Integrated Alcohol Disorder and PTSD Treatment

描述（由申请人提供）： 目标.酒精使用障碍（AD）和创伤后应激障碍（PTSD）的共同发生是常见的。研究支持暴露疗法作为PTSD的一线治疗方法，因为这种方法最有可能导致从这种疾病中持续恢复。然而，AD患者通常不提供暴露疗法，因为他们认为暴露会导致更多的酒精使用和其他危险行为。大多数AD/PTSD的研究和临床治疗都涉及基于应对技能的疗法，这些疗法通常不会持续减少酒精使用和PTSD症状。越来越多的证据表明，这些患有AD/PTSD的人能够处理并受益于暴露。这项拟议的试验将比较综合暴露心理疗法与综合应对技能心理疗法治疗AD/PTSD。此外，在两种治疗条件下，包括治疗过程变量，负面影响的变化和睡眠问题，退伍军人与AD/PTSD的变化机制将进行探讨。重要性：该项目解决了该领域的一个关键障碍-人们普遍认为AD和PTSD患者不能耐受暴露疗法，尽管这是PTSD的最佳实践治疗。如果完成，该项目将有助于改变这种高度流行和高度痛苦的人群的治疗方法。其基本原理是改善证据基础，告知AD/PTSD患者如何实现持续康复。创新：该应用程序旨在改变当前的临床实践模式。通过整合两种循证治疗，提出了对现有干预措施的改进。暴露治疗方案的简单性使其易于传播和修改AD治疗设置。方法论我们提出了一项随机对照试验，以评估一个综合的基于暴露的治疗（综合延长暴露; I-PE）并发AD和PTSD是基于证据的，包括在体内暴露和创伤处理。主要目的是进行一项随机对照试验，以评估I-PE与目前专注于应对技能的干预（寻求安全）相比，对148名患有AD和PTSD的男性和女性退伍军人的影响。假设在治疗后，两组都将显示酒精使用减少，但I-PE将显示比SS更大的PTSD症状减少。在基线后5个月和8个月的随访中，I-PE的饮酒天数百分比和PTSD症状明显少于SS。此外，将检查两种治疗条件的变化机制。

DESCRIPTION (provided by applicant): Objectives. Co-occurrence of alcohol use disorder (AD) and posttraumatic stress disorder (PTSD) is common. Research supports exposure therapy as the front line treatment for PTSD as this approach is most likely to lead to sustained recovery from the disorder. However, individuals with AD are generally not offered exposure therapies because of beliefs that exposure would lead to engagement in greater alcohol use and other dangerous behaviors. Most research and clinical treatment for AD/PTSD have involved coping skills based therapies that have generally not shown sustained reductions in alcohol use and PTSD symptoms. A growing body of evidence suggests these individuals with AD/PTSD are able to handle and benefit from exposure. This proposed trial will compare an integrated exposure psychotherapy to an integrated coping skills psychotherapy for the treatment of AD/PTSD. In addition, mechanisms of change for Veterans with AD/PTSD in both treatment conditions, including therapy process variables, changes in negative affect, and sleep problems, will be explored. Significance: This project addresses a critical barrier in the field - the widely held belief that individuals with AD and PTSD cannot tolerate exposure therapy, although it is the best practice treatment for PTSD. If completed, this project will help change the practices that drive treatment for this highly prevalent and highly distressed population. The fundamental rationale is to improve the evidence base that informs how patients with AD/PTSD can attain sustained recovery. Innovation: This application seeks to shift current clinical practice paradigms. A refinement to existing interventions is proposed through integration of two evidence based treatments. The simplicity of the exposure therapy protocol makes it amenable to dissemination and modification to AD treatment settings. Methodology. We propose a randomized controlled trial to evaluate an integrated exposure-based treatment (Integrated Prolonged Exposure; I-PE) for concurrent AD and PTSD that is evidence based and includes both in-vivo exposure and trauma processing. The primary aim will be to conduct a randomized controlled trial to evaluate the effects of I-PE when compared to a present-focused coping skills based intervention (Seeking Safety) in 148 male and female Veterans who have AD and PTSD. The hypotheses are that at post-treatment both groups will show reductions in alcohol use, but I-PE will demonstrate greater reductions in PTSD symptoms than SS. At 5- and 8- month post-baseline follow-up, I-PE will have significantly fewer percent drinking days and fewer PTSD symptoms than SS. In addition, mechanisms of change in both treatment conditions will be examined.