疾病进程和心理社会变化的影响。 如果这项研究证实了我们的预测，则可以在其他 WTC 健康计划地点轻松且廉价地实施 3RP。 此外，这项研究将具有开创性，因为它是第一个评估身心治疗对共病创伤后应激障碍和呼吸系统疾病的影响的随机临床试验。