Mind Body Treatment for WTC Responders with Comorbid PTSD and Respiratory Illness

描述(由申请人提供)：尽管世贸中心健康计划提供了广泛的临床服务，但超过30%的世贸中心灾难响应者仍面临严重的医疗和/或精神问题。此外，这些患者中有20%同时背负着精神和身体疾病的负担。WTC灾难的两个标志性健康后遗症--创伤后应激障碍(PTSD)和下呼吸道症状(LRS)高度共存。精神疾病，如创伤后应激障碍，会加剧身体疾病，增加治疗不依从、发病率和死亡率。创伤后应激障碍和LRS在WTC应答者中的持续存在强调了这样一个事实，即我们迄今所做的最大努力是不够的，因此，需要新的治疗方法。到目前为止，还没有对WTC应答者进行行为干预，以帮助管理创伤后应激障碍和LRS。心身疗法是短期和长期内同时存在的心理和身体健康问题的高性价比、有效的治疗方法。放松反应复原计划(3RP)是哈佛大学赫伯特·本森博士和他的同事开发的领先和创新的心身疗法之一，旨在减少精神和身体症状。因此，我们建议使3RP适应WTC应答者，并在随机对照试验中测试其同时减少PTSD和LRS的有效性。目前建议的目的是(1)比较3RP和健康促进计划在干预后即刻、干预后3个月和6个月对创伤后应激障碍和生活自责的影响；(2)通过随访评估新干预措施对药物使用、职业和心理社会功能以及卫生服务利用的影响；以及(3)评估 在干预后即刻、干预后3个月和干预后6个月，3RP与健康促进计划对呼吸功能(通过肺活量测定法进行评估)、血压和促炎标志物的影响。我们将使用多模式评估，包括自我报告、结构化临床访谈、每日体内药物使用和技能实践的电子监测，以及生物免疫和炎症标志物。我们预计，3RP不仅将同时减少创伤后应激障碍和LRS，还将促进功能、正确用药和卫生服务利用的改善。这种治疗也将导致改善 压力和炎症的生物标记物。因此，我们将能够直接评估这些生物标志物对病程和心理社会变化的影响。如果这项研究证实了我们的预测，将有可能在其他WTC-Health Program站点轻松且廉价地实施3RP。此外，这项研究将是开创性的，因为它是第一个评估心身治疗对并发的创伤后应激障碍和呼吸系统疾病的影响的随机临床试验。

DESCRIPTION (provided by applicant): More than 30% of responders to the World Trade Center (WTC) disaster continue to experience significant medical and/or psychiatric problems in spite of the extensive clinical services offered by the WTC Health Programs. Moreover, 20% of these patients are burdened by both mental and physical illnesses. The two signature health sequelae of the WTC disaster, post-traumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) are highly comorbid. Psychiatric conditions, such as PTSD, exacerbate physical illness and increase treatment non-compliance, morbidity and mortality. The persistence of PTSD and LRS in WTC responders underscores the fact that our best efforts thus far are not sufficient, and, thus, new treatments are needed. To date, no behavioral intervention has been conducted with WTC responders to aid in the management of both PTSD and LRS. Mind-body treatments are cost-effective, efficacious treatments for comorbid mental-physical health problems in the short and long-term. The Relaxation Response Resiliency Program (3RP) is one of the leading and innovative mind-body treatments developed at Harvard by Dr. Herbert Benson and colleagues to reduce psychiatric and physical symptoms. Thus, we propose to adapt the 3RP to WTC responders and test its efficacy for simultaneously reducing PTSD and LRS in a randomized controlled trial. The aims of the current proposal are to (1) compare the effects of the 3RP versus a Health Enhancement Program on PTSD and LRS immediately post-intervention and at 3, and 6 months post intervention; (2) to evaluate the effects of the new interventions on medication usage, occupational and psychosocial functioning, and health service utilization through follow-ups; and, (3) to evaluate the effects of the 3RP versus the Health Enhancement Program on respiratory functioning (as assessed by spirometry), blood pressure, and pro-inflammatory markers immediately post-intervention and at 3 and 6 months post-intervention. We will use multimodal assessments including self-report, structured clinical interviews, daily in vivo electronic monitoring of medication use and skills practice, and biological immune and inflammation markers. We expect that the 3RP will not only simultaneously reduce PTSD and LRS but will facilitate improvements in functioning, proper medication use, and health service utilization. This treatment will also result in improved biological markers of stress and inflammation. Thus, we will be able to directly evaluate the impact of these biological markers on disease course and psychosocial changes. If this study confirms our predictions, it will be possible to implement the 3RP at other WTC-Health Program sites easily and inexpensively. Moreover, this study will be groundbreaking, as it is the first randomized clinical trial to evaluate the effects of a mind-body treatment on comorbid PTSD and respiratory illness.