Manage Emotions to Reduce Aggression - MERA: A Brief Aggression Treatment for Veterans with PTSD Symptoms

这项随机临床试验(RCT)测试了情绪调节治疗、管理 情绪减少攻击性(MERA)，减少患有创伤后应激的退伍军人的攻击性 改善创伤后应激障碍(PTSD)和改善PTSD治疗的启动。背景：有创伤后应激障碍症状的退伍军人 报告难以控制他们的攻击性，这可能会导致毁灭性的人际和社会 后果，如监禁、家庭暴力和社会支持中断。退伍军人与 创伤后应激障碍主要表现为冲动攻击(情绪性、反应性和失控)，而不是 有预谋的攻击(故意的、工具的和有计划的)。情绪失调，或 在情感意识、情感接受、行为控制和/或内容方面的技能不发达- 适当的调节策略，完全中介创伤后应激障碍严重程度与冲动之间的关系 退伍军人的攻击性。此外，退伍军人报告说，害怕自己的情绪是他们不这么做的一个原因 启动创伤后应激障碍循证心理治疗。情绪调节似乎会影响这两种攻击性 以及为患有创伤后应激障碍的退伍军人启动治疗。因此，这项拟议的研究以情绪调节为目标 减少冲动攻击性和使退伍军人为创伤后应激障碍做好准备的目标基于证据 心理治疗。研究计划：我们的目标是测试一种创新情绪调节的有效性 培训，Mera，对204名患有创伤后应激障碍和冲动攻击性的阿富汗和伊拉克退伍军人进行随机对照试验。 MERA分三个课程提供，以解决年轻退伍军人面临的后勤障碍 重新融入他们的社区。MERA融合了教育、认知-行为和接受- 以技能培训为基础。它还包括有关创伤后应激障碍的情绪体验的信息 治疗。目前的三次集中治疗将作为积极对照组，即 与往常的治疗一致。MERA和目前的中心治疗将在以下方面进行比较 攻击性从第1次治疗到治疗后2个月的变化。我们预测退伍军人将完成 与退伍军人相比，梅拉在IA和情绪调节障碍方面的减少会更多 完全以当下为中心的治疗。最后，创伤后应激障碍循证心理治疗的启动率 (参加1次会议)，将在治疗6个月后通过图表审查进行检查。我们预测退伍军人 Complete Mera将以更高的速度启动PTSD循证心理治疗，而退伍军人 完全以当下为中心的治疗。意义：这项研究支持两个退伍军人事务部任务： 减少攻击性，增加创伤后应激障碍的治疗。创伤后应激障碍是最常见的 退伍军人中昂贵的精神疾病。患有创伤后应激障碍的退伍军人更有可能从事 攻击性行为比患有创伤后应激障碍的平民或没有创伤后应激障碍的退伍军人更好。减少攻击性是一个关键 对退伍军人、他们的家庭和社会的需要。此外，还有一些有效的治疗方法可以减少 尽管有创伤后应激障碍的症状，但很少有退伍军人接受基于证据的心理治疗。其中一个原因是 治疗启动率低是因为退伍军人担心他们将无法控制自己的情绪 当他们开始治疗时会有反应。让退伍军人掌握情绪调节技能和知识 关于创伤后应激障碍治疗可能会帮助他们开始治疗创伤后应激障碍。

This randomized clinical trial (RCT) tests the efficacy of an emotion regulation treatment, Manage Emotions to Reduce Aggression (MERA), to decrease aggression in Veterans with posttraumatic stress disorder (PTSD) and improve PTSD treatment initiation. Background: Veterans with PTSD symptoms report difficulty controlling their aggression which can lead to devastating interpersonal and societal consequences, such as incarceration, family violence, and disruption of social support. Veterans with PTSD primarily engage in impulsive aggression (emotional, reactive, and uncontrolled) rather than premeditated aggression (deliberate, instrumental, and planned). Emotion dysregulation, or underdeveloped skills in emotional awareness, emotional acceptance, behavioral control, and/or content- appropriate regulation strategies, fully mediates the relationship between PTSD severity and impulsive aggression in Veterans. Additionally, Veterans report fearing their emotions as one reason they do not initiate PTSD evidence-based psychotherapy. Emotion regulation appears to influence both aggression and treatment initiation for Veterans with PTSD. Thus, this proposed study targets emotion regulation with the goal of reducing impulsive aggression and preparing Veterans for PTSD evidence-based psychotherapy. Research Plan: Our goal is to test the efficacy of an innovative emotion regulation training, MERA, with a RCT of 204 Afghanistan and Iraq Veterans with PTSD and impulsive aggression. MERA is provided in three sessions to address logistical barriers faced by younger Veterans who are reintegrating into their communities. MERA incorporates education, cognitive-behavioral and acceptance- based skills training. It also includes information about what emotional experiences to expect from PTSD treatments. Three sessions of present centered therapy will serve as an active control group which is consistent with treatment as usual. MERA and present centered therapy will be compared on changes in aggression from Session 1 to the 2-month posttreatment changes. We predict Veterans who complete MERA will have greater reductions in IA and emotion dysregulation as compared to Veterans who complete present centered therapy. Finally, rates of PTSD evidence-based psychotherapy initiation (attend 1 session), will be examined via a chart review 6 months post treatment. We predict Veterans who complete MERA will initiate PTSD evidence-based psychotherapies at a greater rate than Veterans who complete present centered therapy. Significance: This study supports 2 Veterans Affairs missions: reduce aggression and increase PTSD treatment initiation. PTSD is one of the most commonly occurring and costly psychiatric conditions among Veterans. Veterans with PTSD are more likely to engage in aggressive behavior than civilians with PTSD or Veterans without PTSD. Reducing aggression is a critical need for Veterans, their families, and society. Additionally, there are effective treatments that reduce PTSD symptoms, yet few Veterans receive evidence based psychotherapies for PTSD. One reason for the low rate of treatment initiation is that Veterans fear they will not be able to control their emotional responses when they begin treatment. Equipping Veterans with emotion regulation skills and knowledge about PTSD treatments may help them initiate treatment for PTSD.