Adaptation of Mindfulness Training to Treat Moral Injury in Veterans

正念训练用于治疗退伍军人的道德伤害

• 批准号: 10042081
• 负责人: MICHELLE L KELLEY
• 金额: $ 25.26万
• 依托单位: OLD DOMINION UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-21 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10042081
• 关键词: Address; Adherence; Alcohols; Anger; Anxiety; Awareness; Belief; Benchmarking; Blinded; Breathing; Buffers; Characteristics; Chronic stress; Code; Communities; Compassion; Conflict (Psychology); Cross-Sectional Studies; Data; Development; Developmental Process; Disease; Drug usage; Education; Emotions; Esthesia; Event; Evidence based intervention; Exercise; Failure; Feedback; Future; Generations; Goals; Guilt; Health Personnel; Home environment; Injury; Instruction; Intervention; Lead; Literature; Manuals; Meditation; Mental Depression; Mental Health; Methods; Mindfulness Training; Modification; Moral Development; Morals; Online Systems; Outcome; Outcome Measure; Pain; Participant; Phase; Pilot Projects; Post-Traumatic Stress Disorders; Pre-Post Tests; Process; Protocols documentation; Randomized; Randomized Controlled Trials; Research; Research Personnel; Respondent; Sampling; Scanning; Services; Shame; Sleeplessness; Suicide; Support Groups; Surveys; Symptoms; Techniques; Testing; Thinking; Training; Training Support; Trauma; Veterans; Walking; War; Work; addiction; attentional control; base; chronic pain; chronic pain management; combat; comparison group; comparison intervention; design; disability; efficacy trial; evidence base; experience; flexibility; innovation; instructor; member; mindfulness; mindfulness intervention; novel; pain symptom; physical conditioning; primary outcome; programs; psychologic; public health relevance; recruit; sample fixation; satisfaction; secondary outcome; service member; skills; stem; theories; therapy design; treatment adherence; treatment arm

Abstract Combat theatres place service members in situations where they make difficult decisions that may transgress deeply held moral beliefs or witness others’ acts of betrayal. Although many veterans are resilient to these types of experiences, for others, failure to accommodate these events may result in internal conflict that is theorized to lead to the development of moral injury. Moral injury is distinct from posttraumatic stress disorder (PTSD) and has been associated with poor mental health outcomes (e.g., depression, anxiety, suicidality) and alcohol/drug use among veterans. Few evidence-based interventions have been developed to target symptoms of moral injury. In studies with combat wounded veterans, community veterans, and a predominantly VA treatment- seeking sample, our team has demonstrated that mindfulness moderates associations between moral injury symptoms and negative mental health outcomes. In addition, we have demonstrated that combat wounded veterans are willing to take part in a mindfulness-based moral injury intervention, especially if administered in an online interactive web-based program. Using an iterative developmental process, the goal of this project is to adapt an integrative and theory-driven mindfulness-based intervention delivered online to target moral injury in combat wounded veterans. Aim 1 is to modify an evidence-based, online, interactive, instructor-delivered, six- session mindfulness program, originally designed to help active duty members manage physical pain (i.e., Mindfulness to Manage Chronic Pain [MMCP]), such that it addresses the psychologically painful symptoms (e.g., guilt, shame) characteristic of those with moral injury. The newly adapted program, Mindfulness to Manage Moral Injury (MMMI), will then be piloted with one group of eligible combat wounded veterans (N = 6) to generate qualitative feedback on program content and format; revisions based on this feedback will result in preliminary manualization. Subsequently, in Aim 2 we propose to develop a facilitator-led online interactive Education Support (ES) program designed to serve as a control comparison intervention, and then carry out a non- randomized pilot study comparing the feasibility (i.e., credibility, acceptability, study completion, and adherence (e.g., to homework assignments) of ES to the revised MMMI program with N = 20 (10 MMMI; 10 ES) combat wounded veterans. Following this phase of feasibility testing, we will also collect qualitative information and further refine both the MMMI and ES materials. In Aim 3, we propose a small-scale randomized controlled trial (N = 60 combat wounded veterans; 30 MMMI; 30 ES) to collect data on recruitment, credibility and acceptability, completion rates, and adherence in the two newly refined intervention arms at pre-post-test. Aim 3 will assess for potential primary and secondary outcome measures and lay the groundwork for a large-scale randomized R01 controlled efficacy trial. If supported, this work would have the potential to provide a novel and flexible theoretically grounded form of treatment delivered in-home for combat wounded veterans experiencing moral injury symptoms and associated mental health problems.

抽象的 战斗剧院将服务成员安置在他们做出艰难决定的情况下 尽管许多退伍军人对这些类型有弹性 经验，对于其他人来说，未能适应这些事件可能会导致内部冲突，这是理论上的 导致道德伤害的发展。道德损伤与创伤后应激障碍（PTSD）不同，并且 与精神健康结果（例如抑郁症，动画，Suicida）和酒精/药物有关 在退伍军人中使用。很少有基于证据的干预措施以靶向道德符号 在与受伤的退伍军人，社区退伍军人和主要VA治疗的研究中 寻求样本，我们的团队证明，正念可以缓和道德伤害之间的关联 症状和不良心理健康结果。此外，我们已经证明了战斗受伤 退伍军人愿意参加基于正念的道德伤害干预措施，尤其是在 在线交互式基于网络的程序。使用迭代发展过程，该项目的目标是 适应在线提供的基于理论驱动的基于正念的综合和理论驱动的干预措施，以针对道德伤害 战斗受伤的退伍军人。目的1是修改基于证据的，在线，互动，讲师交付，六个 - 会议正念计划最初旨在帮助现役成员管理身体疼痛（即 正念管理慢性疼痛[MMCP]），以解决心理疼痛的症状 （例如，内gui，羞耻）是道德伤害的人的特征。新适应的程序，正念管理 道德损伤（MMMI），然后将用一组合格的战斗受伤的退伍军人（n = 6）驾驶 关于程序内容和格式的定性反馈；基于此反馈的修订将导致初步 手动化。随后，在AIM 2中，我们建议开发促进者主导的在线互动教育 旨在作为控制比较干预措施的支持（ES）计划，然后进行非 - 比较可行性（即信誉，可接受性，研究完成和依从性）的随机试验研究 （例如，到作业分配）ES到修订的MMMI程序，n = 20（10 mmmi; 10 es）战斗 受伤的退伍军人。按照此可行性测试阶段，我们还将收集定性信息， 进一步完善MMMI和ES材料。在AIM 3中，我们提出了一个小型随机对照试验 （n = 60名战斗受伤的退伍军人； 30 mmmi; 30 ES）收集有关招聘，信誉和可接受性的数据， 完成率，并在两个新的干预臂上遵守检查前测试。 AIM 3将评估 对于潜在的初级和次要结果度量，并为大规模随机分组奠定了基础 R01控制有效性试验。如果得到支持，这项工作将有可能提供新颖而灵活的 在战斗受伤的退伍军人中，在家中提供的依据的治疗形式 伤害症状和相关的心理健康问题。