Cognitive-Behavior Therapy for Khmer Refugees: A Randomized Controlled Trial

描述（由申请人提供）：拟议的项目代表了我们的手动化，文化敏感的认知行为治疗的柬埔寨难民与PTSD谁有一个不完全的反应药物和支持性心理治疗的治疗发展的下一步。最初的治疗开发得到了主要研究者（K23，MH 066253）K奖的支持。这将是主要研究者的第一个独立R-01，因此符合NIH新研究者指定指南。最近的一项调查发现，超过50%的柬埔寨人在社区环境中符合PTSD标准，另一项调查显示，超过50%的柬埔寨患者在专科诊所仍然符合PTSD标准，即使经过多年的治疗，包括充分的精神药理学试验和支持疗法。尽管有充分的证据表明CBT在英语群体中治疗PTSD的有效性，但只有五项关于难民群体治疗效果的对照研究。这五项研究中有三项是由我们小组进行的（两项在柬埔寨难民中进行，一项在越南难民中进行）。除了我们对柬埔寨和越南难民的三项研究外，在美国还没有关于CBT治疗少数群体PTSD的有效性的研究。在我们的初步研究中，我们完成了NIH定义的心理社会治疗开发阶段。基于对柬埔寨难民的广泛研究，我们开发了一种手动治疗方法。在柬埔寨难民中，该治疗在一项小型随机对照试验（RCT）中进行了试点，与等待名单进行了比较，然后在一项中型RCT中进行了比较。在一个小型试验中，也是一个随机对照试验，与等待名单相比，证明了对患有难治性创伤后应激障碍的越南难民的疗效。在这些研究中，我们发现手动治疗被广泛接受和有效（具有较大的效应量），通过标准化评估措施进行评估，如临床医生管理的PTSD量表（CAPS）。拟议的赠款将使我们能够进一步调查我们的手动CBT干预柬埔寨难民与治疗抵抗性PTSD的疗效，建立在我们早期的研究，通过进行下一个合乎逻辑的步骤的实证调查：我们的手动治疗的比较另一个积极的治疗条件。

DESCRIPTION (provided by applicant): The proposed project represents the next step in treatment development of our manualized, culturally sensitive cognitive-behavior therapy for Cambodian refugees with PTSD who have had an incomplete response to medications and supportive psychotherapy. The initial treatment development was supported by a K award to the principal investigator (K23, MH066253). This will be the principal investigator's first independent R-01, hence meeting the NIH guidelines for new investigator designation. One recent survey found that over 50% of Cambodians in a community setting met PTSD criteria, and another survey, that over 50% of Cambodian patients in a specialty clinic still met PTSD criteria, even after years of treatment, including adequate trials of psychopharmacology and supportive therapy. Despite the ample evidence of the efficacy of CBT for the treatment of PTSD among English-speaking groups, there are only five controlled studies of treatment efficacy among refugee populations. Three of those five studies were conducted by our group (two among Cambodian refugees, one among Vietnamese refugees). There is no study of the efficacy of CBT for treating PTSD in a minority group in the United States, other than our three studies of Cambodian and Vietnamese refugees. In our preliminary study, we completed NIH-defined stages of psychosocial treatment development. Based on extensive research among Cambodian refugees, we developed a manualized treatment. Among Cambodian refugees, the treatment was piloted in a small randomized controlled trial (RCT), comparing to waitlist, and then, in a medium-sized RCT, also comparing to waitlist. In a small pilot, also a RCT comparing to waitlist, efficacy was demonstrated for Vietnamese refugees with treatment-resistant PTSD. In these studies, we found the manualized treatment to be well accepted and efficacious (with large effect sizes), as assessed by standardized assessment measures, such as the Clinician-Administered PTSD Scale (CAPS). The proposed grant would allow us to further investigate the efficacy of our manualized CBT intervention for Cambodian refugees with treatment-resistant PTSD, building on our earlier studies, by conducting the next logical step of empirical investigation: a comparison of our manualized treatment to another active treatment condition.