Treatment of Prolonged Grief Disorder in Combat Veterans

退伍军人长期悲伤症的治疗

• 批准号: 8811499
• 负责人: Ronald E. Acierno
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-01-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8811499
• 关键词: 21 year old; Absenteeism at work; Acute; Address; Adult; Aftercare; Behavior Disorders; Behavioral; Caring; Cessation of life; Characteristics; Clinical; Cognition Disorders; Cognitive; Communities; Conflict (Psychology); Counseling; Diagnosis; Diagnostic; Disease; Distal; Effectiveness; Employee Strikes; Equipment and supply inventories; Event; Evidence based intervention; Evidence based treatment; Freedom; Frequencies; Future; Grief reaction; Health; Healthcare; Home environment; Human Resources; Impairment; Intervention; Interview; Iraq; Life; Measures; Medical; Mental Depression; Mental Health; Military Personnel; Outcome; Participant; Patient Self-Report; Population; Post-Traumatic Stress Disorders; Prevalence; Process; Randomized Controlled Trials; Relative (related person); Reporting; Research; Risk; Sampling; Services; Social support; Structure; Suicide; Symptoms; Technology; Testing; Therapeutic; Time; Trauma; Treatment Effectiveness; Treatment Protocols; Veterans; War; Work; anxiety symptoms; base; clinical practice; combat; comparative efficacy; coping; cost; depressive symptoms; disability; effective therapy; emotional distress; experience; follow-up; functional disability; implementation research; improved; innovative technologies; meetings; member; operation; prevent; psychological outcomes; public health relevance; standard care; trial design

DESCRIPTION (provided by applicant): Overview: Prevalence of PGD in returning Veterans of Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND) appears to equal that of PTSD (Bolen et al., 2007). This is not altogether surprising, given that loss of life is widespread in most combat theatres. Moreover, combat Veterans experience a 'Dual Burden' of (a) loss and (b) trauma exposure (Iverson et al., 2005; Papa, Neria, & Litz, 2008) in which the potentially added negative impact of repeated significant life threat combines with loss of close attachment and support to cause impairment. Indeed, fully 21.3% of a sample of OIF/OEF Veterans reported significant difficulty coping with grief over combat death; and those who reported difficulty coping with grief were 2.4 times as likely to report health problems, and significantly more likely to report both missing work and increasing medical care use. Even more striking was the finding that effects of grief were independent of either PTSD or Depression, in that, after controlling for both PTSD and MDD, risk of reporting poor health was doubled among those reporting high grief (Toblin et al., 2012). Unfortunately, treatments for grief in Veterans remain understudied. Our research group has recently completed pilot work on an innovative, technology-leveraged treatment protocol for PGD that combines Behavioral Activation with Therapeutic Exposure and appears readily applicable to the Veteran and Military populations. We propose to evaluate this intervention through a repeated measures randomized controlled trial design (pre-treatment, post-treatment, 3 & 6 month follow-up) in order to compare it to the treatment most commonly offered to Veterans with PGD: Cognitive Restructuring and Supportive Grief Counseling (as outlined by the VA / DoD Iraq War Clinician Guide, 2nd ed.) (Pivar, 2007). Both treatments will be delivered over 5 sessions in which sessions 2, 3, and 4 of both treatments will be delivered via televideo to Veterans' homes to increase contextual relevance of treatment components. Measures will cover clinical outcomes, process outcomes, and cost outcomes in order to assess relative effectiveness of treatment across multiple parameters. Participants will be Veterans of OIF/OEF/OND who meet PGD cutoff criteria but do not meet criteria for PTSD (as a 5 session intervention is not considered appropriate for this diagnostic group). This study has the following Specific Aims: (1) To compare the efficacy of BATE-G vs. Cognitive Restructuring and Supportive Grief Counseling in terms of PGD and psychological outcomes in 140 OIF/OEF/OND Veterans, aged 21 years and older, who meet criteria for PGD. (2) To evaluate BATE-G with respect to its relative effects on increasing the frequency of community based reinforcing activities. (3) To evaluate BATE-G with respect to its relative effects on distal treatment targets, including perceived social support and health-related functioning. The following are the study Hypotheses: (1) BATE-G will be more effective than Cognitive Restructuring and Supportive Grief Counseling in reducing symptoms of PGD, both at post-treatment and follow-up. Moreover, BATE-G will be more effective in reducing acute emotional distress and preventing long-term emotional distress in terms of general depression and anxiety symptoms. (2) BATE-G will result in increased frequency of completed positively reinforcing, community-based events when compared to Cognitive Restructuring and Supportive Grief Counseling. (3) BATE-G will result in greater improvements in perceived social support and health. Note: this project is the first evidence-based treatment for PGD in military populations, thus addressing a significant service gap.

描述（由申请人提供）： 概述：伊拉克自由行动 (OIF)、持久自由行动 (OEF) 和新黎明行动 (OND) 退伍军人中 PGD 的患病率似乎与 PTSD 的患病率相同（Bolen 等人，2007 年）。鉴于生命损失很普遍，这并不完全令人惊讶 在大多数战区。此外，退伍军人经历着（a）损失和（b）创伤暴露的“双重负担”（Iverson et al., 2005; Papa, Neria, & Litz, 2008），其中反复出现的重大生命威胁可能带来额外的负面影响，加上失去亲密依恋和支持，从而造成损害。事实上，OIF/OEF 退伍军人样本中有 21.3% 的人表示很难应对战斗死亡的悲痛；那些报告难以应对悲伤的人报告健康问题的可能性是那些报告健康问题的人的 2.4 倍，并且报告失业和增加医疗保健使用的可能性明显更高。更引人注目的是，我们发现悲伤的影响与 PTSD 或抑郁症无关，因为在控制了 PTSD 和 MDD 后，报告高度悲伤的人报告健康状况不佳的风险加倍（Toblin 等，2012）。 不幸的是，退伍军人悲伤的治疗方法仍未得到充分研究。我们的研究小组最近完成了一项创新的技术杠杆治疗方案的试点工作，该方案将行为激活与治疗暴露相结合，并且似乎很容易适用于退伍军人和军人群体。我们建议通过重复测量随机对照试验设计（治疗前、治疗后、3 个月和 6 个月随访）来评估这种干预措施，以便将其与最常向接受 PGD 的退伍军人提供的治疗进行比较：认知重组和支持性悲伤咨询（如 VA / DoD 伊拉克战争临床医生指南，第 2 版所述）（Pivar，2007 年）。两种治疗将分 5 个疗程进行，其中第 2、3 和 4 疗程将通过电视视频在退伍军人家中进行，以增加治疗内容的情境相关性。衡量标准将涵盖临床结果、过程结果和成本结果，以便评估多个参数的治疗相对有效性。参与者将是符合 PGD 截止标准但不符合 PTSD 标准的 OIF/OEF/OND 退伍军人（因为 5 次干预被认为不适合该诊断组）。 本研究有以下具体目标：(1) 在 140 名年龄 21 岁及以上、符合 PGD 标准的 OIF/OEF/OND 退伍军人中，比较 BATE-G 与认知重组和支持性悲伤咨询在 PGD 和心理结果方面的效果。 (2) 评估 BATE-G 对增加基于社区的强化活动频率的相对影响。 (3) 评估 BATE-G 对远端治疗目标的相对影响，包括感知的社会支持和健康相关 发挥作用。 以下是研究假设：(1) 在治疗后和随访中，BATE-G 在减少 PGD 症状方面比认知重组和支持性悲伤咨询更有效。此外，BATE-G将更有效地减少急性情绪困扰，并预防一般抑郁和焦虑症状方面的长期情绪困扰。 (2) 与认知重组和支持性悲伤咨询相比，BATE-G 将导致完成积极强化、基于社区的活动的频率增加。 (3) BATE-G 将带来社会支持和健康感知的更大改善。注：该项目是第一个针对军人群体进行 PGD 的循证治疗方法，从而解决了重大的服务缺口。