Meditation Interventions for Treatment of PTSD in Veterans

描述(由申请人提供)： 创伤后应激障碍(PTSD)是一种衰弱的精神障碍，与高慢性率、低生活质量和严重的人际、职业和社会功能障碍有关。虽然针对创伤后应激障碍的循证心理疗法已经在退伍军人管理局系统内得到了开发和传播，但没有一种治疗方法显示出普遍的有效性，而且人们对退伍军人中治疗反应减弱和治疗退出率上升的问题非常关注。因此，评估患有创伤后应激障碍的退伍军人的替代治疗方式是一个重要的优先事项。自2001年以来，明尼阿波利斯退伍军人医疗保健系统(MVAHCS)向资深临床人群传授了基于正念的压力减轻(MBSR)，这是一种专注于正念冥想的团体干预措施，来自被诊断为创伤后应激障碍的退伍军人的试点数据令人振奋。尽管支持将MBSR应用于其他精神健康和身体问题，但MBSR尚未作为一种治疗创伤后应激障碍的方法进行系统评估。此外，现有的关于MBSR的文献受到方法学缺陷的限制。如果通过科学合理的试验证明是有效的，MSBR可能会为那些无法参与或完成传统暴露疗法的患有创伤后应激障碍的退伍军人提供一种有效、可接受和可容忍的干预措施。这项建议的主要目标是进行一项方法上严格的随机对照试验(RCT)，研究MBSR在治疗退伍军人创伤后应激障碍中的作用，检查症状结果和随后的卫生服务利用情况。考虑到我们令人信服的试点数据，我们建议初步评估MBSR可能与PTSD症状改善有关的假定变化机制(自我报告和电生理标记物，即EEG)，并检查退伍军人群体对MBSR的接受程度。MVAHCS和组建的团队结合了创伤后应激障碍治疗和研究、临床试验和神经科学方面的专业知识，以及MBSR方面的临床专业知识和令人信服的试点数据，以支持当前项目的可行性和范围。MBSR的疗效将相对于以目前为中心的小组疗法(PCGT)进行检验，PCGT是一种非特异性治疗对照组。被诊断患有创伤后应激障碍的退伍军人将被随机分配到MBSR或PCGT，为期9周。每次干预将在接受专家监督的训练有素的临床医生手册后以小组形式提供。治疗的完整性将受到独立监测。治疗后和2个月随访的临床结果评估将独立进行评估。正念冥想的可能机制将使用自我报告和电生理标记物进行评估。我们有以下目标：主要目标1：通过9周的治疗和2个月的随访，评估MBSR作为退伍军人创伤后应激障碍的治疗方法的疗效。次要目标1：确定潜在的基于治疗的创伤后应激障碍预后预测因素。次要目标2：确定不同治疗条件的退伍军人在随后的退伍军人卫生服务利用方面的差异。研究目的：1.评估MBSR的脱落率、依从性和消费者满意度。2.评估退伍军人轻型颅脑损伤治疗的可接受性和结果。 公共卫生相关性： 创伤后应激障碍(PTSD)是一种衰弱的精神障碍，会导致人际、职业和社会功能的严重损害。创伤后应激障碍有有效的治疗方法，但并不是对每个人都有效。需要替代疗法来帮助那些没有得到现有治疗方法帮助的退伍军人。基于正念的压力减轻(MBSR)是一种以正念冥想为重点的团体疗法。MBSR已被发现在帮助有疼痛和焦虑问题的人方面有效。MBSR尚未在患有创伤后应激障碍的退伍军人中进行研究。这项拟议的研究将对患有创伤后应激障碍的退伍军人进行MBSR和标准心理治疗的比较。这项研究与退伍军人的健康有关，因为需要为患有创伤后应激障碍的退伍军人开发替代疗法，这些退伍军人对目前可用的治疗没有反应。

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder associated with high rates of chronicity, poor quality of life, and severe impairments in interpersonal, occupational, and social functioning. While evidence-based psychotherapies for treatment of PTSD have been developed and disseminated within the VA system, no treatment has shown universal effectiveness and there have been great concerns about attenuated treatment response and elevated treatment drop out in veteran populations. The evaluation of alternative treatment modalities for veterans with PTSD is therefore an important priority. The Minneapolis VA Health Care System (MVAHCS) has taught Mindfulness Based Stress Reduction (MBSR), a group-based intervention focused on mindfulness meditation, to veteran clinical populations since 2001, and pilot data from veterans diagnosed with PTSD is promising. Despite support for the application of MBSR to other mental health and physical problems, MBSR has not been systematically evaluated as a treatment for PTSD. Moreover, the existing literature on MBSR is limited by methodological weaknesses. If shown to be efficacious through scientifically sound trials, MSBR may offer an effective, acceptable, and tolerable intervention for veterans suffering PTSD who are unable to engage in or complete traditional exposure-based therapies. The primary goal of this proposal is to conduct a methodologically rigorous randomized controlled trial (RCT) of MBSR in treating PTSD among veterans, examining both symptom outcomes and subsequent health services utilization. Given our compelling pilot data, we propose initial steps to evaluate putative mechanisms of change (self-report and electrophysiology markers, i.e., EEG) through which MBSR may relate to PTSD symptom improvements, and to examine the acceptability of MBSR to the veteran population. The MVAHCS and the assembled team combines expertise in PTSD treatment and research, clinical trials, and neuroscience, with clinical expertise in MBSR and compelling pilot data to support the feasibility and scope of the current project. The efficacy of MBSR will be examined relative to present-centered group therapy (PCGT), a non-specific therapeutic comparison group. Veterans diagnosed with PTSD will be randomized to MBSR or PCGT for 9 weeks. Each intervention will be delivered in group format following manualization by trained clinicians receiving expert supervision. Treatment integrity will be independently monitored. Assessment of clinical outcomes post-treatment and 2 months follow-up will be independently evaluated. Putative mechanisms of mindfulness meditation will be assessed using self-report and electrophysiology markers. We have the following aims: Primary Aim 1: To evaluate the efficacy of MBSR as a treatment for PTSD in veterans compared to PCGT over 9-weeks of treatment and 2-month follow-up. Secondary Aim 1: To identify potential treatment-based predictors of PTSD outcomes. Secondary Aim 2: To identify differences in subsequent VA health services utilization among veterans across treatment conditions. Exploratory Aims: 1. To evaluate rates of drop-out, compliance, and consumer satisfaction with MBSR. 2. To evaluate acceptability and outcomes of treatment with veterans with mild traumatic brain injuries. PUBLIC HEALTH RELEVANCE: Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder which results in serious impairments in interpersonal, occupational and social functioning. Effective treatments are available for PTSD but they do not work for everyone. Alternative treatments are needed to help those veterans not helped by currently available treatments. Mindfulness Based Stress Reduction (MBSR) is a group based treatment focused on mindfulness meditation. MBSR has been found to be effective in helping people with problems with pain and anxiety. MBSR has not yet been studied in veterans with PTSD. The proposed study will compare MBSR with a standard psychotherapy treatment in veterans with PTSD. This research is relevant to Veterans' health because of the need to develop alternative treatments for veterans with PTSD who have not responded to currently available treatments.