Sleep-directed hypnosis as a complement to CPT in treating PTSD

描述（由申请人提供）：该提案旨在测试睡眠指导催眠作为现有经验支持的心理社会干预的补充的有效性，认知加工疗法（CPT）在患有PTSD的人际暴力幸存者样本中。此外，该提案旨在确定治疗中导致症状改善、更大功能领域改善和健康相关问题的作用机制。为此，将进行多方法、多模式评估，包括精神病学、心理学和心理生理学领域的每日和间歇监测。具体而言，40名受试者将被随机分配到催眠+ CPT（hypCPT）条件或症状监测延迟治疗组（SMDT），该症状监测延迟治疗组（SMDT）旨在控制监测的影响、时间的推移，并作为评估睡眠、PTSD症状和日常压力之间基本时间关系的手段。利用半交叉设计，将对照条件交叉至活性治疗，允许在研究中重复。将整个治疗样本（N = 40）与最近仅接受过严格CPT治疗的类似创伤幸存者样本（N = 50）进行比较，通过最近结束的NIH资助的大规模临床试验，在同一研究中心使用相同的措施进行手动治疗。本研究的参与者将接受一系列访谈和自我报告措施，包括1。临床医生管理PTSD量表，2.）DSM-IV轴I障碍的结构化临床访谈，3。标准化创伤访谈，4。）创伤后应激障碍诊断量表，5）贝克抑郁量表- II，6。Pennebaker边缘系统Landuigness量表，7。）SF-36健康调查，8。生活质量量表，9。社会适应量表、匹兹堡睡眠质量指数和失眠严重程度指数。此外，生理指标将用于评估睡眠障碍和过度觉醒之间的关系以及生理反应性随时间的变化。还将进行精神警觉任务，以测试睡眠剥夺（即通过反应时间测量的“嗜睡”）的存在以及随时间的相关变化。受试者将通过使用每日日记监测症状和每日压力源，并在治疗前、治疗后和三个月随访点进行正式评估。进行拟议的研究将有重要的意义，对补救睡眠障碍（最常报告的症状PTSD和最难治疗的一个）利用一种新的方法，催眠，在创伤人群中。同时，这一建议旨在阐明催眠的作用机制，这是一种研究不足的补充治疗元素，在创伤文献中几乎没有经验支持。 公共卫生相关性：创伤后应激障碍（PTSD）通常被认为是慢性和持久的表现，并且通常与多个功能领域的衰弱性损伤相关，从而导致高水平的社会成本（Kessler，2000）睡眠障碍被认为是PTSD发展的早期预测因素（Koren等，2002），是17种PTSD症状中最常报告的（绿色，1993年），被认为是最难治疗的（Krakow，Hollifield，et al，2001;库珀and Clum，1989; Zayfert and DeViva，2004），并被鉴定为PTSD症状与躯体化和功能障碍之间的中介（Clum，Nishith，& Resick，2001; Mellman et al，1995; Mohr等人，2003年）。因此，创伤人群中睡眠障碍的特定补救可能会导致整体PTSD发病率的大幅下降，从而导致心理社会障碍，健康相关问题和社会费用的减少。

DESCRIPTION (provided by applicant): This proposal seeks to test the efficacy of sleep-directed hypnosis as a complement to an existing empirically supported psychosocial intervention, Cognitive Processing Therapy (CPT) in sample of survivors of interpersonal violence suffering from PTSD. Further, this proposal seeks to identify mechanisms of action in the therapy that lead to symptom modification, improvement in larger domains of functioning, and health-related concerns. Towards this end, a multi-method, multimodal assessment will be administered including daily and intermittent monitoring across psychiatric, psychological, and psychophysiological domains. Specifically, forty subjects will be randomly assigned to either a hypnosis + CPT (hypCPT) condition or to a symptom monitoring, delayed treatment group (SMDT) designed to control for the effects of monitoring, the passage of time, and as a means to assess the basic temporal relationship between sleep, PTSD symptoms and daily stress. Utilizing a semicrossover design, the control condition will be crossed over to the active treatment, allowing for a replication within the study. The entire treated sample (N = 40) will be compared to a sample (N = 50) of similar trauma survivors who have recently been treated with a strict CPT only, manualized therapy through the course of a recently concluded NIH-funded large scale clinical trial conducted at the same site and using the same measures. Participants in this study will be administered a battery of interviews and self-report measures including the 1.) Clinician Administered PTSD Scale, 2.) Structured Clinical Interview for DSM-IV Axis I Disorders, 3.) Standardized Trauma Interview, 4.) PTSD Diagnostic Scale, 5) Beck Depression Inventory - II, 6.) Pennebaker Inventory of Limbic Landuigness, 7.) The SF-36 Health Survey, 8.) Quality of Life Inventory, 9.) Social Adjustment Scale, 10) Pittsburgh Sleep Quality Index, and the 11) Insomnia Severity Index. In addition, physiological indices will be used to assess the relationship between sleep impairment and hyperarousal as well as changes over time in physiological reactivity. A Psychomotor Vigilance Task will also be administered to test for the presence of sleep deprivation (i.e. "sleepiness" as measured by reaction time) as well as related changes over time. Subjects will monitor symptoms and daily stressors through the use of daily diaries as well as undergo formal assessments at pre-treatment, post- treatment and three month follow-up points. Conducting the proposed study will have important implications on remediating sleep impairment (the most often reported symptom of PTSD and one of the most refractory to treatment) utilizing a novel approach, the addition of hypnosis, within a traumatized population. Concurrently this proposal aims to illuminate the mechanisms of action in hypnosis, an understudied complementary treatment element with virtually no empirical support in the trauma literature. Public Health Relevance: Posttraumatic Stress Disorder (PTSD) is commonly considered to be chronic and enduring in presentation and is typically associated with debilitating impairment across multiple domains of functioning with a resultant high level of societal cost (Kessler, 2000) Sleep impairment is identified as an early predictor of the development of PTSD (Koren, et al, 2002), is the most often reported of the 17 PTSD symptoms (Green, 1993), is considered one of the most refractory to treatment (Krakow, Hollifield, et al, 2001; Cooper and Clum, 1989; Zayfert and DeViva, 2004), and is identified as a mediator between PTSD symptoms and somatization and functional disability (Clum, Nishith, & Resick, 2001; Mellman et al, 1995; Mohr et al., 2003). Thus the specific remediation of sleep impairment within a trauma population could result in substantial decreases in overall PTSD symptomatology which would then result in reduced psychosocial impairment, health-related concerns, and societal expense.