Evaluation of Web-Based CBT for Women Veterans with PTSD

曾在军队服役的女性是美国人口中迅速增长的少数群体，也是增长最快的 退伍军人事务部（VA）的新用户群不断增长。最近的研究表明， 与平民相比，女性退伍军人报告的创伤暴露率显着较高， 创伤后应激障碍尽管存在基于证据的创伤后应激障碍治疗方法，但大多数女性退伍军人未充分利用VA 在乎有可能接触和吸引这些妇女的一项治疗创新是使用 互联网来进行治疗。已经开发了一些基于网络的PTSD CBT干预措施， 评估。然而，除了一项评估外，所有这些评估都是在美国境外进行的， 人口。例外情况是“在压力情况下进行自我培训和教育”， 主要在男性军人和退伍军人身上进行测试;只有少数女性参与了 两项临床试验评估其疗效。因此，关于其对该人群的疗效的数据有限， 这表明需要评估它是否能满足退伍军人的需要。此外，减压 可能对女性来说不是最佳选择，因为它不是针对女性退伍军人独特的创伤经历而设计的 和需求例如，DESTRESS不包括关于人际创伤的心理教育， 解决社会支持和关系问题的核心妇女退伍军人。为此，我们建议 与具有内容专业知识的女性退伍军人和临床医生进行定性研究，以获得他们的反馈 在减压时，根据反馈对程序进行修改，然后进行试验 一项随机临床试验（RCT），评估了修订后的基于网络的电话辅助干预， 仅支持。具体而言，在第一阶段，我们将与20名退伍军人进行半结构化访谈， PTSD以及4-6个专家提供者关于他们对抑郁症的印象。将作出改变 作为这项形成性工作的结果，同样的女性退伍军人和专家提供者将 重新进行访谈，以提供有关所做更改的反馈。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为干预组和电话支持组。PTSD的测量 将收集症状严重程度（主要结局）以及抑郁和生活质量（次要结局） 在基线、治疗后以及12周和24周随访评估时。关于计划的信息 还将收集利用率、脱落率、患者满意度和可接受性。长期目标是 一项研究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。结果 应该提高我们对女性退伍军人的反应和护理偏好的一般知识， 为她们量身定制治疗，并为女性退伍军人提供创新的基于网络的干预措施。 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.