The impact of modifiable psychosocial factors on Veteransâ long-term trajectories of functioning and quality of life: Promoting recovery by targeting mindfulness and psychological flexibility

创伤后应激障碍(PTSD)、抑郁症、酒精使用障碍(AUD)、创伤性脑 创伤和慢性疼痛经常在9/11战争后的退伍军人中同时发生，并与 有功能障碍和自杀风险。然而，没有任何治疗方法存在(这是特别的 旨在促进退伍军人的功能恢复 战争中常见的精神和身体创伤。这是第二次重新提交的提案 竞争性更新项目服务第三阶段资金(研究评估退伍军人 经验)。在阶段1(RX000304-01A1)中，我们确定了以下方面的风险和弹性因素 与部署相关的心理健康状况，无论这些因素是否可修改。 在阶段2(RX000304-04A1)中，我们通过关注绘制的可修改的预测值来改进我们的方法 来自治疗结果的文献。这一纲领路线的总体目标是 研究是为循证预防和治疗的发展提供信息 旨在帮助返乡退伍军人实现最佳功能的计划 重新融入平民生活。这一愿景在拟议的第三阶段实现，该阶段 建议扩大纵向研究(目标1)，并调整、完善和试行 促进功能恢复的干预措施(目标2)。这项为期两年的纵向研究(N=500)将 检查新奇因素(例如，专注力、感知的负担、受挫的归属感、 精神伤害)和既定的治疗目标(心理灵活性、自我同情、情感 规则)与功能损害的潜在类别轨迹相关，并作为风险预测因子 对于自我导向的暴力(SDV；即自杀风险)，这是退伍军人事务部和RR&D的首要任务。 在之前的阶段，我们将心理僵化确立为心理健康的一个强有力的风险因素 问题、功能障碍和SDV。因此，在目标2中，使用连续队列设计，我们 将[根据退伍军人的反馈]进行适应、改进，并试点测试经过调整的基于证据的 以心理灵活性为目标的干预、接受和承诺疗法(ACT) 促进功能恢复(ACT-FX)。我们之前展示了ACT的前景，一个 旨在改善基于诊断、正念和接受的行为疗法 通过增加与患有创伤后应激障碍的退伍军人的心理灵活性来发挥作用。我们 将测试ACT-FX的可行性和可接受性，[这是一种为促进 与精神疾病相比，与这些共同发生的疾病相关的功能恢复 60例中重度功能障碍退伍军人的常规健康治疗 我们的最终目标是帮助长期受损的退伍军人进入康复轨道。集成 纵向研究的数据(目标1)和治疗研究的数据(目标2)，我们将进行 ACT-FX是否与功能受损的退伍军人转移到 以长期恢复为特征的潜在职业轨迹(目标3；探索性)。

Posttraumatic stress disorder (PTSD), depression, alcohol use disorders (AUD), traumatic brain injury, and chronic pain frequently co-occur among post-9/11 war Veterans and are associated with functional impairment and suicide risk. Yet, no treatment exists [that was specifically designed] to promote functional recovery in Veterans experiencing any combination of these most common mental and physical wounds of war. This is the re-submitted proposal for a second competitive renewal to fund Phase 3 of Project SERVE (Study Evaluating Returning Veterans’ Experiences). In Phase 1 (RX000304-01A1), we identified risk and resilience factors for deployment-related mental health conditions regardless of whether those factors were modifiable. In Phase 2 (RX000304-04A1), we refined our approach by focusing on modifiable predictors drawn from the treatment outcomes literature. The over-arching aim of this programmatic line of research is to inform the development of evidence-based prevention and treatment programs designed to assist returning Veterans with achieving optimal functioning upon reintegrating into civilian life. This vision comes to fruition in the proposed Phase 3, which proposes both to extend the longitudinal study (Aim 1) and to adapt, refine, and pilot test an intervention to promote functional recovery (Aim 2). The 2-year longitudinal study (N = 500) will examine novel factors (e.g., mindfulness, perceived burdensomeness, thwarted belongingness, moral injury) and established treatment targets (psychological flexibility, self-compassion, emotion regulation) in relation to latent class trajectories of functional impairment, and as predictors of risk for self-directed violence (SDV; i.e., suicide risk), which is a top priority for VA and RR&D. In the prior Phases, we established psychological inflexibility as a robust risk factor for mental health problems, functional impairment, and SDV. Thus, in Aim 2, using a Successive Cohort Design, we will adapt, refine [based on Veterans’ feedback], and pilot-test an adapted evidence-based intervention, Acceptance and Commitment Therapy (ACT) that targets psychological flexibility to promote functional recovery (ACT-FX). We previously demonstrated the promise of ACT, a transdiagnostic, mindfulness and acceptance-based behavior therapy aimed at improving functioning by increasing psychological flexibility with Veterans with co-occurring PTSD-AUD. We will test the feasibility and acceptability of ACT-FX, [an individually-tailored intervention to promote functional recovery related to these commonly co-occurring conditions as compared to mental health treatment as usual (TAU) in 60] Veterans with moderate-to-severe functional impairment. Our ultimate goal is to help shift chronically impaired Veterans to a recovery trajectory. Integrating data from the longitudinal study (Aim 1) with data from the treatment study (Aim 2), we will conduct a preliminary test of whether ACT-FX is associated with functionally impaired Veterans moving to a latent class trajectory characterized by long-term recovery (Aim 3; Exploratory).