ABSTRACT

Cognitive processing therapy (CPT) and prolonged exposure therapy (PE) are effective psychotherapies for post-traumatic stress disorder (PTSD). However, these treatments also have high rates of dropout and non-response. Therefore, patients may need a second course of treatment. We compared outcomes for patients who switched between CPT/PE and those who repeated CPT/PE during a second course of treatment. We collected data from Iraq and Afghanistan war veterans (n = 2,958) who received a second course of CPT/PE in the Veterans Health Administration from 2001 to 2017 and had symptom outcomes (PTSD checklist; PCL). We measured the association between treatment sequence and change in PCL score over the second course of treatment using hierarchical Bayesian regression, adjusted for sociodemographic and clinical characteristics. All treatment sequences showed a significant reduction in PCL score over time (β = −4.80; HDI₉₅: −5.74, −3.86). Veterans who switched from CPT to PE had modestly greater PCL reductions during the second course than those who repeated CPT. However, no significant difference in PCL change during the second course was observed between veterans who repeated PE and those who switched from PE to CPT. Veterans participating in a second course of CPT/PE can benefit, and switching treatment may be slightly more beneficial following CPT.

摘要

认知加工疗法 (CPT) 和长期暴露疗法 (PE) 是治疗创伤后应激障碍 (PTSD) 的有效心理疗法。然而，这些治疗也有很高的辍学率和无反应率。因此，患者可能需要第二个疗程。我们比较了在第二个疗程期间在 CPT/PE 之间转换的患者和重复 CPT/PE 的患者的结果。我们收集了伊拉克和阿富汗退伍军人的数据（n= 2,958），他们从 2001 年到 2017 年在退伍军人健康管理局接受了第二个 CPT/PE 疗程并有症状结果（PTSD 检查表；PCL）。我们使用分级贝叶斯回归测量了治疗顺序与第二疗程 PCL 评分变化之间的关联，并根据社会人口学和临床特征进行了调整。所有治疗序列均显示 PCL 评分随时间显着降低（β = -4.80；HDI ₉₅：-5.74，-3.86）。从 CPT 转为 PE 的退伍军人在第二个课程中的 PCL 降低程度略高于重复 CPT 的退伍军人。然而，在重复 PE 的退伍军人和从 PE 转为 CPT 的退伍军人之间，在第二个课程期间的 PCL 变化没有显着差异。参加第二个 CPT/PE 疗程的退伍军人可能会受益，而在 CPT 后转换治疗可能会稍微有益一些。