Developing a Mobile Intervention for Veterans with Posttraumatic Stress Disorder and Problematic Anger

难以控制愤怒是战斗中最常见的重新融入社会的问题 退伍军人，特别是那些被诊断为创伤后应激障碍(PTSD)的人。在退伍军人中，有问题 愤怒与许多负面的心理社会后果有关，包括不良的功能后果(两者 社会和职业)、家庭不和、攻击性、道路愤怒和自杀风险。愤怒也会阻碍 创伤后应激障碍治疗成功。鉴于退伍军人中愤怒问题的高发 对于创伤后应激障碍和相关的功能障碍，显然需要开发创新和有效的 愤怒干预以改善退伍军人的功能结局。移动医疗(MHealth)的使用 技术可以提供一种低成本的方法来增加愤怒管理治疗的覆盖面 退伍军人的高需求群体。 与有问题的愤怒和攻击性相关的机制之一是敌意解读偏见， 即，倾向于将模棱两可的人际关系解释为敌意。通过减少敌意解读 偏见，可能会显著减少有问题的愤怒和攻击性，并改善功能 结果。申请人已经开发并试行了基于计算机的口译偏差修改 成功地减少敌意解读、偏见和愤怒后果的干预。这个项目的目标是 为了进一步发展对患有创伤后应激障碍的退伍军人的干预，使用mHealth技术来增加 这一有希望的方法具有可移植性，可减少愤怒并增强职业和心理社会功能。 研究计划建议开发、完善和试点测试移动应用程序版本的 对患有创伤后应激障碍和有问题的个体的现有基于计算机的口译偏见修改干预 愤怒。中心假设是患有创伤后应激障碍和有问题的愤怒的患者会发现这是一种移动 可以接受干预，并愿意使用它来减少他们的愤怒困难和改善心理社会 和职业功能。拟议的研究项目将涉及以下具体目标：目标1(A)： 开发移动解释偏差修正干预工具，名为《减少移动干预》 针对患有创伤后应激障碍和问题愤怒的退伍军人的愤怒(MIRA)；目标1(B)：使用连续队列设计 完善Mira对患有创伤后应激障碍和有问题的愤怒的退伍军人的干预；目标2：评估 在将米拉与接触者进行比较的先导研究中招募、随机和保留程序的可行性 控制条件，重点是社区重新融入和功能结果，以及b)进行 探索性目的利用心理生理和电子日记监测来确定 这一评估可以用作后续随机化的结果或机械变量 临床试验应用重点是评估MIRA干预的疗效。结果是 生成将指导设计一个足够强大的随机对照试验，以测试Mira干预的有效性 将在CDA-2资助期结束前提供资金。 培训和指导计划概述了课程、培训和经验，这些将提供 具有从事创新和有效治疗的职业基础的申请者 改善患有创伤后应激障碍的退伍军人的功能结果和重新融入社区。以下培训 已经制定了目标：1)获得更多关于移动健康方法的知识；2)获得 进行和分析定性研究的专业知识；3)在设计和分析方面获得更多专业知识 管理临床试验；4)扩展分析临床试验数据的知识和技能；5)扩展 了解康复理论和方法；以及6)获得额外的赠款撰写技能和 一般职业发展。本申请中概述的研究、培训和指导计划将 为PI向独立的退伍军人管理局研究生涯过渡奠定了基础。

Difficulty controlling anger is the most commonly reported reintegration concern among combat Veterans, especially those with a diagnosis of posttraumatic stress disorder (PTSD). In Veterans, problematic anger is associated with numerous negative psychosocial outcomes, including poor functional outcomes (both social and occupational), family discord, aggression, road rage, and suicide risk. Anger can also impede successful outcomes from PTSD treatment. Given the high prevalence of anger problems among Veterans with PTSD and the associated functional impairments, there is a clear need to develop innovative and effective anger interventions to improve functional outcomes of Veterans. The use of mobile health (mHealth) technology could provide a low-cost method to increase the reach of anger management treatments to this high-need group of Veterans. One of the mechanisms associated with problematic anger and aggression is hostile interpretation bias, i.e., a tendency to interpret ambiguous interpersonal situations as hostile. By reducing hostile interpretation bias, it may be possible to significantly reduce problematic anger and aggression and improve functional outcomes. The applicant has developed and piloted a computer-based interpretation bias modification intervention that successfully reduces hostile interpretation bias and anger outcomes. The goal of this project is to further develop this intervention for Veterans with PTSD, using mHealth technology to increase the portability of this promising approach to reduce anger and enhance occupational and psychosocial functioning. The Research Plan proposes to develop, refine, and pilot-test a mobile application version of the existing computer-based interpretation bias modification intervention for individuals with PTSD and problematic anger. The central hypothesis is that patients with PTSD and problematic anger will find this mobile intervention acceptable and will be willing to use it to reduce their anger difficulties and improve psychosocial and occupational functioning. The proposed research project will address the following Specific Aims: Aim 1(a): To develop a mobile interpretation bias modification intervention entitled Mobile Intervention for Reducing Anger (MIRA) for Veterans with PTSD and problematic anger; Aim 1(b): To use a successive cohort design to refine the MIRA intervention for Veterans with PTSD and problematic anger; and Aim 2: To: a) evaluate the feasibility of recruitment, randomization, and retention procedures in a pilot study comparing MIRA to a contact control condition, focusing on community reintegration and functional outcomes, and b) conduct an exploratory aim utilizing psychophysiological and electronic diary monitoring to determine whether this assessment could be utilized as an outcome or mechanistic variable in a subsequent randomized clinical trial application focused on evaluating the efficacy of the MIRA intervention. The results generated will guide the design of a sufficiently-powered RCT to test the effectiveness of the MIRA intervention to be funded by the end of the CDA-2 funding period. The Training and Mentoring Plans outline coursework, training, and experiences that will provide the applicant with the foundation to establish a career focused on developing innovative and effective treatments that improve functional outcomes and community reintegration in Veterans with PTSD. The following Training Goals have been formulated: 1) To acquire additional knowledge of mHealth methodologies; 2) To acquire expertise conducting and analyzing qualitative research; 3) To acquire additional expertise in the design and management of clinical trials; 4) To expand knowledge and skills in analyzing clinical trials data; 5) To extend understanding of rehabilitation theory and methods; and 6) To acquire additional skills in grant-writing and general professional development. The research, training, and mentoring plans outlined in this application will provide the foundation for the PI’s transition to an independent VA research career.