Treatment of Trauma-Related Anger in OEF/OIF/OND Veterans

OEF/OIF/OND 退伍军人创伤相关愤怒的治疗

• 批准号: 9071860
• 负责人: M. Tracie Shea
• 金额: --
• 依托单位: PROVIDENCE 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: 2014-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9071860
• 关键词: Address; Adverse effects; Afghanistan; Aftercare; Aggressive behavior; Anger; Area; Arousal; Behavior Therapy; Behavioral; Caring; Cognitive; Cognitive Therapy; Controlled Study; Development; Diagnosis; Divorce; Domestic Violence; Effectiveness; Epidemiology; Exposure to; Family; Freedom; Goals; Hostility; Impairment; Individual; Intervention; Iraq; Measures; Mediating; Mediator of activation protein; Medical; Military Personnel; Occupational; Occupations; Outcome; Outcome Measure; Persons; Pilot Projects; Population; Post-Traumatic Stress Disorders; Quality of life; Randomized; Randomized Clinical Trials; Reporting; Research; Risk; Sampling; Social Functioning; Stress; Supportive care; Surveys; Symptoms; Testing; Trauma; Treatment Effectiveness; Treatment outcome; Veterans; Vietnam; War; World War II; active control; adverse outcome; anger management; base; combat; effective therapy; efficacy testing; experience; improved; operation; primary outcome; public health relevance; randomized trial; response; secondary outcome; social; trial design

DESCRIPTION (provided by applicant): Poorly controlled anger is a common problem with often devastating effects in veterans who have served in a warzone. Adverse consequences include increased risk for divorce, domestic violence, job loss and instability, and other serious impairments in family, social, and occupational functioning. Recent evidence indicates that anger and aggression are likely to be problems for a significant proportion of veterans of Iraq (Operation Iraqi Freedom, OIF; Operation New Dawn, OND) and Afghanistan (Operation Enduring Freedom, OEF). A survey of reintegration problems among 754 OEF/OIF combat veterans receiving VA Medical care showed that anger was the most commonly reported problem, with 57% reporting increased problems in controlling anger. Despite encouraging evidence for efficacy of cognitive behavioral interventions in treating anger in civilian samples, much less is known about the efficacy of such treatments for anger problems in military personnel following exposure to war zone trauma. Promising preliminary findings for individually based cognitive behavioral treatment have been reported, and there is evidence that a group anger management treatment delivered by teleconferencing is as effective as the same treatment delivered in person, but to date there is not a single adequately powered randomized trial designed to test the efficacy of an anger treatment compared to an active control condition in veterans. Building on findings from our randomized pilot study, the objective of the current proposal is to conduct a randomized clinical trial with sufficient statistical power to test the effectiveness of a manualized cognitive behavioal intervention (CBI) that has been adapted from an existing treatment (Anger Control Therapy; Novaco, 1994, 2001) for the treatment of anger problems in OEF/OIF/OND veterans, compared to a manualized supportive therapy intervention (SI) control condition. One hundred and twenty OEF/OIF/OND veterans reporting significant problems with anger will be randomized to receive 12 individual sessions of one of the two study conditions. Outcomes including measures of anger and aggression; interpersonal, social and occupational functioning; and quality of life will be assessed during and at the end of treatment and at 3 and 6 month follow-ups. Exploratory analyses will examine 1) whether a diagnosis of PTSD impacts treatment effectiveness and 2) potential mediators of treatment outcome with CBI.

描述（由申请人提供）： 控制不好的愤怒是一个常见的问题，对在战区服役的退伍军人来说往往是毁灭性的影响。不利后果包括离婚、家庭暴力、失业和不稳定的风险增加，以及家庭、社会和职业功能的其他严重损害。最近的证据表明，愤怒和侵略性可能是伊拉克（伊拉克自由行动，OIF;新黎明行动，OND）和阿富汗（持久自由行动，OEF）的退伍军人中很大一部分的问题。一项对754名接受退伍军人事务部医疗服务的OEF/OIF战斗退伍军人重返社会问题的调查显示，愤怒是最常见的问题，57%的人报告说在控制愤怒方面存在更多问题。尽管有令人鼓舞的证据表明，认知行为干预在治疗平民样本中的愤怒方面具有疗效，但对暴露于战区创伤后的军事人员的愤怒问题的治疗效果知之甚少。已经报道了基于个体的认知行为治疗的有希望的初步研究结果，并且有证据表明，通过电话会议提供的团体愤怒管理治疗与亲自提供的相同治疗一样有效，但迄今为止，还没有一个足够有力的随机试验旨在测试愤怒治疗的疗效与退伍军人的积极控制条件相比。基于我们的随机试点研究的结果，当前提案的目标是进行一项具有足够统计能力的随机临床试验，以测试从现有治疗中改编的手动认知行为干预（CBI）的有效性（愤怒控制疗法; Novaco，1994，2001），用于治疗OEF/OIF/OND退伍军人的愤怒问题，与手动支持性治疗干预（SI）控制条件相比。120名OEF/OIF/OND退伍军人报告了严重的愤怒问题，他们将随机接受两种研究条件之一的12次单独治疗。在治疗期间和治疗结束时以及3个月和6个月随访时，将评估结果，包括愤怒和攻击性测量;人际、社会和职业功能;以及生活质量。探索性分析将检查1）PTSD的诊断是否影响治疗效果和2）CBI治疗结果的潜在介质。