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: 8857389
• 负责人: EVELYN J BROMET
• 金额: $ 50.58万
• 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 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8857389
• 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）：超过30%的世界贸易中心（WTC）灾难响应者继续经历重大的医疗和/或精神问题，尽管WTC卫生计划提供了广泛的临床服务。 此外，这些病人中有20%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。 精神疾病，如创伤后应激障碍，加重身体疾病，增加治疗不依从性，发病率和死亡率。 PTSD和LRS在WTC反应者中的持续存在强调了一个事实，即我们迄今为止所做的最大努力是不够的，因此需要新的治疗方法。 到目前为止，还没有行为干预已经进行了与世卫组织的反应，以帮助管理创伤后应激障碍和LRS。 身心治疗是具有成本效益的，有效的治疗共病的心理和身体健康问题的短期和长期。 放松反应复原力计划（3 RP）是由赫伯特·本森（Herbert Benson）博士及其同事在哈佛开发的领先且创新的心身治疗方法之一，旨在减少精神和身体症状。 因此，我们建议将3RP适应WTC反应者，并在随机对照试验中测试其同时降低PTSD和LRS的疗效。 本提案的目的是（1）比较3RP与健康促进计划在干预后即刻以及干预后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;以及（3）评估 3RP与健康增强计划在干预后即刻以及干预后3个月和6个月对呼吸功能（通过肺量测定法评估）、血压和促炎标志物的影响。 我们将使用多模式评估，包括自我报告，结构化临床访谈，每日体内电子监测药物使用和技能实践，以及生物免疫和炎症标志物。 我们期望3RP不仅能同时减少PTSD和LRS，而且能促进功能的改善，正确的药物使用和卫生服务的利用。 这种治疗也会改善 压力和炎症的生物标志物。 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，将有可能在其他WTC健康计划地点轻松且廉价地实施3RP。 此外，这项研究将是开创性的，因为它是第一个随机临床试验，以评估心身治疗对共病PTSD和呼吸系统疾病的影响。