Examination of a Safety Aid Reduction Protocol for Treatment Resistant PTSD among Veterans

近年来，军人中的创伤后应激障碍（PTSD）发病率激增。在 作为回应，退伍军人事务部（VA）已在全国范围内开展培训活动， 两种具有强有力经验支持的PTSD治疗方法：延长暴露（PE）治疗和认知处理 治疗（CPT）尽管PE和CPT的有效性得到了充分的证明，但只有少数退伍军人 PTSD启动了这些以创伤为中心的治疗。一种在非创伤中心治疗PTSD的方法 流行的是利用集中于安全辅助减少的经验支持的治疗。安全辅助设备是 适应不良的认知和/或行为策略，旨在防止，避免或减轻焦虑。最初 介绍了一种解释病理性焦虑如何持续存在，尽管反复暴露于恐惧 刺激，安全援助已被发现发挥关键作用的病因和维持各种焦虑 和相关疾病包括创伤后应激障碍重要的是，一项独立的研究表明， 通过认知行为干预来改变。虽然前景看好，但这些试验并不包括 PTSD患者在此背景下，拟议临床科学研究和开发的目的 (CSR&D）职业发展奖-2（CDA-2）是为了适应和扩展现有的安全援助减少 治疗方案，用于退伍军人与创伤后应激障碍。这种治疗方案，称为安全援助减少 PTSD的治疗（START-PTSD），然后将被评估的可接受性和可行性，然后测试之前， 与等待列表对照相比的有效性。参与者将包括患有创伤后应激障碍的个人， 拒绝参加PTSD的循证心理治疗（EBP），即PE或CPT。

Rates of posttraumatic stress disorder (PTSD) among military personnel have surged in recent years. In response, the Department of Veterans Affairs (VA) has launched nationwide training initiatives to disseminate two PTSD treatments with strong empirical support: prolonged exposure (PE) therapy and cognitive processing therapy (CPT). Despite the well-documented effectiveness of PE and CPT, only a minority of Veterans with PTSD initiate these trauma-focused treatments. One approach to addressing PTSD in a non-trauma focused fashion is to utilize empirically supported treatments focused on safety aid reduction. Safety aids are maladaptive cognitive and/or behavioral strategies designed to prevent, avoid, or alleviate anxiety. Initially introduced as a way to explain how pathological anxiety can persist despite repeated exposure to feared stimuli, safety aids have been found to play a critical role in the etiology and maintenance of various anxiety and related conditions including PTSD. Importantly, a separate line of research suggests that safety aids are amenable to change through cognitive behavioral interventions. While promising, these trials did not include patients with PTSD. In this context, the purpose of the proposed Clinical Science Research and Development (CSR&D) Career Development Award-2 (CDA-2) is to adapt and extend an existing safety aid reduction treatment protocol for use among Veterans with PTSD. This treatment protocol, termed Safety Aid Reduction Treatment for PTSD (START-PTSD), will then be evaluated for acceptability and feasibility, prior to testing the efficacy compared to a wait-list control. Participants will include individuals with a diagnosis of PTSD who decline to participate in evidence-based psychotherapies (EBPs) for PTSD, namely PE or CPT.