Mind Body Treatment for WTC Responders with Comorbid PTSD and Respiratory Illness

为患有创伤后应激障碍 (PTSD) 和呼吸系统疾病的 WTC 救援人员提供身心治疗

• 批准号: 8857389
• 负责人: EVELYN J BROMET
• 金额: $ 50.58万
• 依托单位: STATE UNIVERSITY NEW YORK STONY BROOK
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8857389
• 关键词: Mind; Body; Treatment; WTC; Responders

DESCRIPTION (provided by applicant): More than 30% of responders to the World Trade Center (WTC) disaster continue to experience significant medical and/or psychiatric problems in spite of the extensive clinical services offered by the WTC Health Programs. Moreover, 20% of these patients are burdened by both mental and physical illnesses. The two signature health sequelae of the WTC disaster, post-traumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) are highly comorbid. Psychiatric conditions, such as PTSD, exacerbate physical illness and increase treatment non-compliance, morbidity and mortality. The persistence of PTSD and LRS in WTC responders underscores the fact that our best efforts thus far are not sufficient, and, thus, new treatments are needed. To date, no behavioral intervention has been conducted with WTC responders to aid in the management of both PTSD and LRS. Mind-body treatments are cost-effective, efficacious treatments for comorbid mental-physical health problems in the short and long-term. The Relaxation Response Resiliency Program (3RP) is one of the leading and innovative mind-body treatments developed at Harvard by Dr. Herbert Benson and colleagues to reduce psychiatric and physical symptoms. Thus, we propose to adapt the 3RP to WTC responders and test its efficacy for simultaneously reducing PTSD and LRS in a randomized controlled trial. The aims of the current proposal are to (1) compare the effects of the 3RP versus a Health Enhancement Program on PTSD and LRS immediately post-intervention and at 3, and 6 months post intervention; (2) to evaluate the effects of the new interventions on medication usage, occupational and psychosocial functioning, and health service utilization through follow-ups; and, (3) to evaluate the effects of the 3RP versus the Health Enhancement Program on respiratory functioning (as assessed by spirometry), blood pressure, and pro-inflammatory markers immediately post-intervention and at 3 and 6 months post-intervention. We will use multimodal assessments including self-report, structured clinical interviews, daily in vivo electronic monitoring of medication use and skills practice, and biological immune and inflammation markers. We expect that the 3RP will not only simultaneously reduce PTSD and LRS but will facilitate improvements in functioning, proper medication use, and health service utilization. This treatment will also result in improved biological markers of stress and inflammation. Thus, we will be able to directly evaluate the impact of these biological markers on disease course and psychosocial changes. If this study confirms our predictions, it will be possible to implement the 3RP at other WTC-Health Program sites easily and inexpensively. Moreover, this study will be groundbreaking, as it is the first randomized clinical trial to evaluate the effects of a mind-body treatment on comorbid PTSD and respiratory illness.

描述（由申请人提供）：尽管WTC健康计划提供了广泛的临床服务，但超过30％的世界贸易中心响应者（WTC）灾难仍在遇到重大医学和/或精神病问题。 此外，这些患者中有20％受到精神和身体疾病的负担。 WTC灾难的两个签名健康后遗症，创伤后应激障碍（PTSD）和下呼吸道症状（LRS）高度合并。 精神病病，例如PTSD，加剧身体疾病并增加治疗不合规，发病率和死亡率。 WTC响应者中PTSD和LRS的持久性强调了我们迄今为止我们的最大努力还不够的事实，因此需要新的治疗方法。 迄今为止，尚未与WTC响应者进行行为干预，以帮助管理PTSD和LRS的管理。 在短期内，身心疗法是对合并症心理健康问题的经济高效，有效的治疗方法。 放松响应弹性计划（3RP）是赫伯特·本森（Herbert Benson）博士和同事在哈佛大学开发的领先和创新的思维疗法之一，可减少精神病和身体症状。 因此，我们建议将3RP适应WTC响应者，并在随机对照试验中测试其同时降低PTSD和LRS的功效。 当前提案的目的是（1）比较3RP与健康增强计划对PTSD和LRS的影响，并在干预后3个和6个月的干预后立即进行比较； （2）评估新干预措施对药物使用，职业和社会心理功能的影响以及通过随访的卫生服务利用； （3）评估 3RP与呼吸功能的健康增强计划（如肺活量测定法评估），血压和促炎性标记后立即干预后以及干预后3和6个月。 我们将使用多模式评估，包括自我报告，结构化临床访谈，用药和技能实践的每日体内电子监测以及生物免疫和炎症标记。 我们预计，3RP不仅会同时减少PTSD和LRS，而且会促进功能，适当的药物使用和健康服务利用的改善。 这种治疗也会改善 压力和炎症的生物标记。 因此，我们将能够直接评估这些生物标记对疾病过程和社会心理变化的影响。 如果这项研究证实了我们的预测，则可以轻松，廉价地在其他WTC-Health计划网站上实施3RP。 此外，这项研究将是开创性的，因为它是第一次评估思维疗法对合并症PTSD和呼吸系统疾病的影响的随机临床试验。