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

为患有 TBI、疼痛和精神病理学的退伍军人举办的一日生活技能研讨会：评估功效和变化机制

• 批准号: 10552567
• 负责人: Lilian Nazar Dindo
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10552567
• 关键词: Address; Afghanistan; Aftercare; Anxiety; Anxiety Disorders; Area; Behavior; Behavioral; Belief; Caring; Characteristics; Communities; Coping Skills; Diagnosis; Diagnostic; Distress; Education; Educational workshop; Ensure; Evidence based intervention; Exhibits; Exposure to; Face; Family; Feedback; Freedom; Functional disorder; Generalized Anxiety Disorder; Goals; Grant; Health; Health Status; Intervention; Iraq; Life; Long-Term Effects; Mediating; Mediator; Medical; Mental Depression; Mental Health; Mental Health Services; Military Personnel; Minority; Mission; Modeling; Multiple Trauma; Occupational; Outcome; Pain; Pain interference; Participant; Patients; Pattern; Pharmaceutical Preparations; Phase; Post-Concussion Syndrome; Post-Traumatic Stress Disorders; Psyche structure; Psychopathology; Questionnaires; Randomized; Randomized, Controlled Trials; Recommendation; Recording of previous events; Resources; Severities; Societies; Stigmatization; Stress; Symptoms; Time; Traumatic Brain Injury; Treatment Effectiveness; Treatment Efficacy; Veterans; Visit; Work; active method; barrier to care; career; chronic pain; community reintegration; comorbidity; comparative efficacy; coping; demographics; efficacy evaluation; emotional distress; evidence base; experience; follow-up; improved; mild traumatic brain injury; operation; primary outcome; psychologic; psychosocial; secondary outcome; service member; service utilization; skills; social; social stigma; treatment adherence; treatment as usual; treatment comparison; treatment response; wound

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.

创伤性脑损伤（TBI）是从行动中返回伊拉克自由的退伍军人的签名伤口， 持久的自由和操作新黎明（OIF/OEF/OND），最多20％暴露于 轻度TBI（MTBI）并患有持续的脑震荡症状。在有MTBI诊断的人中 大多数人还患有基于压力的心理病理学（例如抑郁症，创伤后应激障碍， 广义动画障碍）以及慢性疼痛。应对困扰，痛苦和其他困难， 退伍军人经常转向适应不良的回避应对策略，这些应对策略可提供短期缓解，但 加剧/维持心理健康问题，对社会，占领，长期影响， 和社区重返社会。不幸的是，退伍军人面临着从事心理健康的重大障碍 包括污名在内的治疗，认为应该克服自己的心理困难的信念，并且 担心接受这种护理会对他们的职业产生负面影响。实用障碍，包括时间 限制，距治疗设施的距离以及相互竞争的优先事项（例如，工作和家庭要求）是 也是护理的障碍。即使在开始心理健康治疗的退伍军人中，只有少数人完成 推荐的基于证据的治疗方案。 接受和承诺疗法（ACT）是一种跨诊断治疗模型，可帮助患者 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 在这种情况下，退伍军人被要求考虑他们离开军队和军队后的“新任务” 即使可能很困难的行动，也要履行其任务的重要性。法案已经建立 在治疗抑郁，焦虑和慢性疼痛方面的有效性，并已有效地实施 各种治疗交付格式，包括为期1天的小组研讨会。为期1天的ACT研讨会地址 MTBI，基于压力的精神病理学和慢性疼痛（Polytrauma Triad）和 重要的治疗障碍。 1）是反诊断的（即适用于多种条件）； 2）目标 基于回避的应对； 3）培养基于接受的应对，并以退伍军人的价值观和目标为基础 激励他们做出艰难的决定； 4）有效地交付，因此更容易获得； 5）少 污名化，因此可以接受； 6）解决治疗依从性和完成的问题。 在RR＆D Spire Pilot Grant的支持下，PIS开发了为期1天的“生命法案”研讨会 特别是针对有MTBI的退伍军人的需求，基于压力的心理病理学和慢性疼痛。退伍军人 然后将其随机分配到“生命行为”研讨会（n = 20）或治疗为 通常（tau; n = 12）。参加为期1天ACT研讨会的所有退伍军人都完成了它，相对于Tau， 在3个月的随访中暴露了苦难和重新融合的更大改善（效应大小为.68和.47， 在这些诺言初步发现的基础上，我们现在建议进行更严格的 与212名退伍军人的随机对照试验将1天ACT研讨会的效率与主动 治疗比较（教育，资源和支持； ERS）关于困扰和社会症状， 占领和社区重返社会。我们还将检查治疗的调解人和主持人 响应以确定哪些ACT组件直接负责治疗效果以及是否是否 治疗益处受到各种个人因素的限制。 建立一个为OEF/OEF/OEF/OND退伍军人的1天ACT研讨会的效率 共存的条件解决了VHA RR＆D的关键优先级：1。开发干预措施，以改善该干预措施 有特定需求的退伍军人的心理健康状况；和2。加强社区，社会和 占领退伍后退伍军人的重新融合和功能，以便他们可以更全面地发挥作用 社会。

项目成果

Acceptance and Commitment Training for Veterans with Polytrauma: A randomized controlled trial protocol.

• DOI: 10.1016/j.cct.2021.106601
• 发表时间: 2021-12
• 期刊: Contemporary clinical trials
• 影响因子: 2.2
• 作者: Uzdavines A;Gonzalez RD;Price A;Broadway D;Smith TL;Rodrigues M;Woods K;Zimmerman MB;Jorge R;Dindo L
• 通讯作者: Dindo L