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Psychosocial Rehabilitation after Moral Injury and Loss with Adaptive Disclosure

道德伤害和损失后的心理康复与适应性披露

基本信息

批准号：
10217063
负责人：
BRETT T LITZ
金额：
--
依托单位：
VA BOSTON HEALTH CARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-06-01 至 2022-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10217063
关键词：
Activities of Daily Living Address Afghanistan Aftercare Aggressive behavior Alcohol abuse Anger Anhedonia Area Attention Behavior Behavioral Caring Chronic Cognitive Contracts Dimensions Disasters Disclosure Elements Emotional Emotional Disturbance Employment Event Evidence based treatment Exposure to Family Family Relationship Family member Feeling suicidal Female Fostering Friends Fright Goals Guilt Health Care Costs Injury Iraq Marines Mental Health Military Personnel Morals Motivation Occupational Patients Post-Traumatic Stress Disorders Privatization Productivity Public Health Quality of life Randomized Randomized Controlled Trials Recovery Rehabilitation therapy Reporting Research Resistance Risk Behaviors Role Self Care Services Severities Shame Site Symptoms Testing Textiles Trauma Veterans Victimization War Work arm automobile accident base clinically significant comorbidity depressive symptoms design disability evidence base experience functional disability functional restoration improved improved functioning in vivo innovation negative affect performance site phenomenological models physical conditioning primary endpoint psychologic psychosocial psychosocial rehabilitation recruit reduce symptoms routine care service member sexual assault skills training social stem stressor success treatment response trial comparing

项目摘要

Relative to most civilian traumas (e.g., sexual assault, car accidents, and disasters), posttraumatic stress disorder (PTSD) from warzone exposure is associated with more chronic and disabling social and occupational functioning problems, as well as poorer response to treatment. Yet, PTSD treatments for war veterans do not target or even systematically assess these functional impairments. Rather, first-line treatments for military- related PTSD focus on symptom change, failing to attend to holistic dimensions of recovery, such as improved work and family functioning and quality of life. The current first-line treatments for PTSD disseminated and mandated in the VA, Prolonged Exposure and Cognitive Processing Therapy, were developed and originally tested on female sexual assault victims. Although strides have been made for these therapies to accommodate veterans traumatized by contexts that are starkly different from most civilian traumas, the therapies still tend to overemphasize victimization from danger-based warzone events as the cause of PTSD and the target for treatment. This is problematic because insufficient attention is paid to the unique phenomenology of warzone experiences within the warrior culture. In particular, existing therapies do not sufficiently address morally compromising war experiences (e.g., killing), termed moral injury (MI), and traumatic loss, neither of which necessarily entail high fear and danger. Yet, these types of experiences are reported by large percentages of veterans as their worst and most currently haunting deployment events. MI and traumatic loss can cause emotional disturbances, such as guilt, shame, low motivation, anhedonia, and anger problems that negatively affect recovery and a variety of functional capacities (e.g., work, self-care, and relationships). The goal of this study is to fill a substantial care-gap in the VA by [testing] an evidence-based treatment for war-related PTSD stemming from MI and traumatic loss focused on improving psychosocial functioning. [We have modified and extended Adaptive Disclosure (AD; Litz et al., 2015), a therapy that was previously tested on deployed Marines, to treat [only] MI and loss (AD-MIL). We have added evidence-based elements to AD designed to foster improvements in functioning and address obstacles to engaging in various functional behaviors in-vivo.] We will conduct a multi-site randomized controlled trial comparing AD-MIL to Present-Centered Therapy (PCT; Frost et al., 2014). We have five hypotheses, grouped into (A) functional change and (B) mental health change. With respect to functional and behavioral change, we hypothesize that post-treatment, 3-, and 6-months post- treatment, Iraq and Afghanistan veterans with PTSD randomized to AD-MIL will have greater: (A.1.) reductions in social, educational, and occupational disability (the primary endpoint); and (A.2.) improvements in quality of life. With respect to change in mental health symptoms, we hypothesize that veterans randomized to AD-MIL will have greater: (B.3.) reductions in PTSD symptom severity and a smaller percentage of PTSD cases; (B.4.) reductions in depressive symptoms; and (B.5.) reductions in shame and guilt. We will also explore the impact of treatment on anger and aggressive behaviors, suicidal ideation, and alcohol abuse. We plan to recruit 93 veterans for each arm of the trial, split equally among the three VA performance sites.

相对于大多数平民创伤（如性侵犯、车祸和灾难），创伤后应激