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：重返伊拉克自由行动(OIF)、持久自由行动(OEF)和新黎明行动(OND)的退伍军人中，PGD的患病率似乎与创伤后应激障碍相当(Boline等人，2007年)。这并不完全令人惊讶，因为生命损失是普遍存在的。 在大多数战斗战区。此外，战斗退伍军人经历了(A)损失和(B)创伤暴露的“双重负担”(Iverson等人，2005；Papa，Neria，&Litz，2008)，在这种情况下，反复的重大生命威胁可能增加的负面影响，加上失去亲密依恋和支持，导致损伤。事实上，在OIF/OEF退伍军人样本中，足足有21.3%的人报告说，他们很难应对因战斗死亡而产生的悲痛；那些报告难以应对悲痛的人报告健康问题的可能性是后者的2.4倍，报告错过工作和增加医疗保健使用的可能性明显更高。更令人惊讶的是，研究发现，悲伤的影响与创伤后应激障碍或抑郁无关，因为在同时控制创伤后应激障碍和MDD后，报告高度悲伤的人报告健康状况不佳的风险增加了一倍(Toblin等人，2012年)。不幸的是，退伍军人悲痛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、技术杠杆的PGD治疗方案的试点工作，该方案结合了行为激活和治疗性暴露，似乎很容易适用于退伍军人和军人。我们建议通过重复的措施随机对照试验设计(治疗前、治疗后、3个月和6个月的随访)来评估这一干预措施，以便将其与最常提供给患有PGD的退伍军人的治疗进行比较：认知重建和支持性悲伤咨询(如退伍军人/国防部伊拉克战争临床医生指南第2版所概述的那样)。(Pivar，2007)。这两种治疗将分5次进行，其中第2次、第3次和第4次治疗将通过电视向退伍军人之家提供，以增加治疗组成部分的背景相关性。措施将涵盖临床结果、过程结果和成本结果，以评估多个参数的治疗相对有效性。参与者将是符合PGD截止标准但不符合创伤后应激障碍标准的OIF/OEF/OND退伍军人(因为5次干预被认为不适合这个诊断小组)。本研究有以下具体目的：(1)比较BATE-G与认知重建和支持性悲伤咨询对符合PGD标准的140名21岁及以上的OIF/OEF/OND退伍军人的PGD和心理结果的影响。(2)评估BATE-G在增加社区强化活动频率方面的相对效果。(3)评估BATE-G对远端治疗目标的相对影响，包括感受到的社会支持和与健康有关的影响 功能正常。研究假设如下：(1)无论是在治疗后还是在随访中，BATE-G都比认知重建和支持性悲痛咨询更能有效地减轻PGD的症状。此外，BATE-G在减少急性情绪困扰和预防一般抑郁和焦虑症状方面的长期情绪困扰方面将更加有效。(2)与认知重建和支持性悲痛咨询相比，BATE-G将导致完成的、积极强化的、基于社区的事件的频率增加。(3)BATE-G将在感受到的社会支持和健康方面产生更大的改善。注：该项目是第一个针对军人群体中的PGD的循证治疗，从而解决了一个显著的服务缺口。