Consulting after Combat: Interviewing Service Members and Veterans to Develop a Therapy to Restore Functioning and Reintegration after Moral Injury Events

大约25%的退伍军人患有创伤后应激障碍（PTSD）寻求治疗 对于涉及潜在道德伤害事件（PMIE）的创伤，而不是基于精神创伤的创伤。 PMIE与功能和精神损害的相关性比基于生命威胁的PMIE更强。 战斗退伍军人报告说，PMIE破坏了他们的身份感和意义感， 信任他人，并产生令人不安的内疚，羞耻，愤怒和厌恶。暴露于 PMIE，也被称为精神伤害，可以解释部署后恢复的差异， 潜在的未解决的治疗目标。现有的一线治疗可能是有限的，因为它们是 来自平民背景，不适合战区背景，不允许退伍军人讨论 与其他退伍军人的PMIE的细节。本项目将开发一个基于关系动态的组 治疗手册，将针对功能和生活质量的退伍军人谁是 受到高强度PMIE的影响。这种关系动态创伤治疗的目标是帮助 退伍军人确定他们目前的症状和他们在战斗/PMIE中的经历之间的联系， 他们当前的生活压力源和关系，以及具有个人特定意义的历史因素 他们的创伤/PMIE。这些探索发生在和谐和同情他人的存在 能够与所表达的体验和情感产生共鸣的人。通过以下方式减轻症状 提高退伍军人的能力，有意识地反思他们的经验，并制定一个综合的 对影响其心理状态的各种因素的自我意识。结果是更大的自我反省， 更少的回避，更大的适应性融入生活经验及其后果和意义 进入一个人的内心世界CDA-2将采用创新的以用户为中心的设计方法， 在治疗开发过程中不断收集用户体验，目标是增加 有效性和可用性。用户反馈将与来自临床的形成性反馈进行合成 专家小组。这一目标将通过追求以下具体目标来实现：目标1：发现 用户需求和偏好以及治疗参与障碍和促进因素 受PMIE影响的退伍军人和[VA创伤临床医生]的观点。目标2：设计治疗手册 并利用退伍军人、创伤临床医生和专家临床咨询委员会的反馈意见进行完善。 目标3：进行两次快速原型开放试验（即，切实测试治疗方法， 原型手册）与受PMIE影响的退伍军人（N = ~12），并根据以下内容迭代修订手册 退伍军人、医疗服务提供者和临床专家小组的反馈意见，并提出以下假设： 手册将满足可用性、可行性、可学习性和可接受性标准。

Approximately 25% of combat Veterans with Posttraumatic Stress Disorder (PTSD) seek treatment for traumas that involve potentially morally injurious events (PMIE) rather than danger-based traumas. PMIEs are more strongly associated with functional and psychiatric impairment than life-threat-based combat. Veterans report that PMIEs disrupt their sense of identity and meaning, ability to connect with and trust others, and engender disturbing guilt, shame, rage, and disgust. The sequelae of exposure to PMIEs, otherwise known as moral injury, may explain variance in post-deployment recovery and is a potential unaddressed treatment target. Existing first-line treatments may be limited because they were derived from civilian contexts, poorly fit the war zone context, and do not allow Veterans to discuss the details of the PMIEs with other Veterans. This project will develop a relational dynamic-based group therapy treatment manual that will target functioning and quality of life among Veterans who are impacted by high magnitude PMIEs. The goal of this relational dynamic trauma therapy is to help Veterans identify connections between their current symptoms and their experiences in combat/PMIEs, their current life stressors and relationships, and the historical factors that carry person-specific meaning to their trauma/PMIE. These explorations take place in the presence of attuned and sympathetic others who can resonate to the experience and the affect being expressed. Symptom reduction occurs through increasing the Veteran’s capacity to consciously reflect on their experiences and develop an integrated self-awareness of the various factors that affect their mental states. The result is greater self-reflection, less avoidance, and greater adaptive incorporation of life experiences and their aftermath and meanings into one’s inner world. This CDA-2 will employ innovative user-centered design methods that continuously gather user experiences during treatment development, with the goal of increased effectiveness and usability. User feedback will be synthesized with formative feedback from a clinical expert panel. This objective will be accomplished by pursuing these specific aims: Aim 1: Discover user needs and preferences as well as treatment-engagement barriers and facilitators from the perspectives of PMIE-impacted Veterans and [VA trauma clinicians]. Aim 2: Design a treatment manual and refine it using feedback from Veterans, [trauma clinicians], and an expert clinical advisory board. Aim 3: Conduct two rapid prototyping open trials (i.e., tangibly testing treatment approaches using a prototype manual) with PMIE-impacted Veterans (N = ~12), and iteratively revise the manual based on Veteran, provider, and clinical expert panel feedback, with the following hypothesis: The treatment manual will meet usability, feasibility, learnability, and acceptability criteria.