A controlled trial of adaptive disclosure-enhanced to improve functioning and treat posttraumatic stress disorder.

Autor:	Litz BT; VA Boston Healthcare System., Yeterian J; VA Connecticut Healthcare System., Berke D; Department of Psychology, Hunter College., Lang AJ; VA San Diego Healthcare System., Gray MJ; Department of Psychology, University of Wyoming., Nienow T; Minneapolis VA Health Care System., Frankfurt S; VISN17 Center of Excellence for Research on Returning War Veterans., Harris JI; VA Bedford Healthcare System., Maguen S; San Francisco VA Health Care System., Rusowicz-Orazem L; School of Public Health, Boston University.
Jazyk:	angličtina
Zdroj:	Journal of consulting and clinical psychology [J Consult Clin Psychol] 2024 Mar; Vol. 92 (3), pp. 150-164.
DOI:	10.1037/ccp0000873
Abstrakt:	Objective: This is a randomized controlled trial (NCT03056157) of an enhanced adaptive disclosure (AD) psychotherapy compared to present-centered therapy (PCT; each 12 sessions) in 174 veterans with posttraumatic stress disorder (PTSD) related to traumatic loss (TL) and moral injury (MI). AD employs different strategies for different trauma types. AD-Enhanced (AD-E) uses letter writing (e.g., to the deceased), loving-kindness meditation, and bolstered homework to facilitate improved functioning to repair TL and MI-related trauma. Method: The primary outcomes were the Sheehan Disability Scale (SDS), evaluated at baseline, throughout treatment, and at 3- and 6-month follow-ups (Brief Inventory of Psychosocial Functioning was also administered), the Clinician-Administered PTSD Scale (CAPS-5), the Dimensions of Anger Reactions, the Revised Conflict Tactics Scale, and the Quick Drinking Screen. Results: There were statistically significant between-group differences on two outcomes: The intent-to-treat (ITT) mixed-model analysis of SDS scores indicated greater improvement from baseline to posttreatment in the AD-E group (d = 2.97) compared to the PCT group, d = 1.86; -2.36, 95% CI [-3.92, -0.77], t(1,510) = -2.92, p < .001, d = 0.15. Twenty-one percent more AD-E cases made clinically significant changes on the SDS than PCT cases. From baseline to posttreatment, AD-E was also more efficacious on the CAPS-5 (d = 0.39). These differential effects did not persist at follow-up intervals. Conclusion: This was the first psychotherapy of veterans with TL/MI-related PTSD to show superiority relative to PCT with respect to functioning and PTSD, although the differential effect sizes were small to medium and not maintained at follow-up. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Databáze:	MEDLINE
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