Written Exposure Therapy (WET) as a brief trauma treatment for Veterans with Co-occurring Substance Use Disorders and PTSD

接受治疗的人中，创伤暴露和创伤后应激障碍（PTSD）的发生率很高。 寻找患有药物滥用障碍 (SUD) 的退伍军人。患有 SUD 的退伍军人中患有共病 PTSD 的因素 导致治疗结果不佳，并与整体心理和身体健康状况较差有关。成瘾的同时 传统上，项目并不能解决创伤后应激障碍（PTSD）问题，越来越多的证据表明，创伤治疗不仅 治疗 PTSD，甚至可能改善患有合并症的患者的 SUD 治疗保留率和结果。 患有 SUD 的退伍军人通常在 SUD 专科诊所接受治疗，那里的工作人员没有接受过创伤方面的培训，因此 不提供 PTSD 治疗。因此，尽管退伍军人事务部 (VA) 优先考虑 对创伤后应激障碍（PTSD）进行有效的循证心理治疗，只有一小部分退伍军人患有创伤后应激障碍（PTSD） SUD接受这种治疗。书面暴露疗法（WET）是一种以创伤为重点的简短干预措施 有效治疗创伤后应激障碍。与传统疗法相比，WET 具有多种优势；它可以分5次进行， 与其他 PTSD 治疗相比，退出率较低，患者满意度高，并且可以轻松 治疗师培训要求最低，因此具有成本效益，因此是理想的选择 在繁忙的 SUD 门诊进行管理干预。之前的一项研究表明，书面接触是 住院 SUD 治疗对于减少女性 PTSD 症状是可行且有效的。在最近的一次 可接受性和可行性试点研究中，寻求 SUD 治疗的患有共病 PTSD 的退伍军人 (N=12) 随机分配至 WET 加常规治疗 (TAU) 或通过中性书写条件增强 TAU。结果 表明这种基于写作的干预是可行且可以接受的。 WET 与更大的相关性 基线后 8 周随访时 PTSD 症状减少，平均数量减少更多 与对照组相比，随访时饮酒和吸毒的天数。 拟议的研究是 SUD 专科诊所内的一项随机临床试验，旨在评估 TAU 是否 另外，WET 优于 TAU，并通过关于 PTSD 和成瘾结果的中立主题写作来增强 接受 SUD 治疗的退伍军人。拟议的研究还将检查自主神经唤醒的生物标记， 心率变异性（HRV），以确定它是否可能是潜在的客观衡量指标 治疗效果。新证据表明高频 HRV 可能对 SUD 和 PTSD 敏感 症状改善以及压力与物质之间联系的可能机制 使用。 [本研究将探讨 HRV 与治疗结果之间的关联。我们还将检查 HRV 评分随时间的变化是否与治疗结果（PTSD 症状和治疗天数）相关 物质使用）。] 该项目的具体目标是检查 TAU 的 WET 增强是否：a) 改善创伤 与 TAU 相比，正在接受门诊 SUD 治疗的患有 SUD 和 PTSD 的退伍军人的症状 具有中性书写控制； b) 与其他退伍军人相比，改善患有 PTSD 的退伍军人的 SUD 结果 TAU 具有中性写入控件。寻求 SUD 治疗且同时患有 PTSD 的退伍军人将 被随机分配到 WET 加 TAU 或通过中性主题写作条件增强的 TAU。措施 每次写作时都会收集创伤症状、痛苦和情绪，以及静息 HRV 和 在基线、治疗后（大约 6 周）、8 周和 12 周后进行额外评估 基线评估。主要结果将是创伤症状、物质使用和 HRV 的变化。如果结果 证明有希望，他们将支持 WET 作为有效的简报、成本效益高、易于传播、辅助 目前 SUD 治疗患有共病 PTSD 的退伍军人。

There are high rates of trauma exposure and posttraumatic stress disorder (PTSD) among treatment- seeking veterans with substance use disorders (SUD). Comorbid PTSD among veterans with SUD contributes to poor treatment outcomes and is associated with worse overall mental and physical health. While addiction programs traditionally do not address PTSD, increasing evidence suggests that trauma treatments not only treat PTSD, but may even improve SUD treatment retention and outcomes among those with comorbidity. Veterans with SUD are usually treated in SUD specialty clinics, where staff are not trained in trauma, and thus do not offer PTSD treatment. So, although the Department of Veterans Affairs (VA) prioritizes the administration of effective evidence-based psychotherapies for PTSD, only a small percentage of veterans with SUD receive this treatment. Written exposure therapy (WET) is a brief trauma-focused intervention shown to effectively treat PTSD. WET has several advantages over traditional therapies; it can be delivered in 5 sessions, has lower dropout compared to other PTSD treatments, has high patient satisfaction, and can be easily delivered with minimal therapist training requirements making it cost efficient and therefore an ideal intervention for administration in a busy outpatient SUD clinic. A previous study suggested written exposure is feasible and effective in decreasing symptoms of PTSD among women in residential SUD treatment. In a recent acceptability and feasibility pilot study, SUD treatment-seeking veterans (N=12) with comorbid PTSD were randomized to WET plus treatment as usual (TAU) or TAU augmented by a neutral writing condition. Results showed this writing-based intervention was feasible and acceptable. WET was associated with a greater decrease in PTSD symptoms at 8-week post-baseline follow-up and a greater decrease in the average number of days of alcohol and drug use at follow-up compared to controls. The proposed study is a randomized clinical trial within a SUD specialty clinic to evaluate whether TAU plus WET is superior to TAU augmented by neutral topic writing on both PTSD and addiction outcomes for veterans in SUD treatment. The proposed study will also examine a biological marker of autonomic arousal, heart rate variability (HRV), in order to determine whether it might be a potential objective measure of treatment efficacy. Emerging evidence suggests high-frequency HRV may be sensitive to SUD and PTSD symptom improvement and a possible mechanism underlying the connection between stress and substance use. [This study will examine the association between HRV and treatment outcomes. We will also examine whether change in HRV scores over time correlates with treatment outcomes (PTSD symptoms and days of substance use).] The specific aims of the project are to examine whether WET augmentation of TAU: a) improves trauma symptoms for veterans with SUD and PTSD who are receiving outpatient SUD treatment compared to TAU with a neutral writing control; and b) improves SUD outcomes for veterans with comorbid PTSD compared to TAU with a neutral writing control. Veterans seeking SUD treatment who present with co-occurring PTSD will be randomized to either WET plus TAU or TAU augmented by a neutral topic writing condition. Measures of trauma symptoms, distress, and mood will be collected at each writing session, with resting HRV and additional assessments at baseline, at post-treatment (approximately 6-weeks), 8-weeks, and 12-weeks post- baseline assessment. Main outcomes will be change in trauma symptoms, substance use, and HRV. If results prove promising, they will support WET as an effective brief, cost efficient, easy to disseminate, adjunct to current SUD treatment for veterans with comorbid PTSD.