Integrated Alcohol Disorder and PTSD Treatment

描述(由申请人提供)： 目标。酒精使用障碍(AD)和创伤后应激障碍(PTSD)并存是很常见的。研究支持暴露疗法作为创伤后应激障碍的一线治疗方法，因为这种方法最有可能导致这种疾病的持续康复。然而，AD患者通常不会得到暴露疗法，因为他们认为暴露会导致更多的酒精使用和其他危险行为。大多数AD/PTSD的研究和临床治疗都涉及基于应对技能的治疗，通常没有显示出酒精使用和PTSD症状的持续减少。越来越多的证据表明，这些患有AD/PTSD的人能够应对并受益于暴露。这项拟议的试验将比较综合暴露心理疗法和综合应对技能心理疗法治疗AD/PTSD。此外，还将探讨患有AD/PTSD的退伍军人在两种治疗条件下的变化机制，包括治疗过程变量、负面情绪的变化和睡眠问题。意义：该项目解决了该领域的一个关键障碍--人们普遍认为AD和PTSD患者不能耐受暴露疗法，尽管这是治疗PTSD的最佳实践。如果完成，该项目将有助于改变推动对这一高度流行和高度痛苦的人群进行治疗的做法。其基本原理是改善证据基础，以告知AD/PTSD患者如何获得持续的康复。创新：这项应用寻求改变当前的临床实践范式。建议通过整合两种循证治疗方法对现有干预措施进行改进。暴露治疗方案的简单性使其易于传播和修改到AD治疗设置。方法论。我们提出了一项随机对照试验来评估合并AD和PTSD的基于暴露的综合治疗(集成延长暴露；I-PE)，这是基于证据的，包括体内暴露和创伤处理。主要目的将是在148名患有AD和PTSD的男性和女性退伍军人中进行随机对照试验，以评估I-PE与目前以应对技能为基础的干预(寻求安全)相比较的效果。假设在治疗后，两组都会显示酒精使用的减少，但I-PE比SS在PTSD症状方面的减少更大。在基线后5个月和8个月的随访中，I-PE的饮酒天数百分比和创伤后应激障碍症状明显少于SS。此外，还将研究这两种处理条件的变化机制。

DESCRIPTION (provided by applicant): Objectives. Co-occurrence of alcohol use disorder (AD) and posttraumatic stress disorder (PTSD) is common. Research supports exposure therapy as the front line treatment for PTSD as this approach is most likely to lead to sustained recovery from the disorder. However, individuals with AD are generally not offered exposure therapies because of beliefs that exposure would lead to engagement in greater alcohol use and other dangerous behaviors. Most research and clinical treatment for AD/PTSD have involved coping skills based therapies that have generally not shown sustained reductions in alcohol use and PTSD symptoms. A growing body of evidence suggests these individuals with AD/PTSD are able to handle and benefit from exposure. This proposed trial will compare an integrated exposure psychotherapy to an integrated coping skills psychotherapy for the treatment of AD/PTSD. In addition, mechanisms of change for Veterans with AD/PTSD in both treatment conditions, including therapy process variables, changes in negative affect, and sleep problems, will be explored. Significance: This project addresses a critical barrier in the field - the widely held belief that individuals with AD and PTSD cannot tolerate exposure therapy, although it is the best practice treatment for PTSD. If completed, this project will help change the practices that drive treatment for this highly prevalent and highly distressed population. The fundamental rationale is to improve the evidence base that informs how patients with AD/PTSD can attain sustained recovery. Innovation: This application seeks to shift current clinical practice paradigms. A refinement to existing interventions is proposed through integration of two evidence based treatments. The simplicity of the exposure therapy protocol makes it amenable to dissemination and modification to AD treatment settings. Methodology. We propose a randomized controlled trial to evaluate an integrated exposure-based treatment (Integrated Prolonged Exposure; I-PE) for concurrent AD and PTSD that is evidence based and includes both in-vivo exposure and trauma processing. The primary aim will be to conduct a randomized controlled trial to evaluate the effects of I-PE when compared to a present-focused coping skills based intervention (Seeking Safety) in 148 male and female Veterans who have AD and PTSD. The hypotheses are that at post-treatment both groups will show reductions in alcohol use, but I-PE will demonstrate greater reductions in PTSD symptoms than SS. At 5- and 8- month post-baseline follow-up, I-PE will have significantly fewer percent drinking days and fewer PTSD symptoms than SS. In addition, mechanisms of change in both treatment conditions will be examined.