Adapting and Piloting Behavioral Activation for Veterans with Co-Occurring AUD and Posttraumatic Stress Disorder

为同时患有 AUD 和创伤后应激障碍的退伍军人调整和试点行为激活

• 批准号: 10644849
• 负责人: Shannon Michelle Blakey
• 金额: $ 24.06万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-10 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10644849
• 关键词: Adult; Aftercare; Alcohol consumption; Alcohols; Anxiety; Assessment tool; Behavior; Behavior Therapy; Behavioral; Benchmarking; Caring; Client satisfaction; Clinical; Clinical Trials; Clinical assessments; Collaborations; Communities; Computer software; Coupled; Crowding; Data; Daughter; Dimensions; Disease; Dropout; Drug Use Disorder; Drug usage; Emotions; Evaluation; Event; Future; Global Positioning System; Goals; Health; Health Promotion; Home; Individual; Intervention; Manuals; Maps; Measurement; Measures; Mediator; Memory; Mental Depression; Methods; Movement; National Institute on Alcohol Abuse and Alcoholism; Nightmare; Outcome; Pamphlets; Participant; Patient Dropouts; Patients; Personal Satisfaction; Persons; Post-Traumatic Stress Disorders; Procedures; Process; Protocols documentation; Randomized; Randomized, Controlled Trials; Recovery; Recovery of Function; Research; Rewards; Sampling; Secure; Severities; Symptoms; Techniques; Technology; Testing; Trauma; Veterans; Veterans Health Administration; Vocation; Walking; Well in self; Work; acceptability and feasibility; active comparator; alcohol abuse therapy; alcohol free; alcohol measurement; alcohol response; alcohol use disorder; avoidance behavior; behavior test; clinical practice; clinically significant; drinking; dual diagnosis; efficacy trial; feasibility testing; high risk; improved; innovation; interest; longitudinal analysis; military veteran; novel; novel strategies; patient handout; pilot test; portability; power analysis; psychiatric comorbidity; psychosocial; recruit; reduce symptoms; rehabilitation research; relapse prevention; response; severe mental illness; social; social determinants; statistics; suicidal risk; sustained recovery; treatment effect; treatment response

Alcohol use disorder (AUD) frequently co-occurs with posttraumatic stress disorder (PTSD) among U.S. military veterans. Compared to veterans with AUD only, veterans with AUD/PTSD have greater symptom severity, more psychosocial functioning difficulties, and higher risk of suicide. Many people with AUD/PTSD perform behaviors aimed at avoiding unpleasant emotions (e.g., drinking to avoid trauma-related nightmares, skipping social events to avoid anxiety-provoking crowds). These “avoidance behaviors” provide temporary relief from unpleasant emotions, but they maintain AUD/PTSD and interfere with long-term functioning. Although treatments for AUD/PTSD exist, they focus on reducing symptoms (not improving functioning) and have dropout rates as high as 50%. Originally developed to treat depression, Behavioral Activation (BA) is an intervention that increases daily participation in rewarding, alcohol-free activities relevant to patients’ social, vocational, and health-related values. Randomized controlled trials (RCTs) adapting BA for other disorders have shown that BA is efficacious for adults with alcohol/drug use disorders and acceptable to veterans with PTSD, but BA has not been used to treat co-occurring AUD/PTSD. Additionally, because RCTs of AUD/PTSD treatments typically emphasize significant mean group differences in AUD/PTSD outcomes, less is known about the degree to which these treatments yield clinically significant improvements at the individual level. Individual-level improvements in AUD/PTSD should be evident not only in subjective clinical assessments, but also in objective measures of geospatial activity. Specifically, patients’ daily geospatial activity is likely to change as they decrease their avoidance behaviors and increase their engagement in various social, vocational, and health-promoting activities. Advances in geospatial methods, coupled with discreet and portable Global Positioning System (GPS) trackers, have made it possible to objectively measure people’s spatial movement within their communities. Yet although geospatial methods have been used to identify social determinants of alcohol use, they have not been used to measure response to AUD or AUD/PTSD treatment. As the long-term objectives of this work are to identify a more acceptable AUD/PTSD treatment option and improve the measurement of AUD/PTSD recovery, this R34 project will address the following specific aims: (1) adapt BA for use with veterans with AUD/PTSD; (2) evaluate the feasibility, acceptability, and preliminary effects of BA (relative to Relapse Prevention) for veterans with AUD/PTSD in a pilot RCT; and (3) explore geospatial analysis of GPS-collected data as a new approach to measuring AUD/PTSD treatment response. This study will advance research and practice by piloting a novel application of BA and a novel measure of AUD/PTSD recovery. This project aligns with the National Institute on Alcohol Abuse and Alcoholism’s special interest in investigating treatments for patients with AUD and co-occurring disorders, dimensions of functioning and well-being associated with recovery, and innovative methods for evaluating AUD treatment and recovery.

在美国，酒精使用障碍（AUD）经常与创伤后应激障碍（PTSD）同时发生。 退伍军人与仅患有AUD的退伍军人相比，患有AUD/PTSD的退伍军人有更大的症状 严重程度、心理社会功能困难更多、自杀风险更高。许多患有AUD/PTSD的人 执行旨在避免不愉快情绪的行为（例如，喝酒来避免与创伤有关的噩梦 跳过社交活动，以避免引起焦虑的人群）。这些“回避行为”提供了暂时的 从不愉快的情绪中得到缓解，但它们会维持AUD/PTSD并干扰长期功能。 尽管存在AUD/PTSD的治疗方法，但它们侧重于减轻症状（而不是改善功能）， 辍学率高达50%最初开发用于治疗抑郁症，行为激活（BA）是一种 干预，增加每天参与有益的，无酒精的活动， 职业和健康价值观。将BA用于其他疾病的随机对照试验（RCT） 已经表明，BA对患有酒精/药物使用障碍的成年人有效， PTSD，但BA尚未用于治疗合并的AUD/PTSD。此外，由于AUD/PTSD的RCT 治疗通常强调AUD/PTSD结局的显著平均组间差异， 关于这些治疗在个体水平上产生临床显著改善的程度。 AUD/PTSD的个体水平改善不仅在主观临床评估中应该是明显的， 也是地理空间活动的客观衡量标准。具体而言，患者的日常地理空间活动可能会 随着他们减少回避行为，增加参与各种社会活动， 职业和促进健康的活动。地理空间方法的进展，加上谨慎和 便携式全球定位系统（GPS）跟踪器，使人们有可能客观地测量人们的 社区内的空间流动。然而，尽管地理空间方法已被用于确定社会 虽然这些指标是酒精使用的决定因素，但它们尚未用于测量对AUD或AUD/PTSD治疗的反应。 由于这项工作的长期目标是确定一个更可接受的AUD/PTSD治疗方案， 改善AUD/PTSD恢复的测量，这个R34项目将解决以下具体目标： (1)调整BA用于患有AUD/PTSD的退伍军人;（2）评估其可行性，可接受性和初步的 在试点RCT中，BA（相对于复发预防）对患有AUD/PTSD的退伍军人的影响;（3）探索 GPS收集的数据的地理空间分析作为测量AUD/PTSD治疗反应的新方法。 本研究将通过引导一种新的BA应用和一种新的 AUD/PTSD恢复。该项目与国家酒精滥用和酒精中毒研究所的特别项目保持一致。 有兴趣研究AUD患者的治疗方法和合并症，功能维度 以及与康复相关的健康状况，以及评估AUD治疗和康复的创新方法。