Treating Adolescents with CSA-Related PTSD

描述（由申请人提供）：9月11日的灾难和迫在眉睫的恐怖主义活动的持续威胁使开发和测试有效干预创伤相关心理障碍（如创伤后应激障碍）的必要性成为当务之急。然而，重要的是要记住，恐怖袭击只是一种创伤，事实上，在美国，与自然灾害、交通事故和袭击等其他类型的创伤相比，恐怖袭击的相关性要小得多。值得注意的是，来自儿童、青少年和成人的大规模流行病学研究的数据表明，儿童性虐待（CSA）的终生患病率为10%。此外，62%的强奸发生在儿童或青少年时期。鉴于CSA的高患病率，以及CSA、PTSD、药物滥用和青春期性再受害之间的明确联系，对于因CSA或性侵犯而遭受PTSD和相关情感困难的青少年，开发高效、有效和易于传播的治疗方法至关重要。目前，对于患有CSA和性侵犯相关创伤后应激障碍的成人和儿童有有效的治疗方法，但对于如何最好地治疗患有创伤后应激障碍和相关症状的创伤青少年，包括与性侵犯相关的创伤后应激障碍，知之甚少。本研究旨在探讨认知行为治疗暴露于CSA和性侵犯的青少年创伤后应激障碍的疗效。最重要的是，治疗将由社区诊所的咨询师进行，该诊所为不同发育阶段的性侵犯受害者提供服务。主要目的是：1)比较两种积极治疗，青少年延长暴露（PE-A）和支持性咨询（SC）在减轻PTSD症状严重程度方面的直接效果；2)评估随访时PE-A治疗效果的维持情况。次要目的是：1)比较PE-A和SC对减轻继发性精神病理症状的作用；2)探讨创伤后应激障碍症状变化与痛苦相关认知和情绪变化的关系。拟议的研究完全符合美国国立卫生研究院/NIMH健康人群2010年制定的国家卫生政策和优先事项：1)提供有效的心理健康治疗，提高患有创伤后应激障碍症状的人的健康生活质量和寿命；2)通过使社区更容易获得专业精神卫生资源来减少精神卫生可及性差距。

DESCRIPTION (provided by applicant): The disaster of September 11 and the constant threat of imminent terrorist activity have brought into the forefront the need to develop and test efficient interventions for trauma-related psychological disturbances such as PTSD. It is important to remember, however, that terror-attacks constitute only one type of trauma and in fact is much less relevant in the US than other types of trauma such as natural disasters, traffic accidents and assault. Notably, data from large-scale epidemiological studies of children, adolescents, and adults indicate a 10% lifetime prevalence of child sexual abuse (CSA). Moreover, 62% of rapes occur during childhood or adolescence. Given the high prevalence of CSA, a clear association between CSA, PTSD, substance abuse, and sexual re-victimization during adolescence, it is of paramount importance to develop efficient, effective, and readily disseminable treatments for adolescents who suffer PTSD and related emotional difficulties as a result of CSA or sexual assault. Presently, there are effective treatment for adults and for children who suffer from CSA and sexual assault related PTSD, but very little is known about how best to treat traumatized adolescents who suffer from PTSD and associated symptoms, including PTSD related to sexual assault. The proposed research aims to examine the efficacy of a cognitive behavioral treatment developed for PTSD in adolescents exposed to CSA and sexual assault. Most importantly, the treatment will be conducted by counselors at a community clinic that provides services to victims of sexual assault across the developmental spectrum. Primary aims are: 1) To compare the immediate outcome of two active treatments, Prolonged Exposure for Adolescents (PE-A) and supportive counseling (SC), in reducing PTSD symptom severity; and 2) To assess maintenance of PE-A treatment gains at follow-up. Secondary aims are: 1) To compare PE-A and SC's effects in reducing secondary psychopathology symptoms; 2) To examine the relationship between change in PTSD symptoms and change in distress-related cognitions and emotions. The proposed research falls squarely within the national health policy and priorities set by the NIH/NIMH Healthy People 2010 by: 1) providing efficacious mental health treatment that promotes the quality and years of healthy life of people suffering from PTSD symptoms; and 2) reducing the mental health access disparity by making specialty mental health resources more accessible to the community at large.