Harrison R. Weinstein, Erika M. Roberge, Suzanne C. Parker
{"title":"在一项寻求治疗的退伍军人的病例对照研究中,强化认知加工治疗与减少PTSD治疗退出有关","authors":"Harrison R. Weinstein, Erika M. Roberge, Suzanne C. Parker","doi":"10.1016/j.cbpra.2022.05.004","DOIUrl":null,"url":null,"abstract":"<div><p>Cognitive Processing Therapy (CPT) is an empirically supported psychotherapy for posttraumatic stress disorder (PTSD). The complex issue of treatment attrition is a frequently cited concern regarding CPT and other evidence-based psychotherapies for PTSD. The current study investigated the feasibility and effectiveness of “intensive” CPT, a treatment-consistent modification of CPT in which sessions are conducted more frequently than standard protocol. Fifty-four military veterans (20% female; <em>M</em><sub>age</sub> = 46; 80% Caucasian) seeking outpatient treatment for PTSD were included in this study. Patients who elected to receive intensive CPT (<em>n</em> = 27) were matched with archival records of individuals who received standard CPT (<em>n</em> = 27). Patients across treatment conditions were matched based on baseline symptom severity as measured by the PTSD Checklist for DSM-5 (PCL-5; <em>M</em><sub>PCL-5</sub> = 52.61). Treatment outcomes were compared and longitudinal multilevel modeling was used to compare rate of symptom change over time. Patients who elected to engage in intensive CPT were twice as likely to complete treatment (88.9%) as those who received standard CPT (44.4%), <em>X</em><sup>2</sup>(1, <em>N</em> = 54) = 12.00, <em>p</em> = .001. On average, intensive CPT patients completed treatment in about 25% of the time as standard CPT patients (33.8 days vs. 125.7 days). Patients in intensive CPT also demonstrated greater benefit: 81.4% reported a clinically significant improvement in PCL-5 scores compared to 51.8% of those in standard CPT, <em>X</em><sup>2</sup>(1, <em>N</em> = 54) = 5.33, <em>p</em> = .020, <em>φ</em> = −0.314. Intensive and standard CPT performed comparably in regard to final PCL-5 score, change over time, and screening cutoff. In addition, there were no differences in treatment outcomes based on licensure status of the provider nor whether treatment was delivered in person or virtually. Intensive CPT represents a novel, treatment-consistent adaptation that was utilized to treat a group of veterans with PTSD with minimal treatment dropout. Patients who elected to engage in more frequent treatment were more likely to complete treatment, did so in one quarter of the time, and reported similar to better treatment outcomes. Providers may consider encouraging their patients to participate in treatment as frequently as they are able. However, preliminary findings are based on a nonrandom sample and design limitations temper conclusions.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"3","resultStr":"{\"title\":\"Intensive Cognitive Processing Therapy Associated With Reduced PTSD Treatment Dropout in a Case-Controlled Study of Treatment-Seeking Veterans\",\"authors\":\"Harrison R. Weinstein, Erika M. Roberge, Suzanne C. Parker\",\"doi\":\"10.1016/j.cbpra.2022.05.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>Cognitive Processing Therapy (CPT) is an empirically supported psychotherapy for posttraumatic stress disorder (PTSD). The complex issue of treatment attrition is a frequently cited concern regarding CPT and other evidence-based psychotherapies for PTSD. The current study investigated the feasibility and effectiveness of “intensive” CPT, a treatment-consistent modification of CPT in which sessions are conducted more frequently than standard protocol. Fifty-four military veterans (20% female; <em>M</em><sub>age</sub> = 46; 80% Caucasian) seeking outpatient treatment for PTSD were included in this study. Patients who elected to receive intensive CPT (<em>n</em> = 27) were matched with archival records of individuals who received standard CPT (<em>n</em> = 27). Patients across treatment conditions were matched based on baseline symptom severity as measured by the PTSD Checklist for DSM-5 (PCL-5; <em>M</em><sub>PCL-5</sub> = 52.61). Treatment outcomes were compared and longitudinal multilevel modeling was used to compare rate of symptom change over time. Patients who elected to engage in intensive CPT were twice as likely to complete treatment (88.9%) as those who received standard CPT (44.4%), <em>X</em><sup>2</sup>(1, <em>N</em> = 54) = 12.00, <em>p</em> = .001. On average, intensive CPT patients completed treatment in about 25% of the time as standard CPT patients (33.8 days vs. 125.7 days). Patients in intensive CPT also demonstrated greater benefit: 81.4% reported a clinically significant improvement in PCL-5 scores compared to 51.8% of those in standard CPT, <em>X</em><sup>2</sup>(1, <em>N</em> = 54) = 5.33, <em>p</em> = .020, <em>φ</em> = −0.314. Intensive and standard CPT performed comparably in regard to final PCL-5 score, change over time, and screening cutoff. In addition, there were no differences in treatment outcomes based on licensure status of the provider nor whether treatment was delivered in person or virtually. Intensive CPT represents a novel, treatment-consistent adaptation that was utilized to treat a group of veterans with PTSD with minimal treatment dropout. Patients who elected to engage in more frequent treatment were more likely to complete treatment, did so in one quarter of the time, and reported similar to better treatment outcomes. Providers may consider encouraging their patients to participate in treatment as frequently as they are able. However, preliminary findings are based on a nonrandom sample and design limitations temper conclusions.</p></div>\",\"PeriodicalId\":51511,\"journal\":{\"name\":\"Cognitive and Behavioral Practice\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2023-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cognitive and Behavioral Practice\",\"FirstCategoryId\":\"102\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1077722922001079\",\"RegionNum\":3,\"RegionCategory\":\"心理学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHOLOGY, CLINICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cognitive and Behavioral Practice","FirstCategoryId":"102","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1077722922001079","RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHOLOGY, CLINICAL","Score":null,"Total":0}
引用次数: 3
摘要
认知加工疗法(CPT)是一种经验支持的创伤后应激障碍(PTSD)心理治疗方法。治疗损耗的复杂问题是CPT和其他基于证据的PTSD心理疗法经常被提及的问题。目前的研究调查了“强化”CPT的可行性和有效性,这是一种治疗一致的CPT修改,其中进行的次数比标准方案更频繁。54名退伍军人(20%为女性;法师= 46;80%的白种人)寻求PTSD门诊治疗纳入本研究。选择接受强化CPT的患者(n = 27)与接受标准CPT的患者(n = 27)的档案记录相匹配。不同治疗条件的患者根据DSM-5的PTSD检查表(PCL-5;mpcl-5 = 52.61)。对治疗结果进行比较,并使用纵向多水平模型来比较症状随时间的变化率。选择强化CPT的患者完成治疗的可能性(88.9%)是接受标准CPT的患者(44.4%)的两倍,X2(1, N = 54) = 12.00, p = 0.001。平均而言,强化CPT患者完成治疗的时间约为标准CPT患者的25%(33.8天对125.7天)。强化CPT患者也表现出更大的获益:81.4%的患者报告临床显着改善PCL-5评分,而标准CPT患者的这一比例为51.8%,X2(1, N = 54) = 5.33, p = 0.020, φ =−0.314。强化和标准CPT在最终PCL-5评分、随时间变化和筛查截止时间方面表现相当。此外,基于提供者的许可状态以及治疗是亲自提供还是虚拟提供,治疗结果没有差异。强化CPT代表了一种新颖的,治疗一致的适应,用于治疗一组患有创伤后应激障碍的退伍军人,治疗退出率最低。选择更频繁治疗的患者更有可能在四分之一的时间内完成治疗,并报告了类似的更好的治疗结果。提供者可以考虑鼓励他们的病人尽可能频繁地参与治疗。然而,初步研究结果是基于非随机样本和设计限制的结论。
Intensive Cognitive Processing Therapy Associated With Reduced PTSD Treatment Dropout in a Case-Controlled Study of Treatment-Seeking Veterans
Cognitive Processing Therapy (CPT) is an empirically supported psychotherapy for posttraumatic stress disorder (PTSD). The complex issue of treatment attrition is a frequently cited concern regarding CPT and other evidence-based psychotherapies for PTSD. The current study investigated the feasibility and effectiveness of “intensive” CPT, a treatment-consistent modification of CPT in which sessions are conducted more frequently than standard protocol. Fifty-four military veterans (20% female; Mage = 46; 80% Caucasian) seeking outpatient treatment for PTSD were included in this study. Patients who elected to receive intensive CPT (n = 27) were matched with archival records of individuals who received standard CPT (n = 27). Patients across treatment conditions were matched based on baseline symptom severity as measured by the PTSD Checklist for DSM-5 (PCL-5; MPCL-5 = 52.61). Treatment outcomes were compared and longitudinal multilevel modeling was used to compare rate of symptom change over time. Patients who elected to engage in intensive CPT were twice as likely to complete treatment (88.9%) as those who received standard CPT (44.4%), X2(1, N = 54) = 12.00, p = .001. On average, intensive CPT patients completed treatment in about 25% of the time as standard CPT patients (33.8 days vs. 125.7 days). Patients in intensive CPT also demonstrated greater benefit: 81.4% reported a clinically significant improvement in PCL-5 scores compared to 51.8% of those in standard CPT, X2(1, N = 54) = 5.33, p = .020, φ = −0.314. Intensive and standard CPT performed comparably in regard to final PCL-5 score, change over time, and screening cutoff. In addition, there were no differences in treatment outcomes based on licensure status of the provider nor whether treatment was delivered in person or virtually. Intensive CPT represents a novel, treatment-consistent adaptation that was utilized to treat a group of veterans with PTSD with minimal treatment dropout. Patients who elected to engage in more frequent treatment were more likely to complete treatment, did so in one quarter of the time, and reported similar to better treatment outcomes. Providers may consider encouraging their patients to participate in treatment as frequently as they are able. However, preliminary findings are based on a nonrandom sample and design limitations temper conclusions.
期刊介绍:
Cognitive and Behavioral Practice is a quarterly international journal that serves an enduring resource for empirically informed methods of clinical practice. Its mission is to bridge the gap between published research and the actual clinical practice of cognitive behavior therapy. Cognitive and Behavioral Practice publishes clinically rich accounts of innovative assessment and diagnostic and therapeutic procedures that are clearly grounded in empirical research. A focus on application and implementation of procedures is maintained.