Evaluation of a Mindfulness-Based Intervention for Gulf War Illness

 描述(由申请人提供)： 背景资料：1990-1991年间，近70万名美国军事人员被部署到波斯湾。至少有四分之一的人报告了负面健康后果，包括疼痛、疲劳和注意力/情绪障碍，称为慢性多症状疾病(CMI)。尽管有几项研究研究了海湾战争(GW)退伍军人发生CMI的原因，但治疗方面的研究仍然有限。目前的CMI管理包括一种由生物-心理-社会模式提供信息的综合方法，带有自我管理部分。基于正念的干预(MBIS)教授冥想练习，旨在增强当下的意识，并强调在项目完成后继续练习。一个广泛使用的正念计划是一个为期8周的计划，称为基于正念的压力减轻(MBSR)。初步证据表明，MBIS可以减轻CMI的症状。另一个广泛使用的自我管理计划是慢性病自我管理计划(CSMP)。具体目标：目标1：在患有CMI的GW退伍军人中，评估MBSR在治疗6个月后在CMI(疼痛、疲劳、认知障碍)症状方面是否比CDSMP有更大的改善。目的2：使用混合方法评估患者对任何一种治疗的满意度和可接受性，包括(A)对退伍军人的定性半结构化访谈，以及(B)患者满意度的测量。探索性目标：评估MBSR在非GW退伍军人的CMI症状以及GW退伍军人和患有CMI的非GW退伍军人的其他健康领域是否比CDSMP有更大的改善。评估的其他领域包括抑郁症状、创伤后应激障碍症状、物质使用和与健康相关的生活质量(HRQOL)。其他分析将探索答复的基线主持人。设计：随机对照试验，比较MBSR和CDSMP。参与者：至少154名患有CMI的GW退伍军人和最多154名患有CMI的非GW退伍军人。干预：MBSR组或CDSMP增强型8周版本。假设和分析：与CDSMP相比，随机接受MBSR的GW退伍军人在6个月的随访中报告的疼痛、疲劳和认知障碍的减少程度显著高于CDSMP，并且对护理更满意。如果MBSR被证明对退伍军人中的CMI症状有效，它将支持为这一人群提供MBSR。

 DESCRIPTION (provided by applicant): Background: Nearly 700,000 US military personnel were deployed to the Persian Gulf in 1990-1991. At least one fourth report negative health consequences including pain, fatigue, and concentration/mood disturbances, known as Chronic Multisymptom Illness (CMI). Although several studies have examined causes of CMI among Gulf War (GW) Veterans, studies of treatment remain limited. Current CMI management includes an integrative approach informed by the biopsychosocial model, with self-management components. Mindfulness-based interventions (MBIs) teach meditation practices intended to enhance present moment awareness and emphasize continued practices after program completion. A widely available mindfulness program is an 8-week program called Mindfulness-Based Stress Reduction (MBSR). Preliminary evidence suggests that MBIs reduce symptoms of CMI. Another widely available self-management program is the Chronic Disease Self- Management Program (CSMP). Specific Aims: Aim 1: Among GW Veterans with CMI, evaluate if MBSR produces greater improvement than CDSMP in symptoms of CMI (pain, fatigue, cognitive failures) at 6-months post-treatment. Aim 2: Assess patient satisfaction and acceptability of either treatment using a mixed methods approach involving (a) qualitative semi-structured interviews of GW Veterans, and (b) a measure of patient satisfaction. Exploratory Aims: Evaluate if MBSR produces greater improvement than CDSMP in symptoms of CMI among non-GW Veterans, as well as other domains of health for both GW Veterans and non-GW Veterans with CMI. Other domains assessed will be depressive symptoms, PTSD symptoms, substance use, and Health-Related Quality of Life (HRQOL). Additional analyses will explore baseline moderators of response. Design: A randomized controlled trial comparing MBSR to CDSMP. Participants: At least 154 GW Veterans with CMI, and up to 154 non-GW Veterans with CMI. Interventions: Group MBSR or an augmented 8-week version of CDSMP. Hypotheses and Analyses: GW Veterans randomized to MBSR will report significantly greater reductions in pain, fatigue, and cognitive failures at 6-month follow-up as compared to CDSMP, and will be more satisfied with care. Implications: If MBSR is shown to be efficacious for symptoms of CMI among GW Veterans, it would support providing MBSR for this population.