Group Cognitive Behavioral Therapy for Anger and Aggression in Veterans with PTSD

针对患有创伤后应激障碍 (PTSD) 退伍军人的愤怒和攻击性的团体认知行为疗法

• 批准号: 8783467
• 负责人: Elizabeth Van Voorhees
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8783467
• 关键词: Address; Afghanistan; Aftercare; Aggressive behavior; Anger; Attention; Behavior Therapy; Clinical; Clinical Trials Cooperative Group; Cognitive Therapy; Data; Development; Effectiveness; Emotional; Emotions; Evaluation; Family; Feasibility Studies; Foundations; Funding; Goals; Guidelines; Hospitals; Intervention; Iraq; Life; Love; Mentors; Methods; Military Personnel; Nature; Outcome; Outcome Measure; Participant; Patient Self-Report; Patients; Pilot Projects; Post-Traumatic Stress Disorders; Procedures; Publishing; Randomized Clinical Trials; Recovery; Rehabilitation therapy; Reporting; Research; Research Personnel; Research Project Grants; Research Training; Sampling; Social support; Specialist; Surveys; Symptoms; Testing; Therapeutic; Time; Training; Trauma; Treatment Efficacy; Treatment Protocols; Veterans; Vietnam; active method; anger management; arm; base; career; clinical practice; cognitive process; combat; community reintegration; comparative effectiveness; design; disorder control; effective therapy; experience; follow-up; functional disability; functional outcomes; group intervention; improved; improved functioning; innovation; male; member; post-traumatic stress; programs; psychosocial; public health relevance; research clinical testing; skills; theories; treatment program; trial comparing; virtual; working group

DESCRIPTION: Posttraumatic stress disorder (PTSD) robustly predicts anger and aggression (Olatunji, Ciesielski, & Tolin, 2010), and U.S. Iraq/Afghanistan-era Veterans report that controlling anger and aggressive urges are primary readjustment concerns (Sayer et al, 2010). Trauma-related anger and aggression are associated with functional impairments that significantly limit community reintegration (Rodriguez, Holowka, & Marx, 2012) and that may persist for decades (Koenen et al, 2003). As more troops return from multiple deployments to Iraq and Afghanistan, there is an urgent and growing need for the development and testing of psychosocial treatment for anger and aggression in combat Veterans with PTSD. VA clinicians are doing their best to be responsive to Veteran's needs by offering anger management treatment to Veterans: A survey of clinical practices within the VA conducted found that 35-65% of VA PTSD specialists report providing anger management to their patients (Rosen et al., 2004). Yet to date only one randomized clinical trial (RCT), published in 1997, has investigated the efficacy of treatment of anger and aggression in Veterans with PTSD (Chemtob et al., 1997). A recent review noted that most researchers who have examined the effects of anger management interventions have not done so as part of a systematic program of research (DiGiuseppe & Tafrate, 2003). The proposed CDA-2 application outlines Training and Mentoring Plans that will provide the applicant with the foundation to establish a career systematically developing, testing, and refining treatments for PTSD-related anger and aggression in Veterans. The following specific Training Goals have been formulated: 1) To acquire the advanced skills in the development and evaluation of clinical interventions necessary to begin an independent research career within the VA; 2) To develop greater expertise in delivery of behavioral interventions to improve functional outcomes and community reintegration in Veterans with PTSD, anger problems, and aggression; 3) To acquire expertise in the development and evaluation of treatment innovations to help Veterans generalize treatment gains beyond the therapy setting; 4) To increase understanding of rehabilitation theory and methods in treatment practices and research; and 5) To achieve critical professional development milestones, including submission of a Merit Review proposal based on the pilot data generated from the CDA-2 project. The Research Plan proposes a pilot feasibility trial for an RCT of Cognitive-Behavioral Therapy for Anger and Aggression in Combat Veterans with PTSD (CBT-A). CBT-A is a 12-week manualized group treatment protocol that has been designed to address the specific needs of combat Veterans whose PTSD-related anger and aggression interfere with effective community reintegration. The group was implemented with 4 male Vietnam Veterans with severe combat-related PTSD who had been referred for anger management treatment, and preliminary data were promising. The active comparison treatment for the pilot RCT will be group Present- Centered Therapy (PCT), a manualized treatment for PTSD that controls for treatment time, social support, and instillation of hope. The proposed research project will address the following Specific Aims: Aim 1: Characterize the differential effects of group CBT-A and group PCT on anger, aggression, and anger/aggression-related limitations to psychosocial functioning and community reintegration in combat Veterans with PTSD; and Aim 2: Evaluate study feasibility and treatment delivery procedures of an RCT comparing CBT-A to a PCT comparison condition. The results generated will guide the design of a full RCT to be funded by the end of the CDA-2 funding period. The research, training, and mentoring plans outlined here will provide the foundation for the PI's independent research career developing a systematic program of research in the treatment of anger and aggression among combat Veterans with PTSD. The availability of empirically-supported anger treatment would benefit the many Veterans with PTSD who return from combat reporting problems with anger and aggression.

说明： 创伤后应激障碍(PTSD)强烈地预测愤怒和攻击性(Olatunji，Ciesielski和Tolin，2010)，美国伊拉克/阿富汗时代的退伍军人报告说，控制愤怒和攻击性冲动是主要的再适应担忧(Sayer等人，2010)。与创伤相关的愤怒和攻击性与显著限制社区融合的功能障碍有关(Rodriguez，Holowka，&Max，2012)，并且可能持续数十年(Koenen等人，2003)。随着越来越多的部队从伊拉克和阿富汗的多次部署返回，迫切需要制定和测试患有创伤后应激障碍的退伍军人的愤怒和攻击性心理社会治疗。退伍军人管理局的临床医生正在尽最大努力通过向退伍军人提供愤怒管理治疗来回应退伍军人的需求：一项对退伍军人管理局临床实践的调查发现，35%-65%的退伍军人创伤后应激障碍专家报告向他们的患者提供愤怒管理(Rosen等人，2004年)。然而，到目前为止，只有一项1997年发表的随机临床试验(RCT)调查了退伍军人使用创伤后应激障碍治疗愤怒和攻击性的疗效(Chemtob等人，1997年)。最近的一篇综述指出，大多数研究愤怒管理干预效果的研究人员并没有将其作为系统研究计划的一部分(Digituseppe&Tafrate，2003)。拟议的CDA-2申请概述了培训和指导计划，将为申请者建立一个职业生涯奠定基础，系统地开发、测试和完善退伍军人中与创伤后应激障碍相关的愤怒和攻击性治疗。已经制定了以下具体的培训目标：1)获得在退伍军人管理局内开始独立研究生涯所需的临床干预措施开发和评估方面的高级技能；2)在提供行为干预方面发展更多的专业知识，以改善患有创伤后应激障碍、愤怒问题和攻击性的退伍军人的功能结果和重新融入社区；3)获得治疗创新开发和评估方面的专业知识，以帮助退伍军人在治疗环境之外推广治疗成果；4)在治疗实践和研究中增加对康复理论和方法的理解；以及5)实现关键的专业发展里程碑，包括根据CDA-2项目产生的试点数据提交功绩审查建议。该研究计划提出了一项针对患有创伤后应激障碍的退伍军人愤怒和攻击性的认知行为疗法(CBT-A)随机对照试验的可行性试验。CBT-A是一项为期12周的手动团体治疗方案，旨在满足与创伤后应激障碍相关的愤怒和攻击行为干扰有效重新融入社区的退伍军人的具体需要。该小组由4名患有严重战斗相关创伤后应激障碍的越南男性退伍军人实施，他们被转介接受愤怒管理治疗，初步数据是有希望的。试验性随机对照试验的积极对照治疗将是以小组为中心的治疗(PCT)，这是一种针对创伤后应激障碍的机械化治疗，控制治疗时间、社会支持和希望的灌输。拟议的研究项目将涉及以下具体目标：目标1：描述CBT-A组和PCT组对患有创伤后应激障碍的战斗退伍军人的愤怒、攻击性以及与愤怒/攻击相关的限制心理社会功能和重新融入社区的不同影响；目标2：评估将CBT-A与PCT进行比较的随机对照试验的研究可行性和治疗提供程序。所产生的结果将指导设计一项完整的区域工作队，以便在CDA-2资助期结束时为其提供资金。这里概述的研究、培训和指导计划将为PI的独立研究生涯提供基础，该计划将为治疗患有创伤后应激障碍的战斗退伍军人的愤怒和攻击性的系统研究计划奠定基础。经验支持的愤怒治疗的可用性将使许多患有创伤后应激障碍的退伍军人受益，他们从战斗中报告愤怒和攻击性问题回来。