军事相关的PTSD心理治疗:随机临床试验的审查
Maria M Steenkamp1, Brett T Litz2, Charles W Hoge3
1Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, New York.
JAMA
|August 5, 2015
概括
认知处理疗法 (CPT) 和长期接触显示,许多患有PTSD的军人和退伍军人患者的症状有显著改善. 然而,高无反应率和持续的症状表明需要更好的PTSD治疗.
科学领域:
- 精神病学
- 心理学
- 军事卫生
背景情况:
- 创伤后应激障碍 (PTSD) 是军人和退伍军人的普遍和残疾状况.
- 目前PTSD的第一线心理治疗主要涉及以创伤为中心的方法,专注于创伤细节或相关的认知和情感影响.
研究的目的:
- 评估各种心理治疗在军事和退伍军人的有效性.
- 综合这些人群中 PTSD 治疗的随机临床试验结果.
主要方法:
- 在PubMed,PsycINFO和PILOTS进行了一项系统的搜索,用于在1980年1月至2015年3月期间发表的随机临床试验 (RCT).
- 纳入标准侧重于军事和退伍军人群体中PTSD的个人和团体心理治疗,结果分析了36项研究.
主要成果:
- 认知处理疗法 (CPT) 和长期暴露,是研究最多的以创伤为重点的疗法,在小组内表现出很大的效果 (科恩d范围为0.78-1.10).
- 接受CPT或长期暴露的参与者中有49%至70%获得了临床上有意义的症状改善,表现优于等待列表和常规治疗对照组.
- 尽管情况有所改善,但很大一部分患者 (60% - 72%) 在治疗后仍保持了PTSD诊断,CPT和长期暴露对非创伤治疗的优势只有极小.
结论:
- 对于许多患有PTSD的军人和退伍军人来说, CPT和长期暴露等以创伤为中心的干预措施具有临床意义.
- 高率的无反应和持续的症状凸显了急需加强后应激障碍治疗策略的必要性.
- 进一步研究和开发基于证据的新型心理治疗,无论是以创伤为重点还是非创伤为重点,对于改善这一群体的结果至关重要.
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