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Meditation Interventions for Treatment of PTSD in Veterans

冥想干预治疗退伍军人的创伤后应激障碍

基本信息

批准号：
8513126
负责人：
KELVIN O. LIM
金额：
--
依托单位：
MINNEAPOLIS VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-01-01 至 2013-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8513126
关键词：
Address Aftercare Anxiety Attenuated Clinical Clinical Trials Clinical assessments Consumer Satisfaction Data Diagnosis Drops Educational process of instructing Effectiveness Electroencephalography Electrophysiology (science)Evaluation Goals Group Therapy Health Healthcare Systems Impairment Intervention Literature Measures Mediation Meditation Mental Health Mental Health Services Mental disorders Modality Monitor Neurobiology Neurosciences Occupational Outcome Pain Patient Self-Report Population Post-Traumatic Stress Disorders Psychotherapy Quality of life Randomized Randomized Controlled Trials Recording of previous events Relative (related person)Research Social Functioning Supervision Symptoms System Therapeutic Training Traumatic Brain Injury Treatment outcome Veterans Work alternative treatment base comparison group design effective therapy evidence base follow-up health care service utilization mindfulness mindfulness meditation mindfulness-based stress reduction physical conditioning research clinical testing skills sound treatment response

项目摘要

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder associated with high rates of chronicity, poor quality of life, and severe impairments in interpersonal, occupational, and social functioning. While evidence-based psychotherapies for treatment of PTSD have been developed and disseminated within the VA system, no treatment has shown universal effectiveness and there have been great concerns about attenuated treatment response and elevated treatment drop out in veteran populations. The evaluation of alternative treatment modalities for veterans with PTSD is therefore an important priority. The Minneapolis VA Health Care System (MVAHCS) has taught Mindfulness Based Stress Reduction (MBSR), a group-based intervention focused on mindfulness meditation, to veteran clinical populations since 2001, and pilot data from veterans diagnosed with PTSD is promising. Despite support for the application of MBSR to other mental health and physical problems, MBSR has not been systematically evaluated as a treatment for PTSD. Moreover, the existing literature on MBSR is limited by methodological weaknesses. If shown to be efficacious through scientifically sound trials, MSBR may offer an effective, acceptable, and tolerable intervention for veterans suffering PTSD who are unable to engage in or complete traditional exposure-based therapies. The primary goal of this proposal is to conduct a methodologically rigorous randomized controlled trial (RCT) of MBSR in treating PTSD among veterans, examining both symptom outcomes and subsequent health services utilization. Given our compelling pilot data, we propose initial steps to evaluate putative mechanisms of change (self-report and electrophysiology markers, i.e., EEG) through which MBSR may relate to PTSD symptom improvements, and to examine the acceptability of MBSR to the veteran population. The MVAHCS and the assembled team combines expertise in PTSD treatment and research, clinical trials, and neuroscience, with clinical expertise in MBSR and compelling pilot data to support the feasibility and scope of the current project. The efficacy of MBSR will be examined relative to present-centered group therapy (PCGT), a non-specific therapeutic comparison group. Veterans diagnosed with PTSD will be randomized to MBSR or PCGT for 9 weeks. Each intervention will be delivered in group format following manualization by trained clinicians receiving expert supervision. Treatment integrity will be independently monitored. Assessment of clinical outcomes post-treatment and 2 months follow-up will be independently evaluated. Putative mechanisms of mindfulness meditation will be assessed using self-report and electrophysiology markers. We have the following aims: Primary Aim 1: To evaluate the efficacy of MBSR as a treatment for PTSD in veterans compared to PCGT over 9-weeks of treatment and 2-month follow-up. Secondary Aim 1: To identify potential treatment-based predictors of PTSD outcomes. Secondary Aim 2: To identify differences in subsequent VA health services utilization among veterans across treatment conditions. Exploratory Aims: 1. To evaluate rates of drop-out, compliance, and consumer satisfaction with MBSR. 2. To evaluate acceptability and outcomes of treatment with veterans with mild traumatic brain injuries.

描述（由申请人提供）：创伤后应激障碍（PTSD）是一种使人衰弱的精神障碍，与慢性化率高、生活质量差以及人际、职业和社会功能严重受损相关。虽然创伤后应激障碍治疗的循证心理疗法已经在VA系统中开发和传播，但没有治疗显示出普遍的有效性，并且对退伍军人群体中减弱的治疗反应和升高的治疗脱落率存在极大的担忧。因此，评估退伍军人创伤后应激障碍的替代治疗方式是一个重要的优先事项。明尼阿波利斯VA医疗保健系统（MVAHCS）自2001年以来一直在向退伍军人临床人群教授基于正念的压力减轻（MBSR），这是一种以正念冥想为重点的基于小组的干预措施，并且被诊断患有创伤后应激障碍的退伍军人的试点数据很有希望。尽管支持MBSR应用于其他心理健康和身体问题，但MBSR尚未被系统地评估为PTSD的治疗方法。此外，关于正念减压的现有文献受到方法论缺陷的限制。如果通过科学合理的试验证明是有效的，MSBR可以为那些无法参与或完成传统的基于创伤的治疗的患有PTSD的退伍军人提供有效，可接受和可容忍的干预。这项提案的主要目标是进行一项严格的方法论随机对照试验（RCT）的正念减压治疗创伤后应激障碍的退伍军人，检查症状的结果和随后的卫生服务利用。鉴于我们令人信服的试点数据，我们提出了初步步骤，以评估假定的变化机制（自我报告和电生理标志物，即，脑电图），通过该MBSR可能与PTSD症状的改善，并检查MBSR的退伍军人群体的可接受性。MVAHCS和组装的团队结合了PTSD治疗和研究，临床试验和神经科学的专业知识，MBSR的临床专业知识和令人信服的试点数据，以支持当前项目的可行性和范围。MBSR的疗效将相对于以现在为中心的团体治疗（PCGT）进行检查，PCGT是一个非特异性治疗对照组。被诊断患有PTSD的退伍军人将被随机分配到MBSR或PCGT，为期9周。每项干预措施将在接受专家监督的训练有素的临床医生进行手动操作后以小组形式提供。将独立监测治疗完整性。将独立评价治疗后和2个月随访的临床结局评估。正念冥想的假定机制将使用自我报告和电生理学标记进行评估。我们的目标如下：主要目标1：评估正念减压疗法与PCGT相比在9周治疗和2个月随访中治疗退伍军人创伤后应激障碍的疗效。次要目的1：确定潜在的基于治疗的PTSD结局预测因子。次要目的2：确定不同治疗条件下退伍军人后续VA卫生服务利用率的差异。探索目标：1.评估退出率、依从性和消费者对正念减压疗法的满意度。2.评估轻度创伤性脑损伤退伍军人治疗的可接受性和结果。