Sleep-directed hypnosis as a complement to CPT in treating PTSD

睡眠导向催眠作为 CPT 的补充治疗 PTSD

• 批准号: 7387689
• 负责人: TARA E GALOVSKI
• 金额: $ 22.65万
• 依托单位: UNIVERSITY OF MISSOURI-ST. LOUIS
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-01 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7387689
• 关键词: Accounting; Arousal; Auditory; Beck depression inventory; Behavior Therapy; Chronic; Clinical; Cognitive; Cognitive Therapy; Complement; Condition; Conduct Clinical Trials; Control Groups; Cues; DSM-IV; Daily; Depth; Development; Diagnostic; Disease; Electromyography; Elements; Elevation; Emotional; Equipment and supply inventories; Face; Frequencies; Funding; General Population; Genetic Crossing Over; Health Surveys; Heart Rate; Hypnosis; Hypnotherapy; Image; Imagery; Impairment; Interpersonal Violence; Intervention; Interview; Lead; Learning; Life; Literature; Maintenance; Major Depressive Disorder; Measures; Mediator of activation protein; Methods; Mitochondrial Carnitine Palmitoyltransferase Pathway; Modification; Monitor; Nightmare; Noise; Outcome; Parasomnias; Participant; Patient Self-Report; Pattern; Perception; Physiological; Population; Population Control; Post-Traumatic Stress Disorders; Process; Protocols documentation; Psychopathology; Psychophysiology; Psychosocial Assessment and Care; Public Health; Quality of life; Randomized; Reaction Time; Refractory; Relaxation; Reporting; SF-36; Sampling; Severities; Site; Skin; Sleep; Sleep Deprivation; Sleep disturbances; Sleeplessness; Social Adjustment; Stimulus; Stress; Structure; Suggestion; Survivors; Symptoms; Testing; Therapeutic; Therapeutic Effect; Time; Trauma; Trauma Research; Traumatic Stress Disorders; conditioning; cost; design; diaries; falls; follow-up; functional disability; hypnotic; indexing; novel strategies; physical assault; psychologic; psychosocial; remediation; response; skill acquisition; sleep onset; stressor; tool; vigilance

DESCRIPTION (provided by applicant): This proposal seeks to test the efficacy of sleep-directed hypnosis as a complement to an existing empirically supported psychosocial intervention, Cognitive Processing Therapy (CPT) in sample of survivors of interpersonal violence suffering from PTSD. Further, this proposal seeks to identify mechanisms of action in the therapy that lead to symptom modification, improvement in larger domains of functioning, and health-related concerns. Towards this end, a multi-method, multimodal assessment will be administered including daily and intermittent monitoring across psychiatric, psychological, and psychophysiological domains. Specifically, forty subjects will be randomly assigned to either a hypnosis + CPT (hypCPT) condition or to a symptom monitoring, delayed treatment group (SMDT) designed to control for the effects of monitoring, the passage of time, and as a means to assess the basic temporal relationship between sleep, PTSD symptoms and daily stress. Utilizing a semicrossover design, the control condition will be crossed over to the active treatment, allowing for a replication within the study. The entire treated sample (N = 40) will be compared to a sample (N = 50) of similar trauma survivors who have recently been treated with a strict CPT only, manualized therapy through the course of a recently concluded NIH-funded large scale clinical trial conducted at the same site and using the same measures. Participants in this study will be administered a battery of interviews and self-report measures including the 1.) Clinician Administered PTSD Scale, 2.) Structured Clinical Interview for DSM-IV Axis I Disorders, 3.) Standardized Trauma Interview, 4.) PTSD Diagnostic Scale, 5) Beck Depression Inventory - II, 6.) Pennebaker Inventory of Limbic Landuigness, 7.) The SF-36 Health Survey, 8.) Quality of Life Inventory, 9.) Social Adjustment Scale, 10) Pittsburgh Sleep Quality Index, and the 11) Insomnia Severity Index. In addition, physiological indices will be used to assess the relationship between sleep impairment and hyperarousal as well as changes over time in physiological reactivity. A Psychomotor Vigilance Task will also be administered to test for the presence of sleep deprivation (i.e. "sleepiness" as measured by reaction time) as well as related changes over time. Subjects will monitor symptoms and daily stressors through the use of daily diaries as well as undergo formal assessments at pre-treatment, post- treatment and three month follow-up points. Conducting the proposed study will have important implications on remediating sleep impairment (the most often reported symptom of PTSD and one of the most refractory to treatment) utilizing a novel approach, the addition of hypnosis, within a traumatized population. Concurrently this proposal aims to illuminate the mechanisms of action in hypnosis, an understudied complementary treatment element with virtually no empirical support in the trauma literature. Public Health Relevance: Posttraumatic Stress Disorder (PTSD) is commonly considered to be chronic and enduring in presentation and is typically associated with debilitating impairment across multiple domains of functioning with a resultant high level of societal cost (Kessler, 2000) Sleep impairment is identified as an early predictor of the development of PTSD (Koren, et al, 2002), is the most often reported of the 17 PTSD symptoms (Green, 1993), is considered one of the most refractory to treatment (Krakow, Hollifield, et al, 2001; Cooper and Clum, 1989; Zayfert and DeViva, 2004), and is identified as a mediator between PTSD symptoms and somatization and functional disability (Clum, Nishith, & Resick, 2001; Mellman et al, 1995; Mohr et al., 2003). Thus the specific remediation of sleep impairment within a trauma population could result in substantial decreases in overall PTSD symptomatology which would then result in reduced psychosocial impairment, health-related concerns, and societal expense.

描述（由申请人提供）：该提案旨在测试睡眠定向催眠的功效，以补充现有的经验支持的社会心理干预，认知加工疗法（CPT）在遭受PTSD的人际暴力样本样本中。此外，该建议旨在确定疗法中的作用机制，从而导致症状改变，较大的功能领域的改善以及与健康相关的问题。为此，将进行多种模式评估，包括跨精神病，心理学和心理生理学领域的日常和间歇性监测。具体而言，有40名受试者将被随机分配给催眠 + CPT（HYPCPT）条件或症状监测，延迟治疗组（SMDT），旨在控制监测的影响，时间的流逝以及评估的手段睡眠，PTSD症状和日常压力之间的基本时间关系。利用半体体设计，控制条件将越过活跃的治疗，从而可以在研究中进行复制。将整个处理样品（n = 40）与类似的创伤幸存者的样本（n = 50）进行比较，这些样本最近仅通过严格的CPT治疗，通过最近结束的NIH资助的大规模手动治疗试验在同一地点进行并使用相同的措施进行。这项研究的参与者将管理一系列访谈和自我报告措施，包括1.）临床医生管理PTSD量表，2。）DSM-IV轴I疾病的结构化临床访谈，3。）。 PTSD诊断量表，5）贝克抑郁量清单-II，6。）pennebaker边缘Landuigness的清单，7。）SF -36健康调查，8。）8。）生活质量清单，9。）社会调整量表，10）匹兹堡睡眠质量指数和11）失眠严重程度指数。此外，生理指标将用于评估睡眠障碍与高伴侣之间的关系以及生理反应性的随着时间的变化。还将执行精神运动警惕任务，以测试是否存在睡眠剥夺（即按反应时间衡量的“嗜睡”）以及随时间的变化。受试者将通过每日日记来监测症状和日常压力源，并在治疗前，治疗后和三个月的随访点进行正式评估。进行拟议的研究将对治疗睡眠障碍（经常报道的PTSD症状，也是治疗最难治性的症状之一）具有重要意义，该方法是在受创伤的人群中加入催眠的方法。同时，该提案旨在阐明催眠中的作用机理，这是一个研究的互补治疗元素，几乎没有创伤文献中的经验支持。 公共卫生相关性：创伤后应激障碍（PTSD）通常被认为是慢性和持久的表现，通常与多个功能型损害的损害有关，从而导致高水平的社会成本（Kessler，2000年）被确定为睡眠障碍。 PTSD发展的早期预测指标（Koren等，2002）是17种PTSD症状中最常报道的（Green，1993），被认为是治疗最难治性的一种（Krakow，Hollifield等人，等等。 2001年;库珀和克鲁姆，1989年； 2003）。因此，在创伤人群中对睡眠障碍的特定补救可能会导致PTSD症状的总体减少，从而导致心理社会障碍，与健康相关的担忧和社会费用减少。