One-Day Life Skills Workshop for Veterans with TBI, Pain, and Psychopathology

为患有创伤性脑损伤、疼痛和精神病理学的退伍军人举办的一日生活技能研讨会

• 批准号: 9242164
• 负责人: Lilian Nazar Dindo
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9242164
• 关键词: Afghanistan; Anxiety; Anxiety Disorders; Behavior Therapy; Belief; Caring; Characteristics; Chronic; Clinical; Cognitive; Comorbidity; Comprehensive Health Care; Conflict (Psychology); Diagnosis; Diagnostic; Distress; Educational workshop; Eligibility Determination; Emotional; Enrollment; Ensure; Feedback; Freedom; Goals; Health Personnel; Healthcare; Hour; Individual; Intervention; Interview; Iraq; Life; Manuals; Medical; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Modeling; Morbidity - disease rate; Neurobehavioral Manifestations; Pain; Pain interference; Patients; Population; Post-Concussion Syndrome; Post-Traumatic Stress Disorders; Procedures; Protocols documentation; Psychologist; Psychopathology; Quality of life; Questionnaires; Randomized; Randomized Clinical Trials; Research Personnel; Services; Stress; Symptoms; Testing; Traumatic Brain Injury; Treatment Efficacy; Veterans; base; behavior change; career; chronic pain; emotional symptom; experience; flexibility; follow up assessment; group intervention; improved; medical specialties; mild traumatic brain injury; mortality; multidisciplinary; operation; patient population; physical symptom; psychologic; response; rural setting; satisfaction; service member; skills; social stigma; suicidal risk; treatment adherence; treatment as usual; wound

Traumatic brain injury (TBI) is the signature wound of Veterans returning from Operations Iraqi Freedom, Enduring Freedom and Operation New Dawn (OIF/OEF/OND), with up to 20 percent experiencing persistent post-concussive symptoms. Among those with a mild TBI (mTBI) diagnosis, the majority also suffers from stress-based psychopathology, including depression, post-traumatic stress disorder, and other anxiety disorders, as well as chronic pain. Poor management of multiple conditions results in increased morbidity and mortality, increased risk for suicide, and significantly decreased quality of life. Importantly, the association between seeking mental health care and stigma among Veterans is high. Veterans are often unwilling to seek mental health services due to concern that receiving such care would negatively impact their careers and the belief that they should be able to overcome psychological difficulties on their own. Furthermore availability of specialty services is limited for Veterans living in rural settings. Thus the challenge for treatment providers is to provide a unified, efficient, accessible, and acceptable intervention for Veterans with these interdependent systemic comorbid concerns. Acceptance and Commitment Therapy (ACT) is a trans- diagnostic (i.e., applies to more than one diagnosis) behavioral intervention aimed at helping individuals develop the skills needed to pursue valued goals and directions in the face of life's challenges. It provides a unified model of behavior change that has shown promise in treating depression and anxiety, as well as chronic medical conditions. Importantly, ACT has been effectively implemented in various treatment-delivery formats, including 1-day workshops. This flexibility in delivery format allows focus to be placed on how best to package and deliver the intervention to meet the needs of this Veteran patient population, to ensure treatment adherence, and also to increase chances of dissemination into clinical settings. Providing a 1-day ACT “workshop” for Veterans with mTBI, pain, and mental health problems will allow unitary comprehensive care for the range of emotional, physical, and cognitive symptoms experienced by these Veterans. Presenting the treatment as a “workshop” rather than “therapy” will also be better suited for the Veterans who may not be explicitly seeking specialized mental health care. Finally, a 1-day workshop ensures treatment adherence and completion, the lack of which is often the greatest obstacle to effective delivery of mental health services. The aims of this study are to 1) develop a 1-day (5-hour) “ACT on Life” workshop plus an individual booster session tailored specifically for Veterans with mTBI, stress-based psychopathology, and pain. A multi- disciplinary team of a clinical psychologist, neuropsychiatrist, cognitive psychologist, chaplain, and anthropologist will provide expert input for use in producing the therapist intervention and patient manual; 2) enroll 10 Veterans with mTBI, stress-based psychopathology, and pain in the “ACT on Life” workshop to obtain qualitative and quantitative feedback from Veterans about the intervention; use Veteran feedback to refine the treatment procedures and manuals; and examine feasibility and acceptability of the intervention; and 3) randomize 30 Veterans with mTBI, pain, and stress-based psychopathology to the refined “ACT on Life” workshop or to Treatment as usual (TAU) to examine the preliminary efficacy of the intervention on quality of life and functioning, stress-based symptoms of psychopathology, and pain interference.

创伤性脑损伤（TBI）是从伊拉克自由行动返回的退伍军人的标志性伤口， 持久自由和新黎明行动（OIF/OEF/OND），高达20%的人经历了持续的 脑震荡后的症状在轻度TBI（mTBI）诊断的患者中，大多数还患有 基于压力的精神病理学，包括抑郁症，创伤后应激障碍和其他焦虑 疾病以及慢性疼痛。对多种疾病的管理不善导致发病率增加， 死亡率，自杀风险增加，生活质量显著下降。重要的是，协会 寻求心理健康护理和退伍军人之间的耻辱感之间的关系很高。退伍军人往往不愿寻求 由于担心接受这种护理会对他们的职业生涯产生负面影响， 他们相信自己应该能够克服心理上的困难。此外， 专业服务是有限的退伍军人生活在农村环境。因此，治疗提供者面临的挑战 是为退伍军人提供一个统一的，有效的，可访问的和可接受的干预， 相互依赖的系统性共病问题。接受和承诺疗法（ACT）是一种跨- 诊断（即，适用于一个以上的诊断）行为干预，旨在帮助个人 培养在面对生活挑战时追求有价值的目标和方向所需的技能。它提供了一个 行为改变的统一模式，在治疗抑郁症和焦虑症方面显示出了希望， 慢性疾病。重要的是，ACT已在各种治疗交付中得到有效实施。 包括为期一天的研讨会。这种交付格式的灵活性使人们能够将重点放在如何最好地 包装和提供干预措施，以满足退伍军人患者人群的需求，以确保治疗 坚持，也增加了传播到临床环境的机会。提供1天ACT 为患有mTBI，疼痛和心理健康问题的退伍军人举办的“研讨会”将允许单一的综合护理， 这些退伍军人所经历的情绪、身体和认知症状的范围。呈现所述 治疗作为一个“车间”，而不是“治疗”也将更适合退伍军人谁可能不 明确寻求专门的精神健康护理。最后，为期一天的研讨会确保治疗依从性， 精神卫生服务的完成往往是有效提供精神卫生服务的最大障碍。的 本研究的目的是：1）开发一个为期1天（5小时）的“ACT on Life”研讨会， 专门为患有mTBI、基于压力的精神病理学和疼痛的退伍军人量身定制的会议。一个多- 一个由临床心理学家、神经精神病学家、认知心理学家、牧师和 人类学家将提供专家意见，用于制作治疗师干预和患者手册; 2） 招募10名患有mTBI、基于压力的精神病理学和疼痛的退伍军人参加“ACT on Life”研讨会，以获得 退伍军人对干预措施的定性和定量反馈;使用退伍军人的反馈来完善 治疗程序和手册;并审查干预措施的可行性和可接受性;以及3） 将30名患有mTBI、疼痛和基于压力的精神病理学的退伍军人随机分配到精制的“ACT on Life” 研讨会或照常治疗（TAU），以检查干预措施对治疗质量的初步疗效。 生活和功能，精神病理学的基于压力的症状，以及疼痛干扰。