Background and objectives

Reduction of trauma related negative cognitions, such as guilt, is thought to be a mechanism of change within PTSD treatments like prolonged exposure (PE). Research suggests PE can directly address guilt cognitions. However, whether pharmacotherapies for PTSD can remains unclear.

Methods

Data from a randomized controlled trial of PE plus placebo (PE + PLB), sertraline plus enhanced medication management (SERT + EMM), and their combination (PE + SERT) in 195 Veterans from recent wars was analyzed.

Results

The unadjusted means and mixed-effects model showed guilt decreased significantly over the follow-up time as expected; however, contrary to our hypothesis, PE conditions were not associated with greater reductions in guilt than the SERT + EMM condition. As hypothesized, week 12 reduction in guilt predicted post-treatment (weeks 24–52) reduction in PTSD and depression, but not impairments in function.

Limitations

Generalizability of findings is limited by the sample being comprised of combat Veterans who were predominantly male, not on SSRI at study entry, willing to be randomized to therapy or medication, and reporting low levels of guilt. To reduce differences in provider attention, SERT + EMM was administered over 30 min to include psychoeducation and active listening; it is unknown if this contributed to effects on guilt.

Conclusions

PE + PLB, SERT + EMM, and PE + SERT were equally associated with reduction in trauma related guilt. Reducing trauma related guilt may be a pathway to reducing PTSD and posttraumatic depression symptoms. Further study is needed to determine how best to treat trauma related guilt and to understand the mechanisms by which guilt improves across different treatments for PTSD.

中文翻译：

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长时间接触和/或舍曲林后内疚认知的降低预示着 PTSD 和抑郁症的后续改善

背景和目标

减少与创伤相关的负面认知，如内疚，被认为是 PTSD 治疗如长时间暴露 (PE) 中的一种变化机制。研究表明，PE可以直接解决内疚认知。然而，PTSD 的药物治疗是否可以尚不清楚。

方法

分析了来自近期战争中 195 名退伍军人的 PE 加安慰剂 (PE + PLB)、舍曲林加增强药物管理 (SERT + EMM) 及其组合 (PE + SERT) 的随机对照试验的数据。

结果

未经调整的均值和混合效应模型显示，随着预期的随访时间，内疚感显着下降；然而，与我们的假设相反，与 SERT + EMM 条件相比，PE 条件与内疚感的减少无关。正如假设的那样，第 12 周内疚感的减少预示着治疗后（第 24-52 周）PTSD 和抑郁症的减少，但不是功能障碍。

限制

调查结果的普遍性受到样本的限制，这些退伍军人主要是男性，在研究开始时未使用 SSRI，愿意随机接受治疗或药物治疗，并且报告的内疚程度较低。为了减少提供者关注的差异，SERT + EMM 被管理超过 30 分钟，以包括心理教育和积极倾听；目前尚不清楚这是否有助于对内疚的影响。

结论

PE + PLB、SERT + EMM 和 PE + SERT 与创伤相关内疚感的减少同样相关。减少与创伤相关的内疚感可能是减少 PTSD 和创伤后抑郁症状的途径。需要进一步的研究来确定如何最好地治疗与创伤相关的内疚感，并了解在不同的 PTSD 治疗中内疚感改善的机制。