ABSTRACT

Background: It is unclear whether the evidence-based treatments for PTSD are as effective in patients with CA-PTSD.

Objective: We aimed to investigate the effectiveness of three variants of prolonged exposure therapy.

Method: We recruited adults with CA-PTSD. Participants were randomly assigned to Prolonged Exposure (PE; 16 sessions in 16 weeks), intensified Prolonged Exposure (iPE; 12 sessions in 4 weeks followed by 2 booster sessions) or a phase-based treatment, in which 8 sessions of PE were preceded by 8 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR+PE; 16 sessions in 16 weeks). Assessments took place in week 0 (baseline), week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. The primary outcome was clinician-rated PTSD symptom severity.

Results: We randomly assigned 149 patients to PE (48), iPE (51) or STAIR+PE (50). All treatments resulted in large improvements in clinician assessed and self-reported PTSD symptoms from baseline to 1-year follow-up (Cohen’s d > 1.6), with no significant differences among treatments. iPE led to faster initial symptom reduction than PE for self-report PTSD symptoms (t ₁₃₅ = −2.85, p = .005, d = .49) but not clinician-assessed symptoms (t₁₃₅ = −1.65, p = .10) and faster initial symptom reduction than STAIR+PE for self-reported (t ₁₃₅ = −4.11, p < .001, d = .71) and clinician-assessed symptoms (t ₁₃₅ = −2.77, p = .006, Cohen’s d = .48) STAIR+PE did not result in significantly more improvement from baseline to 1-year follow-up on the secondary outcome emotion regulation, interpersonal problems and self-esteem compared to PE and iPE. Dropout rates did not differ significantly between conditions.

Conclusions: Variants of exposure therapy are tolerated well and lead to large improvements in patients with CA-PTSD. Intensifying treatment may lead to faster improvement but not to overall better outcomes.

The trial is registered at the clinical trial registry, number NCT03194113, https://clinicaltrials.gov/ct2/show/NCT03194113

摘要

背景：目前尚不清楚基于证据的 PTSD 治疗对 CA-PTSD 患者是否同样有效。

目的：我们旨在研究三种延长暴露疗法的有效性。

方法：我们招募了患有 CA-PTSD 的成年人。参与者被随机分配到延长暴露（PE；16 周内 16 次）、强化延长暴露（iPE；4 周内 12 次，随后进行 2 次强化治疗）或基于阶段的治疗，其中 8 次 PE 之前是8 节情感和人际调节技能培训（STAIR+PE；16 周 16 节课）。在第 0 周（基线）、第 4 周、第 8 周、第 16 周（治疗后）以及 6 个月和 12 个月的随访中进行评估。主要结果是临床医生评定的 PTSD 症状严重程度。

结果：我们将 149 名患者随机分配至 PE（48 人）、iPE（51 人）或 STAIR+PE（50 人）。从基线到 1 年随访 (Cohen's d > 1.6)，所有治疗都导致临床医生评估和自我报告的 PTSD 症状有很大改善，治疗之间没有显着差异。对于自我报告的 PTSD 症状（t ₁₃₅  = −2.85，p = .005，d = .49），iPE 比 PE 导致初始症状减少更快，但临床医生评估的症状没有（t ₁₃₅  = −1.65，p = .10）并且比 STAIR+PE 更快的初始症状减轻自我报告 ( t ₁₃₅  = −4.11, p < .001, d= .71) 和临床医生评估的症状 ( t ₁₃₅  = −2.77, p = .006, Cohen's d = .48) STAIR+PE 并未导致次要结果从基线到 1 年随访的显着改善与 PE 和 iPE 相比，情绪调节、人际关系问题和自尊。辍学率在不同条件下没有显着差异。

结论：暴露疗法的变体耐受性良好，可使 CA-PTSD 患者得到很大改善。强化治疗可能会导致更快的改善，但不会带来更好的整体结果。

该试验已在临床试验登记处注册，编号为 NCT03194113，https://clinicaltrials.gov/ct2/show/NCT03194113