Importance Effective and efficient treatment is needed for posttraumatic stress disorder (PTSD) in active duty military personnel. Objective To examine the effects of massed prolonged exposure therapy (massed therapy), spaced prolonged exposure therapy (spaced therapy), present-centered therapy (PCT), and a minimal-contact control (MCC) on PTSD severity. Design, Setting, and Participants Randomized clinical trial conducted at Fort Hood, Texas, from January 2011 through July 2016 and enrolling 370 military personnel with PTSD who had returned from Iraq, Afghanistan, or both. Final follow-up was July 11, 2016. Interventions Prolonged exposure therapy, cognitive behavioral therapy involving exposure to trauma memories/reminders, administered as massed therapy (n = 110; 10 sessions over 2 weeks) or spaced therapy (n = 109; 10 sessions over 8 weeks); PCT, a non–trauma-focused therapy involving identifying/discussing daily stressors (n = 107; 10 sessions over 8 weeks); or MCC, telephone calls from therapists (n = 40; once weekly for 4 weeks). Main Outcomes and Measures Outcomes were assessed before and after treatment and at 2-week, 12-week, and 6-month follow-up. Primary outcome was interviewer-assessed PTSD symptom severity, measured by the PTSD Symptom Scale–Interview (PSS-I; range, 0-51; higher scores indicate greater PTSD severity; MCID, 3.18), used to assess efficacy of massed therapy at 2 weeks posttreatment vs MCC at week 4; noninferiority of massed therapy vs spaced therapy at 2 weeks and 12 weeks posttreatment (noninferiority margin, 50% [2.3 points on PSS-I, with 1-sided &agr; = .05]); and efficacy of spaced therapy vs PCT at posttreatment. Results Among 370 randomized participants, data were analyzed for 366 (mean age, 32.7 [SD, 7.3] years; 44 women [12.0%]; mean baseline PSS-I score, 25.49 [6.36]), and 216 (59.0%) completed the study. At 2 weeks posttreatment, mean PSS-I score was 17.62 (mean decrease from baseline, 7.13) for massed therapy and 21.41 (mean decrease, 3.43) for MCC (difference in decrease, 3.70 [95% CI,0.72 to 6.68]; P = .02). At 2 weeks posttreatment, mean PSS-I score was 18.03 for spaced therapy (decrease, 7.29; difference in means vs massed therapy, 0.79 [1-sided 95% CI, −∞ to 2.29; P = .049 for noninferiority]) and at 12 weeks posttreatment was 18.88 for massed therapy (decrease, 6.32) and 18.34 for spaced therapy (decrease, 6.97; difference, 0.55 [1-sided 95% CI, −∞ to 2.05; P = .03 for noninferiority]). At posttreatment, PSS-I scores for PCT were 18.65 (decrease, 7.31; difference in decrease vs spaced therapy, 0.10 [95% CI, −2.48 to 2.27]; P = .93). Conclusions and Relevance Among active duty military personnel with PTSD, massed therapy (10 sessions over 2 weeks) reduced PTSD symptom severity more than MCC at 2-week follow-up and was noninferior to spaced therapy (10 sessions over 8 weeks), and there was no significant difference between spaced therapy and PCT. The reductions in PTSD symptom severity with all treatments were relatively modest, suggesting that further research is needed to determine the clinical importance of these findings. Trial Registration clinicaltrials.gov Identifier: NCT01049516

中文翻译：

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超过 2 周、8 周和以现在为中心的长期暴露疗法对军事人员 PTSD 症状严重程度的影响

重要性 对于现役军人的创伤后应激障碍 (PTSD)，需要有效且高效的治疗。目的 检验大量延长暴露疗法（massed therapy）、间隔延长暴露疗法（spaced therapy）、以当下为中心的疗法（PCT）和最小接触控制（MCC）对 PTSD 严重程度的影响。设计、设置和参与者 随机临床试验于 2011 年 1 月至 2016 年 7 月在德克萨斯州胡德堡进行，招募了 370 名从伊拉克、阿富汗或两者返回的患有 PTSD 的军人。最终随访时间为 2016 年 7 月 11 日。 干预 延长暴露疗法、认知行为疗法，包括暴露于创伤记忆/提醒，作为集体疗法（n = 110；2 周内 10 次）或间隔疗法（n = 109；10）超过 8 周的课程）；PCT，一种非创伤性治疗，涉及识别/讨论日常压力源（n = 107；8 周内 10 个疗程）；或 MCC，来自治疗师的电话（n = 40；每周一次，持续 4 周）。主要结果和措施 在治疗前后以及 2 周、12 周和 6 个月的随访中评估结果。主要结果是访问者评估的 PTSD 症状严重程度，通过 PTSD 症状量表 - 访谈（PSS-I；范围，0-51；分数越高表示 PTSD 严重程度；MCID，3.18），用于评估 2治疗后数周 vs 第 4 周的 MCC；治疗后 2 周和 12 周集中治疗与间隔治疗的非劣效性（非劣效边际，50% [PSS-I 2.3 分，单侧 &agr; = .05]）；间隔治疗与 PCT 在治疗后的疗效。结果 在 370 名随机参与者中，分析了 366 名（平均年龄，32.7 [SD，7.3] 岁；44 名女性 [12.0%]；平均基线 PSS-I 评分，25.49 [6.36]）和 216 名（59.0%）完成的数据研究。治疗后 2 周，集中治疗的平均 PSS-I 评分为 17.62（从基线平均下降 7.13），MCC 为 21.41（平均下降，3.43）（下降差异，3.70 [95% CI，0.72 至 6.68]；P = .02）。治疗后 2 周，间隔治疗的平均 PSS-I 评分为 18.03（下降，7.29；平均与集中治疗的差异，0.79 [单侧 95% CI，-∞ 至 2.29；非劣效性 P = .049]）和治疗后 12 周时，集中治疗为 18.88（降低，6.32），间隔治疗为 18.34（降低，6.97；差异，0.55 [单侧 95% CI，-∞ 至 2.05；非劣效性 P = .03]）。在治疗后，PCT 的 PSS-I 评分为 18。65（减少，7.31；减少与间隔治疗的差异，0.10 [95% CI，-2.48 至 2.27]；P = .93）。结论和相关性 在患有 PTSD 的现役军人中，集体治疗（2 周内 10 次疗程）在 2 周随访时比 MCC 更能降低 PTSD 症状的严重程度，并且不劣于间隔治疗（8 周内 10 次疗程），并且间隔治疗和PCT之间没有显着差异。所有治疗后 PTSD 症状严重程度的降低都相对温和，这表明需要进一步研究来确定这些发现的临床重要性。试验注册clinicaltrials.gov 标识符：NCT01049516 在 2 周的随访中，集中治疗（2 周内 10 次治疗）比 MCC 更能减轻 PTSD 症状的严重程度，并且不劣于间隔治疗（8 周内 10 次治疗），间隔治疗和 PCT 之间没有显着差异。所有治疗后 PTSD 症状严重程度的降低都相对温和，这表明需要进一步研究来确定这些发现的临床重要性。试验注册clinicaltrials.gov 标识符：NCT01049516 在 2 周的随访中，集中治疗（2 周内 10 次治疗）比 MCC 更能减轻 PTSD 症状的严重程度，并且不劣于间隔治疗（8 周内 10 次治疗），间隔治疗和 PCT 之间没有显着差异。所有治疗后 PTSD 症状严重程度的降低都相对温和，这表明需要进一步研究来确定这些发现的临床重要性。试验注册clinicaltrials.gov 标识符：NCT01049516 表明需要进一步的研究来确定这些发现的临床重要性。试验注册clinicaltrials.gov 标识符：NCT01049516 表明需要进一步的研究来确定这些发现的临床重要性。试验注册clinicaltrials.gov 标识符：NCT01049516