Cognitive-Behavior Treatment for Victims of Mass Violenc

大规模暴力可以说是影响最多人的心理健康的最严重形式的灾难，因此，满足大规模暴力受害者的心理健康需求是一项重大的公共卫生挑战。 需要为大量受大规模暴力影响的个人提供有效和早期的创伤后应激障碍治疗。 此外，由于没有针对大规模暴力和灾难幸存者的PTSD心理健康治疗的随机对照试验，因此没有具体的循证程序可以推荐以满足这一人群的特殊需求。 由于灾后资源往往稀缺，有效的干预措施必须是有效、可行、迅速可用并高效地提供给尽可能多的受灾个人。 在治疗其他创伤背景下的PTSD方面，有相当多的证据表明，认知行为疗法（CBT）程序在减少PTSD症状方面取得了实质性的成功。总的来说，现有的证据表明，使用延长暴露（PE）和压力接种训练（SIT），CBT的两个组成部分，与PTSD患者的理论和经验的理由。 现有研究的一个实际限制是，它们仅限于单独管理的治疗环境，通常需要在专业精神卫生保健环境中提供8至12个疗程。 这些治疗的劳动密集型性质代表了在大规模暴力事件的背景下向数千名患有PTSD的个体提供治疗的重大障碍。 该项目的主要目的是评估一个简短的，以初级护理为基础的CBT格式，旨在为PTSD患者提供有效的自我管理技能。 支持这种干预的基本原理是，通过在单次治疗期间进行适当和强化的治疗师输入，并系统地补充随后的自我导向的基于网络的信息和日常家庭作业活动指导，患有源于大规模暴力的PTSD的初级保健患者可以从已证明有效减少PTSD症状的策略中受益。 五角大楼9/11袭击的幸存者将被随机分配到PE，SIT或支持性咨询对照组。 患者的依从性和症状将在网上监测。 将在治疗后6个月和12个月对患者进行随访。

Mass violence is arguably the most severe form of disaster affecting the mental health of the largest number of people, thus addressing the mental health needs of victims of mass violence is a major public health challenge. There is a need for delivering effective and early treatments for PTSD to the large number of affected individuals by mass violence. In addition, since there are no randomized controlled trials of mental health treatments for PTSD in survivors of mass violence and disasters, there are no specific evidence-based procedures that can be recommended to meet the special needs of this population. Because resources are often scarce in the aftermath of disasters, a useful intervention is one that is effective, feasible, rapidly available, and efficiently delivered to the largest proportion of affected individuals possible. In terms of treating PTSD in other trauma contexts, there is considerable evidence that cognitive-behavioral therapy (CBT) procedures have substantial success in reducing the array of PTSD symptoms. Overall, the available evidence points to the theoretical and empirical justification for using Prolonged Exposure (PE) and Stress Inoculation Training (SIT), two components of CBT, with patients presenting with PTSD. A practical limitation of available studies is that they are limited to individually administered therapy contexts that typically require between 8 and 12 sessions delivered in a specialty mental health care- setting. The labor-intensive nature of these therapies represents a significant obstacle to provision of therapy to thousands of individuals suffering PTSD in the context of mass violence events. The major aim of this project is to evaluate an abbreviated, primary care-based format of CBT that aims to provide effective self-management skills to individuals with PTSD. The rationale underpinning this intervention is that with appropriate and intensive therapist input during a single session of therapy, supplemented systematically with subsequent self- directed web-based information and guidance for daily homework activity, primary care patients with PTSD stemming from mass violence can benefit from the strategies that have demonstrated efficacy in reducing PTSD symptoms. Survivors of the Pentagon attack on 9/11 will be randomly assigned to PE, SIT, or a supportive counseling control group. Patients' compliance and symptoms will be monitored on the web. Patients will be followed 6 and 12 months post-treatment.