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).

中文翻译：

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一项增强适应性披露的对照试验，以改善功能和治疗创伤后应激障碍。


目的 这是一项随机对照试验 (NCT03056157)，对 174 名患有与创伤性丧失 (TL) 和精神伤害（MI）。 AD 针对不同的创伤类型采用不同的策略。 AD-增强型（AD-E）使用写信（例如，给死者）、慈爱冥想和强化家庭作业来促进功能的改善，以修复与 TL 和 MI 相关的创伤。方法 主要结果是 Sheehan 残疾量表 (SDS)，在基线、整个治疗过程以及 3 个月和 6 个月的随访时进行评估（还进行了心理社会功能简要量表）、临床医生管理的 PTSD 量表 (CAPS) -5)、愤怒反应的维度、修订后的冲突策略量表和快速饮酒屏幕。结果 两个结果存在统计学上显着的组间差异： SDS 评分的意向治疗 (ITT) 混合模型分析表明，与对照组相比，AD-E 组 (d = 2.97) 从基线到治疗后有更大的改善。 PCT组，d=1.86； -2.36，95% CI [-3.92，-0.77]，t(1,510) = -2.92，p < .001，d = 0.15。与 PCT 病例相比，在 SDS 上发生临床显着变化的 AD-E 病例多出 21%。从基线到治疗后，AD-E 对 CAPS-5 也更有效 (d = 0.39)。这些差异效应在随访期间不会持续存在。结论 这是第一个针对患有 TL/MI​​ 相关 PTSD 的退伍军人的心理治疗，在功能和 PTSD 方面显示出相对于 PCT 的优越性，尽管差异效应大小为小到中等，且在随访中未维持。 （PsycInfo 数据库记录 (c) 2024 APA，保留所有权利）。