PTSD Hyperarousal Symptoms Treated with Physiological Stress Management

通过生理压力管理治疗 PTSD 过度警觉症状

• 批准号: 7685552
• 负责人: WALTON Thompson ROTH
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-01 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7685552
• 关键词: Address; Aftercare; Age; Alcohol abuse; Alcohol consumption; Alcohols; Ambulatory Care Facilities; Ambulatory Monitoring; Anger; Anti-Anxiety Agents; Anxiety; Anxiety Disorders; Arousal; Benzodiazepines; Breathing; Client; Clinical; Clinical Psychology; Cognitive; Cognitive Therapy; Comorbidity; Control Groups; Dependence; Diagnosis; Diagnostic and Statistical Manual; Disease; Distress; Educational process of instructing; Effectiveness; Evaluation; Event; Exercise; Feedback; Freedom; Future; Galvanic Skin Response; Generalized Anxiety Disorder; Group Therapy; Health; Health Professional; Health Services; Heart Rate; Hour; Incentives; Individual; Inpatients; Intervention; Interview; Iraq; Knowledge; Laboratories; Licensing; Measurement; Measures; Memory; Mental Health; Mental disorders; Methods; Mission; Monitor; Muscle relaxation phase; Nightmare; Outcome Study; Outpatients; Pain; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacologic Substance; Pharmacological Treatment; Physical activity; Physiologic Monitoring; Physiological; Physiology; Play; Population; Post-Traumatic Stress Disorders; Preparation; Procedures; Process; Psychologist; Psychophysiology; Questionnaires; Randomized; Randomized Clinical Trials; Recruitment Activity; Regulation; Relaxation; Relaxation Therapy; Reporting; Research; Research Personnel; Residual state; Role; Safety; Services; Severities; Sleep; Sleeplessness; Soldier; Stress; Students; Substance abuse problem; Symptoms; Techniques; Testing; Time; Training; Trauma; Veterans; Waiting Lists; War; Work; base; cingulate cortex; clinically significant; combat; disability; efficacy testing; efficacy trial; experience; hypnotic; innovation; mental health personnel; neuroimaging; non-drug; operation; pre-doctoral; programs; psychologic; public health relevance; research clinical testing; sedative; sex; stress management; success; treatment program; volunteer

DESCRIPTION (provided by applicant): Hyperarousal is a key symptom of PTSD. Even after receiving trauma-focused therapy, PTSD patients may continue to suffer from hyperarousal. Neuroimaging findings in PTSD support the idea that regulation of autonomic arousal from the cingulate cortex can be helpful in reducing anxiety. Our main objectives are to measure hyperarousal in VA outpatients with PTSD related to combat experience in the last 10 years and to test the efficacy of physiological relaxation training in reducing this hyperarousal. Measurements will be both physiological, using 24 hour ambulatory monitoring of skin conductance, heart rate, and physical activity during waking and sleeping, and psychological, using self-reports and clinician interviews. Specific aims include initially evaluating 100 or more PTSD patients for the severity of their hyperarousal symptoms. Of these, 50 with at least moderate hyperarousal who either have participated in a trauma-focused therapy or have declined to participate in such a therapy will be recruited for a therapy trial. Volunteers will be randomized to treatment consisting of 5 sessions of individual physiological relaxation training with electromyographic and capnographic feedback over a 4-week period or to a 2-month waiting period after which they also may receive this therapy. Physiological evaluations of the patients' ability to relax while sitting quietly and their arousal levels during daily activities and sleep will be measured at three times - before treatment, 1 month after treatment, and 6 months after treatment. Clinical evaluations by interviews and questionnaires on measures of symptoms and disability will be measured at the same time points. The waiting-list group and a nonanxious control group will be tested psychophysiologically twice at the same interval as the patients before and 1 month after treatment. The control group will allow us to calibrate our physiological measures in the setting in which they are being applied. We hypothesize that this therapy will relieve both self-reported and objective, physiological symptoms of hyperarousal. Relevance to health and the VA mission: Many of our clients at the VA Palo Alto Mental Health Outpatient Services for PTSD are veterans of Iraq who need help with hyperarousal symptoms. This study will fill in gaps in our knowledge about the physiology of these symptoms and about the efficacy of relaxation therapies. Non- pharmacological treatments like the ones that we propose may relieve patients' hyperarousal to an extent that they are less tempted to turn to alcohol or sedative drugs. Physiological proof of the effectiveness of relaxation procedures in this clinical group would help convince clinicians to apply them and patient consumers to try them. PUBLIC HEALTH RELEVANCE: This project is highly relevant because of the large number of soldiers returning from Iraq are likely to be diagnosed with a mental illness, and about half of those will receive a diagnosis of PTSD. We mental health professionals and researchers are making every effort to prepare us for their treatment. Supplemental non- pharmaceutical treatments for hyperarousal need to be tested for efficacy in this new wave of PTSD patients, to establish their role among other treatments that are being offered or will be offered. VA mental health personnel know from past experience that combat PTSD patients often do not respond to a single treatment or treatment program. Having more treatment options with proven efficacy, will be of great clinical utility. Attempts to relieve anxiety with alcohol or other substances may be the reason for the high comorbidity between PTSD and alcohol and substance abuse in US combat veterans, although in some studies, substance abuse has tended to precede the traumatic event [13]. Ways for veterans to control their anxiety without the use of alcohol or benzodiazepine anxiolytics, which also tend to be problematic in this population, could be of great value in relieving the distress and disability caused by PTSD. In fact, non-drug anxiety management techniques have often been included in therapy packages for PTSD, but until a package is "dismantled," the current and future value of its individual components cannot be known. Although it is unlikely that any relaxation method can replace other therapy components known to be useful in PTSD such as exposure and cognitive restructuring, the methods we propose could turn out to be important supplements to those therapies. This application is innovative in being willing to challenge two clinical objections that have discouraged acceptance of relaxation for treatment of PTSD and other anxiety disorders: First, that relaxation is a "safety aid," ultimately limiting treatment success, and second, that a treatment directed to a single symptom of PTSD rather than to the disorder as a whole cannot be useful. Efficacy trials that we conducted have shown that such objections are not valid for PD and trials in progress suggest that they are not valid for episodic anxiety, a kind of spectrum PD, or for PTSD symptoms in those patients. Furthermore, we challenge the assumption that trauma-focused therapies make SMT irrelevant since they address the specific causes of PTSD. Our experience with persistent hyperarousal and other PTSD symptoms in veterans of previous wars gainsays this. Finally, in assessing our results we will examine physiological measures of relaxation, not just self- report and clinical measures. Physiological monitoring will be applied not only during the training exercises and in the laboratory, but also ambulatorily for 24-hour periods that include daily activities and sleep.

描述（由申请人提供）： 过度兴奋是创伤后应激障碍的一个重要症状。即使在接受创伤治疗后，PTSD患者可能会继续遭受过度觉醒。创伤后应激障碍的神经影像学研究结果支持扣带皮层对自主觉醒的调节有助于减轻焦虑的观点。 我们的主要目标是测量在过去10年的战斗经验与创伤后应激障碍的VA门诊患者的过度觉醒，并测试在减少这种过度觉醒的生理放松训练的疗效。测量将是生理性的，使用24小时动态监测皮肤电导、心率和清醒和睡眠期间的身体活动，以及心理性的，使用自我报告和临床医生访谈。具体目标包括初步评估100名或更多PTSD患者的过度觉醒症状的严重程度。其中，将招募50名至少中度过度觉醒的患者进行治疗试验，这些患者要么参加了创伤集中治疗，要么拒绝参加这种治疗。志愿者将随机接受治疗，包括在4周内进行5次单独的生理放松训练，并进行肌电图和二氧化碳监测反馈，或者接受2个月的等待期，之后他们也可以接受这种治疗。将在治疗前、治疗后1个月和治疗后6个月三次测量患者静坐时放松能力的生理学评估以及日常活动和睡眠期间的唤醒水平。将在同一时间点通过访谈和问卷调查对症状和残疾进行临床评价。等待组和非焦虑对照组将在治疗前和治疗后1个月的相同时间间隔进行两次心理生理测试。对照组将允许我们在应用它们的设置中校准我们的生理测量。我们假设，这种疗法将缓解自我报告和客观的生理症状的过度觉醒。 与健康和退伍军人事务部使命的相关性：我们在退伍军人事务部帕洛阿尔托创伤后应激障碍心理健康门诊服务的许多客户都是伊拉克的退伍军人，他们需要帮助治疗过度觉醒症状。这项研究将填补我们对这些症状的生理学和放松疗法的疗效的知识空白。像我们提出的非药物治疗可能会减轻患者的过度觉醒，使他们不那么容易转向酒精或镇静药物。在这个临床群体中放松程序的有效性的生理证据将有助于说服临床医生应用它们和患者消费者尝试它们。 公共卫生相关性： 该项目具有高度相关性，因为大量从伊拉克返回的士兵可能被诊断患有精神疾病，其中约一半将接受创伤后应激障碍的诊断。我们精神卫生专业人员和研究人员正在尽一切努力为他们的治疗做好准备。针对过度觉醒的补充性非药物治疗需要在这一新一波创伤后应激障碍患者中进行疗效测试，以确定它们在正在提供或即将提供的其他治疗中的作用。退伍军人事务部的心理健康人员从过去的经验中知道，与创伤后应激障碍作斗争的患者往往对单一的治疗或治疗方案没有反应。有更多的治疗选择与证明疗效，将有很大的临床效用。 试图用酒精或其他物质缓解焦虑可能是美国退伍军人中PTSD与酒精和药物滥用之间高共病率的原因，尽管在一些研究中，药物滥用倾向于在创伤事件之前[13]。退伍军人在不使用酒精或苯二氮卓类抗焦虑药的情况下控制焦虑的方法，在这一人群中也往往是有问题的，在减轻创伤后应激障碍引起的痛苦和残疾方面可能具有很大的价值。事实上，非药物焦虑管理技术经常被包括在创伤后应激障碍的治疗方案中，但是直到一个方案被"拆除"，它的各个组成部分的当前和未来价值都是未知的。虽然任何放松方法都不太可能取代其他已知对PTSD有用的治疗成分，如暴露和认知重建，但我们提出的方法可能会成为这些疗法的重要补充。 本申请的创新之处在于愿意挑战两个临床反对意见，这两个反对意见阻碍了接受放松治疗创伤后应激障碍和其他焦虑症：第一，放松是一种"安全辅助"，最终限制了治疗的成功，第二，针对创伤后应激障碍的单一症状而不是整个障碍的治疗是无效的。我们进行的功效试验表明，此类反对意见对PD无效，正在进行的试验表明，它们对这些患者的发作性焦虑（一种谱系PD）或创伤后应激障碍症状无效。此外，我们挑战的假设，创伤为重点的治疗，使SMT无关，因为他们解决了创伤后应激障碍的具体原因。我们在经历过战争的退伍军人中发现的持续性过度觉醒和其他创伤后应激障碍症状的经验否定了这一点。 最后，在评估我们的结果时，我们将检查放松的生理措施，而不仅仅是自我报告和临床措施。生理监测不仅将在训练和实验室中应用，还将在24小时内进行，包括日常活动和睡眠。