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

描述(由申请人提供)：拟议的项目代表着我们为患有创伤后应激障碍的柬埔寨难民开发的手工、文化敏感的认知行为疗法的下一步，这些难民对药物和支持性心理治疗有不完全的反应。最初的治疗开发得到了对首席研究员(K23，MH066253)的K奖的支持。这将是首席调查员的第一个独立R-01，因此符合NIH关于新调查员指定的指南。最近的一项调查发现，在社区环境中，超过50%的柬埔寨人符合创伤后应激障碍标准，另一项调查发现，即使经过多年的治疗，包括充分的精神药理学和支持性治疗，专科诊所仍有超过50%的柬埔寨患者符合创伤后应激障碍标准。尽管有充分的证据表明CBT在说英语的人群中治疗创伤后应激障碍的有效性，但只有五项关于难民人口治疗有效性的对照研究。这五项研究中有三项是由我们小组进行的(两项针对柬埔寨难民，一项针对越南难民)。除了我们对柬埔寨和越南难民的三项研究外，还没有关于CBT在美国少数族裔群体中治疗创伤后应激障碍的疗效的研究。在我们的初步研究中，我们完成了NIH定义的心理社会治疗发展阶段。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，这种治疗是在一项小型随机对照试验(RCT)中进行的，与等待名单进行比较，然后在中型随机对照试验中，也与等待名单进行比较。在一项小型试验中，与等待名单相比，这也是一项随机对照试验，对患有难治性创伤后应激障碍的越南难民显示了疗效。在这些研究中，我们发现，通过标准化的评估方法，如临床医生管理的创伤后应激障碍量表(CAPS)，我们发现机械化治疗被很好地接受和有效(效果大)。拟议的赠款将使我们能够在我们先前研究的基础上，通过开展下一个符合逻辑的实证调查步骤，进一步调查我们对患有难治性创伤后应激障碍的柬埔寨难民进行的手动CBT干预的有效性：将我们的手动治疗与另一种积极的治疗条件进行比较。

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.