Behavior Treatment for Chronic PTSD

描述（由申请人提供）：创伤后应激障碍（PTSD），创伤经历（如战斗、身体和性侵犯）后出现的一种严重的慢性焦虑症，其特征是急性症状重现、情绪麻木、逃避、过度觉醒和社会功能严重受损。有终生患病率，在一般人群中高达14%，在战斗退伍军人中超过30%。强化暴露疗法减少了慢性创伤后应激障碍的标志性特征（例如，侵入，生理反应）和许多相关的一般焦虑，目前被认为是社会心理治疗的选择。然而，暴露疗法并不能减少创伤后应激障碍的“负面”症状（例如，逃避、技能缺陷、社会孤立、人际关系困难、愤怒控制）。创伤管理疗法（TMT）是一种针对慢性战斗相关创伤后应激障碍的多组分行为治疗，通过结合患者教育、暴露疗法、社交技能训练（包括情绪管理）和系统的家庭作业，解决临床综合征的各个方面。初步证据表明，在退伍军人事务部接受治疗的退伍军人中，TMT在广泛的PTSD症状范围内得到了广泛的改善。这项应用是评估TMT疗效的下一步。具体来说，这个项目是一项前瞻性随机研究，比较TMT和暴露疗法治疗退伍军人慢性创伤后应激障碍。48名受试者将从华盛顿特区的退伍军人医疗中心招募，治疗将进行17周（积极治疗阶段）；受试者将被额外随访12个月（随访阶段），以确定治疗在四个功能领域的长期效果：(1)核心创伤后应激障碍症状；(2)社会和情感功能；(3)其他精神疾病的症状（如抑郁症）；(4)治疗的可信度和满意度。此申请是根据R21（探索/发展补助金）机制提交的。

DESCRIPTION (provided by applicant): Post-traumatic stress disorder (PTSD), a severe and chronic anxiety disorder that follows traumatic experiences (e.g., combat, physical, and sexual assault), is characterized by acute symptoms of re-experiencing, emotional numbing, avoidance, hyperarousal, and severe impairment in social functioning. There is lifetime prevalence, as high as 14% in the general population and over 30% among combat veterans. Intensive exposure therapy reduces the hallmark features of chronic PTSD (e.g., intrusions, physiological reactivity) and much of the associated general anxiety, and currently is considered the psychosocial treatment of choice. However, exposure therapy does not reduce the "negative" symptoms of PTSD (e.g., avoidance, skill deficits, social isolation, interpersonal difficulties, anger control). Trauma Management Therapy (TMT), a multi-component behavioral treatment for chronic combat-related PTSD addresses all aspects of the clinical syndrome, using a combination of patient education, exposure therapy, social skills training (including emotional management) and systematic homework assignments. Preliminary evidence shows that overall TMT results in broad improvement across the wide spectrum of PTSD symptoms in veterans treated within the VA. This application is the next step in the evaluation of the efficacy of TMT. Specifically, this project is a prospective randomized study comparing TMT to Exposure Therapy only for treatment of chronic PTSD in combat veterans within the VA. Forty-eight subjects will be recruited from VA Medical Centers in Washington, D.C. Treatment will be administered over a 17-week period (active treatment phase); and subjects will be followed for an additional 12-months (follow-up phase) to ascertain long-term effects of treatment across four domains of functioning: (1) core PTSD symptoms; (2) social and emotional function; (3) symptoms of other psychiatric conditions (e.g., depression); and (4) treatment credibility and satisfaction. This application is submitted under the R21 (Exploratory/Developmental Grants) Mechanism.