Integrated Alcohol Disorder and PTSD Treatment

酒精障碍和创伤后应激障碍综合治疗

• 批准号: 8768465
• 负责人: SONYA NORMAN
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-10-01 至 2017-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8768465
• 关键词: Address; Adult; Affect; Aftercare; Alcohol consumption; Alcohol dependence; Alcohols; Belief; Clinical Treatment; Cognition; Cognitive Therapy; Comorbidity; Coping Skills; Dangerous Behavior; Data; Disease; Distress; ETV3 gene; Evidence based treatment; Female; Grant; Guidelines; Health; Individual; Intervention; Lead; Mediator of activation protein; Methodology; Modification; Outcome; Participant; Patients; Population; Post-Traumatic Stress Disorders; Process; Protocols documentation; Psychotherapy; Quality of life; REM Sleep; Randomized Controlled Trials; Recovery; Relapse; Research; Research Personnel; Research Support; Risk; Safety; Sleep; Sleep Disorders; Symptoms; Trauma; Treatment outcome; Veterans; alcohol use disorder; base; clinical practice; common treatment; depressive symptoms; drinking; evidence base; follow-up; improved; in vivo; innovation; male; satisfaction

DESCRIPTION (provided by applicant): Objectives. Co-occurrence of alcohol use disorder (AD) and posttraumatic stress disorder (PTSD) is common. Research supports exposure therapy as the front line treatment for PTSD as this approach is most likely to lead to sustained recovery from the disorder. However, individuals with AD are generally not offered exposure therapies because of beliefs that exposure would lead to engagement in greater alcohol use and other dangerous behaviors. Most research and clinical treatment for AD/PTSD have involved coping skills based therapies that have generally not shown sustained reductions in alcohol use and PTSD symptoms. A growing body of evidence suggests these individuals with AD/PTSD are able to handle and benefit from exposure. This proposed trial will compare an integrated exposure psychotherapy to an integrated coping skills psychotherapy for the treatment of AD/PTSD. In addition, mechanisms of change for Veterans with AD/PTSD in both treatment conditions, including therapy process variables, changes in negative affect, and sleep problems, will be explored. Significance: This project addresses a critical barrier in the field - the widely held belief that individuals with AD and PTSD cannot tolerate exposure therapy, although it is the best practice treatment for PTSD. If completed, this project will help change the practices that drive treatment for this highly prevalent and highly distressed population. The fundamental rationale is to improve the evidence base that informs how patients with AD/PTSD can attain sustained recovery. Innovation: This application seeks to shift current clinical practice paradigms. A refinement to existing interventions is proposed through integration of two evidence based treatments. The simplicity of the exposure therapy protocol makes it amenable to dissemination and modification to AD treatment settings. Methodology. We propose a randomized controlled trial to evaluate an integrated exposure-based treatment (Integrated Prolonged Exposure; I-PE) for concurrent AD and PTSD that is evidence based and includes both in-vivo exposure and trauma processing. The primary aim will be to conduct a randomized controlled trial to evaluate the effects of I-PE when compared to a present-focused coping skills based intervention (Seeking Safety) in 148 male and female Veterans who have AD and PTSD. The hypotheses are that at post-treatment both groups will show reductions in alcohol use, but I-PE will demonstrate greater reductions in PTSD symptoms than SS. At 5- and 8- month post-baseline follow-up, I-PE will have significantly fewer percent drinking days and fewer PTSD symptoms than SS. In addition, mechanisms of change in both treatment conditions will be examined.

描述（由申请人提供）： 目标。酒精使用障碍（AD）和创伤后应激障碍（PTSD）同时出现很常见。研究支持暴露疗法作为创伤后应激障碍的一线治疗方法，因为这种方法最有可能导致疾病持续康复。然而，AD 患者通常不会接受暴露疗法，因为他们相信暴露会导致更多的饮酒和其他危险行为。大多数针对 AD/PTSD 的研究和临床治疗都涉及基于应对技能的疗法，这些疗法通常没有显示出持续减少饮酒和 PTSD 症状。越来越多的证据表明，这些患有 AD/PTSD 的人能够应对暴露并从中受益。这项拟议的试验将比较综合暴露心理疗法和综合应对技能心理疗法治疗 AD/PTSD 的效果。此外，还将探讨患有 AD/PTSD 的退伍军人在两种治疗条件下的变化机制，包括治疗过程变量、负面情绪的变化和睡眠问题。意义：该项目解决了该领域的一个关键障碍——人们普遍认为患有 AD 和 PTSD 的人不能耐受暴露疗法，尽管它是治疗 PTSD 的最佳实践。如果完成，该项目将有助于改变对这一高度流行和高度痛苦的人群进行治疗的做法。基本原理是改善 AD/PTSD 患者如何实现持续康复的证据基础。创新：该应用程序旨在改变当前的临床实践范式。通过整合两种基于证据的治疗方法，提出了对现有干预措施的改进。暴露疗法方案的简单性使其易于传播和修改 AD 治疗环境。方法论。我们提出了一项随机对照试验，以评估针对并发 AD 和 PTSD 的基于综合暴露的治疗（综合长期暴露；I-PE），该治疗是基于证据的，包括体内暴露和创伤处理。主要目的是在 148 名患有 AD 和 PTSD 的男性和女性退伍军人中进行一项随机对照试验，以评估 I-PE 与基于当前应对技能的干预措施（寻求安全）的效果。假设在治疗后，两组的饮酒量都会减少，但 I-PE 会比 SS 更明显地减少 PTSD 症状。在基线后 5 个月和 8 个月的随访中，与 SS 相比，I-PE 的饮酒天数百分比和 PTSD 症状明显更少。此外，还将检查两种治疗条件的变化机制。