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Study aim
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The purpose of this study was to compare the effectiveness of Acceptance-Based Behavioral Therapy and pharmacotherapy in Post-traumatic stress disorder (PTSD).
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Design
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The present study is a randomized clinical trial conducted from August 4 to December 27, 2017 in Sadr and Baqiyatallah Hospital in Tehran, Iran. The statistical population of the study consisted of war-related PTSD patients who referred to the hospitals in Baqiyatallah and Sadr Hospitals in Tehran. The research sample was selected on the basis of previous research and using the formula for estimating the sample size of 41 people. In order to calculate the sample size, the test power 80% and the significance level 95% was considered. After the psychiatric interview, based on psychiatric diagnostic criteria (DSM-5) by a psychiatrist and a structured clinical interview with SCID-I and II, the subjects were randomly by random numbers assigned to two experimental groups (ABBT with pharmacotherapy) and a control group (pharmacotherapy).
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Settings and conduct
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After coordination with Sadr and Baqiyatallah Hospital in Tehran, Iran medical sessions start. , ABBT was performed in 12 individual sessions for 45 minutes, based on the guidelines for the development of the Roemer and Orsillo Psychological Disorders Protocol, which was coordinated by the present study authors for PTSD. ABBT's setting agenda is:
session1: Implementation of pre- test included Assessment of the severity of the symptoms of PTSD, experiential avoidance, quality of life, and valuable life. Introducing Acceptance-Based Behavioral Therapy, assessment of One’s Relationship with Internal Experiences, Challenging the control of negative thoughts and emotions (control as the problem: creative hopelessness ) and the Destructive Effects of Experiential Avoidance, Introductory Breathing Exercise, Introduction to self-monitoring.
session 2-4: Introducing Mindfulness and Cognitive defuse, To teach mindfulness exercises included: Body scan practice, The Three Minute Breathing Space and Mindfulness practice in everyday life.
session 5-7: Introducing Values and Values-Driven Behavior, Assessment of Values, Goals, Actions, and Barriers, Increasing Engagement in Valued Activities.
session 8-10: Introducing Acceptance and Enhancing Commitment, Cultivating Acceptance through Mindfulness skills and metaphors.
session 11-12: Maintaining and Enhancing Mindfulness, Acceptance, and Commitment, implementation of post- test included Assessment of severity of the symptoms of PTSD, experiential avoidance, quality of life, and valuable life.
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Participants/Inclusion and exclusion criteria
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Samples were Patients referring to Sadr and Baqiyatallah Hospital. This study inclusion criteria were: the diagnosis of PTSD type of war, the lack of psychological treatment for at least one month before entering the study, having a minimum age of 18 and a maximum of 60 years, and the ability to read and write. Exclusion criteria were: having psychotic symptoms and substance abuse, having suicidal thoughts and having severe personality disorders.
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Intervention groups
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The intervention and control group of PTSD patients is referred to the Sadr and Baqiyatallah Hospital. on average, they were in the Iran-Iraq war for three years. All subjects received medication at least 3 months ag. Pharmacotherapy (experimental and control group) was supervised by the psychiatrist for both groups. Each group received 50 to 200 mg of sertraline or fluoxetine 20 to 80 mg per day. The intervention group received ABBT and Pharmacotherapy at the same time. The control group received only Pharmacotherapy .
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Main outcome variables
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the severity of the symptoms of PTSD, experiential avoidance, quality of life, and valuable life