One-day Life Skills Workshop for Veterans with TBI, pain, and Psychopathology: Evaluating efficacy and mechanism of change

创伤性脑损伤(TBI)是从伊拉克自由行动归来的老兵的标志性伤口， 持久自由行动和新黎明行动(OIF/OEF/OND)，高达20%暴露于 轻度颅脑损伤(MTBI)，并出现持续的脑震荡后症状。在那些被诊断为mTBI的人中， 大多数人还患有以压力为基础的精神病理(例如，抑郁症、创伤后应激障碍、 广泛性焦虑症)，以及慢性疼痛。为了应对痛苦、痛苦和其他困难， 退伍军人经常求助于适应不良的回避型应对策略，这些策略提供了短期缓解，但 加剧/维持心理健康问题，并对社会、职业、 和重新融入社区。不幸的是，退伍军人在从事心理健康方面面临重大障碍 治疗，包括耻辱，相信一个人应该自己克服心理困难，以及 担心接受这种护理会对他们的职业生涯产生负面影响。包括时间在内的实际障碍 限制、距离治疗设施的距离和相互竞争的优先事项(例如，工作和家庭需求)是 也是护理方面的障碍。即使在开始心理健康治疗的退伍军人中，也只有一小部分人完成了 循证治疗的推荐疗程。 接受和承诺治疗(ACT)是一种跨诊断的治疗模式，帮助患者 通过促进基于接受的应对和参与有意义的生活活动来克服回避。在……里面 在此背景下，退伍军人被要求思考他们在离开军队和军队后的“新使命(S)” 参与完成使命的行动的重要性，即使它可能是困难的。ACT已经确立 在治疗抑郁、焦虑和慢性疼痛方面的疗效，并已在 各种治疗-提供形式，包括为期一天的小组讲习班。为期一天的ACT研讨会将介绍 患有创伤性脑损伤的退伍军人的特殊需求、基于压力的精神病理学和慢性疼痛(多发性创伤三联症)和 治疗的重要障碍。它1)是跨诊断的(即，适用于多种情况)；2)目标 基于回避的应对；3)培养基于接受的应对，并建立退伍军人的价值观和目标，以 激励他们做出艰难的决定；4)高效交付，因此更容易获得；5)更少 污名化，从而被接受；以及6)解决治疗坚持和完成的问题。 在RR&D SPIRE试点拨款的支持下，PIS开发了一个为期一天的“ACT on Life”研讨会 专为患有重型颅脑损伤的退伍军人、基于压力的精神病理学和慢性疼痛而设计。退伍军人 有这种多发性创伤的患者随后被随机分配到‘ACT on Life’研讨会(N=20)或接受治疗 正常(TAU；N=12)。所有参加为期1天的ACT研讨会的退伍军人都完成了它，相对于TAU， 在3个月的随访中表现出更大的痛苦和重新融入的改善(效果大小为.68和.47， )。在这些有希望的初步发现的基础上，我们现在提议进行更严格的 对212名退伍军人进行的随机对照试验，比较为期1天的ACT研讨会和积极的 治疗比较(教育、资源和支持；急诊服务)对痛苦症状和社交症状的影响 职业和社区重新融合。我们还将检查治疗的调解人和主持人 确定哪些ACT组件直接对治疗效果负责以及是否 治疗福利受到各种个人因素的制约。 为患有mTBI和多发性脑损伤的OEF/OEF/OND退伍军人举办为期一天的ACT研讨会的疗效 共存条件解决了VHA RR&D的主要优先事项：1.制定干预措施，以改善 有特殊需要的退伍军人的心理健康状况；以及2.加强社区、社会和 部署后退伍军人的职业重返社会和职能发挥作用，使他们能够在 社会。

Traumatic brain injury (TBI) is the signature wound of Veterans returning from Operations Iraqi Freedom, Operation Enduring Freedom and Operation New Dawn (OIF/OEF/OND), with up to 20 percent exposed to a mild TBI (mTBI) and experiencing persistent post-concussive symptoms. Among those with a mTBI diagnosis, the majority also suffers from stress-based psychopathology (e.g., depression, post-traumatic stress disorder, generalized anxiety disorder), as well as chronic pain. To cope with distress, pain, and other difficulties, Veterans often turn to maladaptive avoidant coping strategies which offer short term relief but exacerbate/maintain mental health problems and have detrimental long-term effects on social, occupational, and community reintegration. Unfortunately, Veterans face significant barriers to engaging in mental health treatment, including stigma, the belief that one should overcome psychological difficulties on his/her own, and concern that receiving such care would negatively impact their careers. Practical barriers, including time constraints, distance from a treatment facility, and competing priorities (e.g., work and family demands), are also barriers to care. Even among Veterans who start mental health treatment, only a small minority complete a recommended course of evidence-based therapy. Acceptance and Commitment Therapy (ACT) is a trans-diagnostic treatment model that helps patients to overcome avoidance by promoting acceptance-based coping and engagement in meaningful life activities. In this context, Veterans are asked to think about their “new mission(s)” after leaving the military and the importance of engaging in actions that fulfill their mission even when it may be difficult. ACT has established efficacy in the treatment of depression, anxiety, and chronic pain, and has been effectively implemented in various treatment-delivery formats, including 1-day group workshops. A 1-day ACT workshop addresses specific needs of Veterans with mTBI, stress-based psychopathology, and chronic pain (polytrauma triad) and important barriers to treatment. It 1) is trans-diagnostic (i.e., applies to more than one condition); 2) targets avoidance-based coping; 3) cultivates acceptance-based coping and builds on Veteran’s values and goals to motivate them to make difficult decisions; 4) is delivered efficiently and thus more accessible; 5) is less stigmatizing and thus acceptable; and 6) address problems with treatment adherence and completion. With the support of an RR&D SPiRE pilot grant, the PIs developed a 1-day ‘ACT on Life’ workshop tailored specifically for the needs of Veterans with mTBI, stress-based psychopathology, and chronic pain. Veterans with this polytrauma were then randomly assigned to the ‘ACT on Life’ workshop (N=20) or to Treatment as Usual (TAU; N=12). All Veterans attending the 1-day ACT workshop completed it, and relative to TAU, exhibited greater improvements in distress and reintegration at the 3-month follow-up (effect sizes .68 and .47, respectively). Building on these promising preliminary findings, we now propose to conduct a more rigorous randomized controlled trial with 212 Veterans to compare the efficacy of the 1-day ACT workshop to an active treatment comparison (Education, Resources, and Support; ERS) on symptoms of distress and social, occupational, and community reintegration. We will also examine mediators and moderators of treatment response to identify which ACT components are directly responsible for treatment effectiveness and whether treatment benefits are constrained by various personal factors. Establishing the efficacy of a 1-day ACT workshop for OEF/OEF/OND Veterans with mTBI and multiple coexistent conditions addresses key priorities of VHA RR&D: 1. developing interventions which will improve the psychological health status of Veterans who have specific needs; and 2. enhancing the community, social, and occupational reintegration and functioning of post-deployment Veterans so that they may function more fully in society.