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

战后咨询：采访现役军人和退伍军人，制定一种治疗方法，以在精神伤害事件后恢复功能和重新融入社会

• 批准号: 10315112
• 负责人: Sheila Frankfurt
• 金额: --
• 依托单位: OLIN TEAGUE VETERANS CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-11-01 至 2027-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10315112
• 关键词: Affect; Caring; Clinical; Clinical Research; Clinical Trials; Conscious; Consult; Development; Drops; Effectiveness; Event; Exposure to; Family member; Feedback; Goals; Group Therapy; Guilt; Health Personnel; Human; Impairment; Injury; Intervention; Interview; K-Series Research Career Programs; Learning; Life; Life Experience; Literature; Manuals; Mental Health; Mentors; Methods; Military Personnel; Modeling; Modernization; Morals; Participant; Patient-Centered Care; Patients; Persons; Post-Traumatic Stress Disorders; Provider; Qualitative Research; Quality of life; Recovery; Rehabilitation therapy; Reporting; Research; Self Perception; Self-Examination; Shame; Symptoms; Testing; Time; Training; Trauma; Trust; Veterans; War; acceptability and feasibility; base; career; combat; combat trauma; combat veteran; design; effective therapy; experience; functional restoration; implementation science; improved; innovation; mental state; preference; prototype; psychosocial; reduce symptoms; service member; stressor; therapy development; treatment group; usability; user centered design

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.

大约 25% 患有创伤后应激障碍 (PTSD) 的退伍军人寻求治疗 适用于涉及潜在道德伤害事件 (PMIE) 的创伤，而不是基于危险的创伤。 PMIE 与功能和精神障碍的相关性比基于生命威胁的障碍更为密切 战斗。退伍军人报告说，PMIE 扰乱了他们的身份感和意义以及与他人联系的能力 信任他人，并产生令人不安的内疚、羞耻、愤怒和厌恶。接触后遗症 PMIE，也称为精神伤害，可以解释部署后恢复的差异，并且是一种 潜在的未解决的治疗目标。现有的一线治疗可能受到限制，因为它们 源自平民背景，不太适合战区背景，并且不允许退伍军人讨论 与其他退伍军人的 PMIE 的详细信息。该项目将开发一个基于关系动态的群体 治疗手册将针对退伍军人的功能和生活质量 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 退伍军人确定他们当前的症状与他们在战斗/PMIE 中的经历之间的联系， 他们当前的生活压力和人际关系，以及具有个人特定意义的历史因素 他们的创伤/PMIE。这些探索是在有协调和同情心的其他人在场的情况下进行的 谁能够对所表达的体验和情感产生共鸣。症状减轻是通过 提高退伍军人有意识地反思自己的经历并发展综合能力的能力 对影响其心理状态的各种因素的自我意识。结果就是更加自我反省， 减少回避，更好地适应性地融入生活经历及其后果和意义 进入一个人的内心世界。 CDA-2 将采用以用户为中心的创新设计方法 在治疗开发过程中不断收集用户体验，以提高治疗效果 有效性和可用性。用户反馈将与临床的形成性反馈综合起来 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 用户的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 并根据退伍军人、[创伤临床医生]和专家临床咨询委员会的反馈对其进行完善。 目标 3：进行两项快速原型开放试验（即，使用 原型手册）与受 PMIE 影响的退伍军人（N = ~12），并根据 退伍军人、提供者和临床专家小组的反馈，提出以下假设： 治疗 手册将满足可用性、可行性、可学习性和可接受性标准。