标题：Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial
摘要：Background: It is unclear whether the evidence-based treatments for PTSD are as effective
in patients with CA-PTSD.
Objective: We aimed to investigate the effectiveness of three variants of prolonged exposure therapy.
Method: We recruited adults with CA-PTSD. Participants were randomly assigned to
Prolonged Exposure (PE; 16 sessions in 16 weeks), intensified Prolonged Exposure (iPE; 12
sessions in 4 weeks followed by 2 booster sessions) or a phase-based treatment, in which 8
sessions of PE were preceded by 8 sessions of Skills Training in Affective and Interpersonal
Regulation (STAIR+PE; 16 sessions in 16 weeks). Assessments took place in week 0 (baseline),
week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. The primary
outcome was clinician-rated PTSD symptom severity.
Results: We randomly assigned 149 patients to PE (48), iPE (51) or STAIR+PE (50). All treatments
resulted in large improvements in clinician assessed and self-reported PTSD symptoms from baseline
to 1-year follow-up (Cohen’s d > 1.6), with no significant differences among treatments. iPE led to
faster initial symptom reduction than PE for self-report PTSD symptoms (t135 = −2.85, p = .005, d = .49)
but not clinician-assessed symptoms (t135 = −1.65, p = .10) and faster initial symptom reduction than
STAIR+PE for self-reported (t135 = −4.11, p < .001, d = .71) and clinician-assessed symptoms (t135
= −2.77, p = .006, Cohen’s d = .48) STAIR+PE did not result in significantly more improvement from
baseline to 1-year follow-up on the secondary outcome emotion regulation, interpersonal problems
and self-esteem compared to PE and iPE. Dropout rates did not differ significantly between
conditions.
Conclusions: Variants of exposure therapy are tolerated well and lead to large improvements in
patients with CA-PTSD. Intensifying treatment may lead to faster improvement but not to overall
better outcomes.
