A Randomized Controlled Pilot Trial of Primary Care Treatment Integrating Motivation and Exposure Treatment (PC-TIME) in Veterans With PTSD and Harmful Alcohol Use

IF 3.4 2区心理学 Q2 PSYCHIATRY

Behavior Therapy Pub Date : 2023-09-10 DOI:10.1016/j.beth.2023.08.011

Kyle Possemato, Nadine R. Mastroleo, Christina Balderrama-Durbin, Paul King, Ariella Davis, Brian Borsari, Sheila A.M. Rauch

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引用次数: 0

Abstract

Individuals with posttraumatic stress disorder (PTSD) often engage in harmful alcohol use. These co-occurring conditions are associated with negative health consequences and disability. PTSD and harmful drinking are typically experienced as closely related—thus treatments that target both simultaneously are preferred by patients. Many individuals with PTSD and harmful alcohol use receive primary care services but encounter treatment barriers in engaging in specialty mental health and substance use services. A pilot randomized controlled trial of a brief integrated treatment for PTSD and harmful drinking versus primary care treatment as usual (PC-TAU) took place in three U.S. Department of Veterans Affairs (VA) primary care clinics. The intervention (primary care treatment integrating motivation and exposure [PC-TIME]) combines motivational interviewing to reduce alcohol use and brief prolonged exposure for PTSD delivered over five brief sessions. Participants (N = 63) were veterans with PTSD and harmful drinking. Multilevel growth curve modeling examined changes in drinking (average number of drinks per drinking day and percentage of heavy drinking days) and self-reported PTSD severity at baseline, 8, 14, and 20 weeks. Participants reported high satisfaction with PC-TIME and 70% (n = 23) completed treatment. As hypothesized, a significantly steeper decrease in self-reported PTSD severity and heavy drinking was evident for participants randomized to PC-TIME compared with PC-TAU. Contrary to expectations, no significant posttreatment differences in PTSD diagnoses were observed. PC-TIME participants were less likely to exceed National Institute for Alcoholism and Alcohol Abuse (NIAAA) guidelines for harmful alcohol use posttreatment compared with PC-TAU participants. PC-TIME is a promising brief, primary care-based treatment for individuals with co-occurring PTSD and harmful alcohol use. A full-scale randomized clinical trial is needed to fully test its effectiveness.

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针对患有创伤后应激障碍和酗酒的退伍军人的 "动机与暴露治疗相结合的初级保健治疗（PC-TIME）"随机对照试点试验

患有创伤后应激障碍（PTSD）的人经常酗酒。这些并发症与不良健康后果和残疾有关。创伤后应激障碍和有害饮酒通常被认为是密切相关的，因此同时针对这两种情况的治疗方法是患者的首选。许多患有创伤后应激障碍和有害饮酒的人接受了初级保健服务，但在接受专科心理健康和药物使用服务时却遇到了治疗障碍。美国退伍军人事务部（VA）的三家初级保健诊所开展了一项试点随机对照试验，对创伤后应激障碍和有害饮酒的简短综合治疗与常规初级保健治疗（PC-TAU）进行了对比。干预措施（集动机和暴露于一体的初级保健治疗 [PC-TIME]）结合了动机访谈以减少酒精使用，以及通过五节简短的课程对创伤后应激障碍进行简短的长期暴露。参与者（N = 63）均为患有创伤后应激障碍和有害饮酒的退伍军人。多层次增长曲线模型研究了基线、8、14 和 20 周时饮酒量（平均每天饮酒量和大量饮酒天数百分比）和自我报告的创伤后应激障碍严重程度的变化。参与者对 PC-TIME 的满意度很高，70%（n = 23）的人完成了治疗。正如假设的那样，与 PC-TAU 相比，随机接受 PC-TIME 治疗的参与者在自我报告的创伤后应激障碍严重程度和大量饮酒方面的下降幅度明显更大。与预期相反，治疗后创伤后应激障碍的诊断结果没有明显差异。与 PC-TAU 参与者相比，PC-TIME 参与者在治疗后超过美国国家酒精中毒和酒精滥用研究所（NIAAA）有害酒精使用准则的可能性较小。对于同时患有创伤后应激障碍和有害饮酒的人来说，PC-TIME 是一种很有前景的以初级保健为基础的简短治疗方法。需要进行全面的随机临床试验来充分检验其有效性。

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来源期刊

Behavior Therapy Multiple-

CiteScore

7.40

自引率

2.70%

发文量

113

审稿时长

121 days

期刊介绍： Behavior Therapy is a quarterly international journal devoted to the application of the behavioral and cognitive sciences to the conceptualization, assessment, and treatment of psychopathology and related clinical problems. It is intended for mental health professionals and students from all related disciplines who wish to remain current in these areas and provides a vehicle for scientist-practitioners and clinical scientists to report the results of their original empirical research. Although the major emphasis is placed upon empirical research, methodological and theoretical papers as well as evaluative reviews of the literature will also be published. Controlled single-case designs and clinical replication series are welcome.