TREATMENT OF PTSD IN FEMALE SEXUAL ABUSE SURVIVORS

一项虽小但不断增长的文献表明，认知行为疗法 (CBT)是强奸或战区创伤幸存者的有效治疗方法 患有创伤后应激障碍(PTSD)的人，但没有 已发表的研究在PTSD患者中测试CBT 儿童期性虐待。此外，以前的CBT治疗结果 研究还没有监测到它对心理生理学和 已知的神经生物学异常与创伤后应激障碍有关。致信地址 在这两个问题上，一项随机临床试验被提出，将 对儿童期性行为继发的创伤后应激障碍妇女样本进行CBT评估 虐待。该项目的具体目标是：1)实现认知- 行为治疗方案；2)提供全面、纵向的 评估创伤后应激障碍症状，共同出现的精神问题， 心理生理反应和神经激素水平；以及3)测试 关于CBT近期和长期有效性的假设 与支持性咨询(SC)和等待名单对照进行比较。 84例女性儿童期继发性创伤后应激障碍患者 虐待将被随机分配到两个积极治疗组中的一个， CBT或SC，或到等待名单控制组。所有的女人都会是 最初评估和经过14个疗程的治疗(或在 在等待名单对照组的情况下，九周后)使用结构化 访谈和自我报告问卷。此外，无论是标准的 评估创伤后应激障碍(心率、皮肤)的心理生理指标 电导、面部肌电)及心血管辅助措施 反应性(心输出量、射血前时间和外周总时间 抗药性)将在治疗后最初和立即获得 一旦暴露在创伤中-无关的和创伤相关的被动和积极的- 应对任务。24小时无尿皮质醇、肾上腺素和 去甲肾上腺素以及甲状腺激素谱也将被 量过了。两个积极治疗组将接受相同的评估 在完成治疗六个月后，将获得临时 治疗3个月后进行心理测评。我们假设 CBT将比SC和等待名单更有效：1)在减少创伤后应激障碍方面 症状；2)降低心理生理反应的幅度 实验室应激源；3)使神经激素水平正常化；4) 减少抑郁、分离和其他焦虑症状。除了它的 临床价值作为一项治疗结果研究，该项目应该创造一个 有机会测试一些关于 创伤后应激障碍的精神病理学和病理生理学。

A small but growing literature suggests that cognitive-behavioral therapy (CBT) is an effective treatment for survivors of rape or war-zone trauma who develop posttraumatic stress disorder (PTSD), but there are no published studies testing CBT in PTSD patients who have been exposed to childhood sexual abuse. Furthermore, previous CBT treatment outcome studies have not monitored its effect on psychophysiological and neurobiological abnormalities known to be associated with PTSD. To address both of these issues, a randomized clinical trial is proposed that will evaluate CBT in a sample of women with PTSD secondary to childhood sexual abuse. The specific aims of this project are: 1) to implement a cognitive- behavioral treatment program; 2) to provide comprehensive, longitudinal assessment of PTSD symptoms, co-occurring psychiatric problems, psychophysiological reactivity, and neurohormonal levels; and 3) to test hypotheses concerning the immediate and long-term effectiveness of CBT in comparison to supportive counseling (SC) and wait-list controls. Eighty-four female outpatients with PTSD secondary to childhood sexual abuse will be randomly assigned to one of the two active-treatment groups, CBT or SC, or to a wait-list control group. All of the women will be assessed initially and after fourteen sessions of treatment (or in the case of the wait-list control group, after nine weeks) using structured interviews and self-report questionnaires. In addition, both the standard psychophysiological measures for assessing PTSD (heart rate, skin conductance, and facial EMG) and supplementary measures of cardiovascular reactivity (cardiac output, pre-ejection period, and total peripheral resistance) will be obtained initially and immediately following treatment upon exposure to trauma-unrelated and trauma-related passive- and active- coping tasks. Twenty-four hour urinary-free cortisol, epinephrine, and norepinephrine, as well as thyroid hormone profiles, will also be measured. The two active-treatment groups will undergo the same assessment six months after completing treatment and will receive an interim psychometric assessment three months after treatment. We hypothesize that CBT will be more effective than both SC and wait-list: 1) in reducing PTSD symptoms; 2) in decreasing the magnitude of psychophysiological responses to laboratory stressors; 3) in normalizing neurohormonal levels; and 4) in reducing depressive, dissociative, and other anxiety symptoms. Besides its clinical value as a treatment outcome study, this project should create an opportunity to test a number of theoretical questions regarding the psychopathology and pathophysiology of PTSD.