PDF(Pubmed)
Abstract：
Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a well-established treatment for pediatric posttraumatic stress disorder (PTSD). Animal-assisted therapy (AAT) has been proposed as an adjunct to TF-CBT that may improve treatment effects through enhanced targeting of affect regulation, as indexed by specific changes in the respiratory sinus arrhythmia (RSA). The current study reports results from a randomized controlled feasibility trial (N = 33; Mage = 11.79 [SD = 3.08]; 64% White; 67% female) that measured RSA during Sessions 1, 4, 8, and 12 of a twelve-session TF-CBT protocol and tested whether: 1) TF-CBT + AAT achieved higher average RSA amplitudes relative to TF-CBT alone, and 2) RSA regulation, defined as less variability around person-specific RSA slopes during treatment, explained variation in post-treatment PTSD symptoms. Multilevel modeling failed to support an effect for TF-CBT + AAT on RSA amplitudes (δ001 = 0.08, p = 0.844). However, regardless of treatment condition, greater RSA withdrawal was observed within Sessions 4 (γ11 = -.01, p < .001) and 12 (γ13 = -.01, p = .015) relative to the Session 1 baseline. The average level of RSA amplitude in Session 8 was also significantly lower compared to Session 1 (γ02 = -0.70, p = .046). Intraindividual regression models demonstrated that greater RSA regulation predicted improved PTSD symptoms at post-treatment after adjusting for pre-treatment levels (b3 = 20.00, p = .012). These preliminary results offer support for future confirmatory trials testing whether affect regulation, as indexed by changes in RSA, is a mechanism of action for TF-CBT in the treatment of pediatric PTSD.
摘要：
创伤集中的认知行为疗法（TF-CBT）是儿科创伤后应激障碍（PTSD）的公认治疗方法。动物辅助疗法（AAT）已被提议作为TF-CBT的辅助手段，可以通过增强对情感调节的靶向来改善治疗效果。以呼吸性窦性心律失常（RSA）的具体变化为索引。目前的研究报告了一项随机对照可行性试验的结果（N=33;Mage=11.79[SD=3.08];64％的白人;67％的女性），该试验在12个疗程的TF-CBT方案的第1、4、8和12节期间测量了RSA，并测试了是否：1）TF-CBTAAT相对于单独的TF-CBT振幅而言，达到了更高的平均RSA。2)RSA监管，定义为治疗过程中特定人的RSA斜率周围的变异性较小，解释了治疗后PTSD症状的变化。多级建模无法支持TF-CBTAAT对RSA振幅的影响（δ001=0.08，p=0.844）。然而,无论治疗条件如何，相对于第1期基线，第4期(γ11=-.01，p<.001)和第12期(γ13=-.01，p=.015)观察到更大的RSA戒断。与会话1相比，会话8中RSA振幅的平均水平也显着降低（γ02=-0.70，p=0.046）。个体间回归模型表明，在调整治疗前水平后，更高的RSA调节可预测治疗后PTSD症状改善（b3=20.00，p=0.012）。这些初步结果为未来验证性试验提供了支持，测试是否会影响监管，以RSA的变化为索引，是TF-CBT治疗小儿PTSD的作用机制。
