Mindfulness Treatment for Anger in Veterans with PTSD

 描述：（申请人提供） 患有创伤后应激障碍（PTSD）的退伍军人表现出愤怒和攻击行为的增加。愤怒和攻击性失调会给配偶、家庭成员和朋友带来恐惧和痛苦，导致关系恶化，并对退伍军人的社会、职业和其他重要功能领域产生不利影响。基于标准认知行为疗法（CBT）的愤怒和攻击性干预措施是有限的，部分原因是它们不直接针对与攻击性最密切相关的特定PTSD症状，即过度觉醒和生理反应性增加。此外，它们并不能帮助个人意识到和洞察他们的愤怒状态，这是有效管理愤怒和攻击所必需的。正念包括对一个人的直接经验的自我调节注意力，并采取接受一个人的当前经验的方向。对平民进行的研究发现，正念可以有效地减少愤怒和攻击性。到目前为止，还没有研究探讨正念在减少创伤后应激障碍退伍军人的愤怒和攻击性方面的有效性。这项拟议的研究旨在研究一种已建立的正念干预的初步疗效，即基于正念的减压（MBSR）在减少创伤后应激障碍退伍军人中与创伤相关的愤怒和攻击性方面的效果。拟议的项目还旨在审查解释其影响的潜在作用机制。Kachadourian博士是弗吉尼亚州西黑文国家创伤后应激障碍中心临床神经科学部的博士后研究员，他对酒精、创伤后应激障碍、愤怒和攻击性进行了基础研究。她目前的兴趣包括进行临床试验，以测试新的治疗方法，如正念冥想治疗创伤后应激障碍退伍军人的愤怒和攻击。培训目标：该CDA-2申请的目标包括提高Kachadourian博士在进行临床试验研究和高级统计分析方面的专业知识，并提高她在正念干预方面的熟练程度。这将通过一个严格的正规教学计划，与在临床试验研究和正念，创伤后应激障碍，愤怒和攻击方面经验丰富的研究人员合作，以及一项随机对照试点研究来完成，该研究旨在检查MBSR在减少创伤后应激障碍退伍军人中的愤怒和攻击方面的初步疗效。方法：60名患有PTSD的退伍军人将被随机分配参加PTSD心理教育课程（创伤恢复教育课程或TREC）或MBSR。所有参与者都将参加基线，治疗后和3个月的随访会议，以评估自我报告的愤怒和侵略随时间的变化。在治疗后阶段，参与者还将使用在基线阶段开发的创伤叙述进行创伤想象程序。然后，他们将参加一个旨在评估挑衅性攻击的实验室范例。除了检查参与MBSR是否会降低自我报告的愤怒和攻击水平外，这项研究还将检查参与者在体内暴露于创伤提醒后是否会降低攻击性。正念在多大程度上减少了生理反应，增加了情绪调节也将被检查。这项研究的关键问题是，正念是否会减少患有PTSD的退伍军人的愤怒和攻击性。Kachadourian将能够实现她的长期目标，成为一名独立的VA科学家，在测试新的临床干预措施方面具有专业知识，以治疗患有PTSD的退伍军人的问题愤怒和攻击。

 DESCRIPTION: (provided by applicant) Military Veterans suffering from posttraumatic stress disorder (PTSD) have been shown to exhibit increases in anger and aggressive behavior. Dysregulated anger and aggression can create fear and distress in spouses, family members, and friends resulting in deteriorated relationships, and can have a detrimental impact on Veterans' social, occupational and other important areas of functioning. Standard Cognitive Behavioral Therapy (CBT)-based interventions for anger and aggression are limited in part because they do not directly target the specific PTSD symptoms most strongly associated with aggression, namely increased hyperarousal and physiological reactivity. Further, they do not assist individuals in achieving awareness and insight into their anger states, which is necessary for effective management of anger and aggression. Mindfulness involves the self-regulation of attention on one's immediate experience and adopting an orientation of acceptance toward one's present experiences. Research studies conducted with civilians have found mindfulness to be effective in reducing anger and aggression. To date, no research has examined the effectiveness of mindfulness in decreasing anger and aggression among Veterans with PTSD. The proposed study aims to examine the initial efficacy of an established mindfulness intervention, Mindfulness Based Stress Reduction (MBSR) in decreasing trauma-related anger and aggression in Veterans with PTSD. The proposed project also aims to examine potential mechanisms of action accounting for its effects. Dr. Kachadourian is a postdoctoral fellow in the Clinical Neurosciences Division o the National Center for PTSD at the West Haven VA who has conducted basic research on alcohol, PTSD, anger, and aggression. Her current interests include conducting clinical trials to test novel therapeutic approaches like mindfulness meditation in treating anger and aggression among military Veterans with PTSD. TRAINING GOALS: The objectives for this CDA-2 application include advancing Dr. Kachadourian's expertise in conducting clinical trial research and advanced statistical analyses, and increasing her proficiency in mindfulness interventions. This will be accomplished through a rigorous program of formal didactics, collaboration with researchers experienced in clinical trials research and in mindfulness, PTSD, anger, and aggression, and a randomized controlled pilot study examining the initial efficacy of MBSR in decreasing anger and aggression among Veterans with PTSD. METHODS: Sixty Veterans with PTSD experiencing problems with anger and aggression will be randomly assigned to participate in a PTSD psychoeducational course (Trauma Recovery Education Class or TREC) or MBSR. All participants will attend a baseline, post-treatment, and 3-month follow-up session to assess changes in self-reported anger and aggression over time. At the post-treatment session, participants will also engage in a trauma-imagery procedure using trauma narratives developed at the baseline session. They then will participate in a laboratory paradigm designed to assess provoked aggression. In addition to examining whether participation in MBSR decreases self-reported levels of anger and aggression, this study will examine whether MBSR decreases aggression in participants after being exposed to trauma reminders in vivo. The extent to which mindfulness reduces physiological reactivity and increases emotion regulation will also be examined. The key question in this study is whether mindfulness decreases anger and aggression in Veterans with PTSD. Through this award, Dr. Kachadourian will be able to achieve her long-term goal of becoming an independent VA scientist with expertise in testing novel clinical interventions to treat problematic anger and aggression in military Veterans with PTSD.