Thriving in the Midst of Moral Pain: The Acceptability and Feasibility of Acceptance and Commitment Therapy for Moral Injury (ACT-MI) Among Warzone Veterans

在道德痛苦中茁壮成长：战区退伍军人对道德伤害接受和承诺疗法（ACT-MI）的可接受性和可行性

• 批准号: 9901365
• 负责人: SEAN BARNES
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9901365
• 关键词: Address; Adherence; Aftercare; Alcohol or Other Drugs use; Behavior; Belief; Caring; Client satisfaction; Clinical; Cognition; Consent; Data; Development; Disease; Distress; Dose; Emotions; Enrollment; Esthesia; Evaluation; Event; Evidence based intervention; Evidence based treatment; Exposure to; Feeling suicidal; Future; Goals; Impairment; Individual; Information Systems; Injury; Intervention; Interview; Learning; Literature; Maintenance; Manuals; Measurement; Measures; Mental Depression; Military Personnel; Morals; Nature; Outcome; Outcome Measure; Pain; Participant; Pathologic; Patient Outcomes Assessments; Patient Self-Report; Patients; Performance; Pilot Projects; Population; Post-Traumatic Stress Disorders; Provider; Psychotherapy; Questionnaires; Randomized; Randomized Controlled Trials; Recovery; Recovery of Function; Refractory; Reporting; Research; Research Design; Risk Factors; Sample Size; Self Care; Shame; Social Functioning; Specific qualifier value; Structure; Substance abuse problem; Symptoms; Syndrome; Testing; Thinking; Time; United States National Institutes of Health; Veterans; Visit; Work; active control; arm; authority; base; clinically significant; community reintegration; depressive symptoms; design; efficacy study; efficacy testing; efficacy trial; evidence base; experience; follow up assessment; follow-up; functional disability; high risk behavior; improved; in vivo; injury recovery; interest; power analysis; psychologic; psychosocial; randomized controlled design; recruit; reduce symptoms; rehabilitation research; research and development; response; retention rate; skills; social; social learning; suicidal behavior; suicidal risk; trial design

Warzone Veterans exposed to morally injurious events frequently experience numerous difficulties in functioning. These Veterans often report suicidal ideation and behavior, substance abuse, symptoms of depression and PTSD, and problems in resuming valued living (e.g., spiritual practice, close relationships).1-7 Despite the transdiagnostic nature of moral injury, there are no moral injury-specific transdiagnostic interventions. Existing interventions tend to be focused on treating moral injury in the context of PTSD.10-11 In addition to an emphasis on PTSD, these interventions target beliefs associated with moral injury as causal factors in the development and maintenance of suffering.10-12 An emphasis on altering beliefs associated with moral injury may not optimally facilitate functional recovery as moral pain from moral violations may be justified. As one third of warzone Veterans endorse exposure to morally injurious events, it is vital to develop interventions that can be efficiently disseminated in VHA to facilitate functional recovery.8-9 The ideal intervention must simultaneously address moral emotions and promote values consistent behavior in the face of these emotions. Acceptance and Commitment Therapy for moral injury (ACT-MI) is a recovery-based, psychosocial treatment ideally suited for Veterans endorsing difficulties in functioning related to moral injury.15 ACT teaches skills to help Veterans relate differently to painful thoughts, emotions, urges, and sensations.40 Rather than focusing on symptom reduction, ACT is an evidence-based intervention that directly targets functional recovery by assisting Veterans in identifying and engaging in values-consistent behavior even in the presence of distress. In Veteran populations specifically, ACT has been demonstrated effective in treating suicidal ideation and depression and as a result, has been “rolled-out” as an evidence based psychotherapy for depression within VHA.59-60 ACT-MI operates on the principles of ACT, with an explicit focus on the social functions of moral emotions.13-14 ACT-MI is the only intervention for moral injury that is based on social functionalism which purports that moral emotions (e.g., shame, pride) serve evolutionary purposes essential to group survival.15 Thus learning to interact with moral emotions differently is crucial to recovery. In ACT-MI, a group-based intervention is used to facilitate in-vivo exposure to moral emotions in the context of values. The proposed two arm randomized controlled pilot study will evaluate the acceptability of ACT-MI and an active control treatment, and determine the feasibility of the randomized controlled trial design for a future full-scale efficacy study. To accomplish this goal we will continue to refine ACT-MI. Veterans enrolled will be randomized to: (a) Present Centered Therapy (PCT) or (b) ACT-MI, both of which will consist of 12, 90-minute group sessions. The specific aims of this study are to: (1) Evaluate the acceptability of the ACT-MI intervention for Veterans experiencing impairment in functioning associated with moral injury, (2) Determine the feasibility of the efficacy study design, and to (3) Select measures and calculate the necessary sample size for a future efficacy study. The performance of validated scales will be measured, in addition to selected NIH Patient Reported Outcomes Measurement Information System modules.78 All participants will complete a baseline assessment, post treatment, and follow-up assessment one and three months after completion of ACT-MI or PCT. Participants in both groups will also complete a post-treatment assessment on the acceptability of the intervention. The proposed study represents a crucial first step in a line of research likely to yield a recovery- oriented, empirically-supported intervention for moral injury among Veterans. The objectives of ACT-MI directly align with Rehabilitation Research and Development's goal to improve Veteran functioning, increase community reintegration, and to facilitate Veteran centered care.

遭受道德伤害事件的战区退伍军人经常会遇到许多困难 发挥作用。这些退伍军人经常报告自杀意念和行为、药物滥用、自杀症状 抑郁症和创伤后应激障碍（PTSD），以及恢复有价值的生活（例如精神实践、亲密关系）方面的问题。1-7 尽管道德伤害具有跨诊断性质，但没有针对道德伤害的跨诊断方法 干预措施。现有的干预措施往往侧重于治疗 PTSD 背景下的精神伤害。10-11 除了强调 PTSD 之外，这些干预措施还将与道德伤害相关的信念作为因果关系。 10-12 强调改变与痛苦相关的信念 道德伤害可能无法最佳地促进功能恢复，因为道德侵犯带来的道德痛苦可能会 有理有据。由于三分之一的战区退伍军人赞成接触道德上有伤害性的事件，因此至关重要的是 可以在 VHA 中有效传播的干预措施，以促进功能恢复。8-9 理想的 干预必须同时解决道德情绪并促进价值观一致的行为 这些情绪。 针对精神伤害的接受和承诺疗法（ACT-MI）是一种基于恢复的、 心理社会治疗非常适合退伍军人，支持与功能相关的困难 15 ACT 教授技能，帮助退伍军人以不同的方式处理痛苦的想法、情绪、冲动、 40 ACT 不是专注于减轻症状，而是一种基于证据的干预措施， 通过协助退伍军人识别和参与价值观一致的活动，直接以功能恢复为目标 即使存在痛苦时的行为。特别是在退伍军人群体中，ACT 已被证明 可有效治疗自杀意念和抑郁症，因此已作为基于证据的证据“推出” VHA.59-60 ACT-MI 中抑郁症的心理治疗按照 ACT 的原则进行，具有明确的 关注道德情感的社会功能。13-14 ACT-MI 是唯一针对道德伤害的干预措施 基于社会功能主义，该主义声称道德情感（例如羞耻、自豪）服务于进化 15 因此，学习以不同的方式与道德情感互动对于群体生存至关重要。 恢复。在 ACT-MI 中，采用基于小组的干预措施来促进道德情感的体内暴露 价值观的背景。拟议的两组随机对照试点研究将评估 ACT-MI 和主动控制治疗的可接受性，并确定该方案的可行性 未来全面功效研究的随机对照试验设计。为了实现这个目标我们 将继续完善 ACT-MI。登记的退伍军人将被随机分配到： (a) 当前中心治疗 (PCT) (b) ACT-MI，两者均包含 12 场 90 分钟的小组课程。 本研究的具体目的是：（1）评估 ACT-MI 干预的可接受性 经历与精神伤害相关的功能障碍的退伍军人，(2) 确定可行性 功效研究设计，以及 (3) 选择措施并计算未来所需的样本量 功效研究。除了选定的 NIH 患者之外，还将测量经过验证的量表的性能 报告结果测量信息系统模块。78 所有参与者都将完成基线 ACT-MI 完成后一到三个月的评估、治疗后和随访评估，或 PCT。两组参与者还将完成治疗后的可接受性评估 干涉。拟议的研究代表了可能带来复苏的一系列研究中至关重要的第一步—— 针对退伍军人道德伤害的定向、实证支持的干预措施。 ACT-MI 的目标 直接与康复研究和开发的目标保持一致，以改善退伍军人的功能，增加 重返社区，并促进以退伍军人为中心的护理。