Teaching Loved Ones to Help Veterans Optimize their PTSD Care and Healing

教导亲人帮助退伍军人优化他们的创伤后应激障碍护理和治疗

• 批准号: 10013653
• 负责人: Laura Meis
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10013653
• 关键词: Address; Baseline Surveys; Behavioral; Caring; Cognitive; Couples; Couples Therapy; Data; Diagnosis; Diagnostic; Distress; Divorce; Dropout; Educational process of instructing; Evolution; Exercise; Exposure to; Family; Family member; Feedback; Funding; Goals; Health; Healthcare; Household; Individual; Intervention; Interview; Leadership; Life; Life Style; Lifting; Manuals; Medical center; Mental Health; Methods; Military Personnel; Mission; Modeling; Outcome; Pain management; Pathway interactions; Patient-Focused Outcomes; Patients; Personal Satisfaction; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Prediction of Response to Therapy; Process Assessment; Provider; Psychotherapy; Quality of life; Randomized Clinical Trials; Recovery; Recovery of Function; Research; Series; Services; Social Controls; Social Functioning; Social Work; Societies; Structure; Suicide; Suicide prevention; Surveys; Symptoms; Techniques; Trauma; Unemployment; Veterans; base; clinically significant; evidence base; experience; family support; functional disability; functional outcomes; healing; improved; improved outcome; in vivo; innovation; interest; intervention effect; loved ones; meetings; member; physical conditioning; recruit; reduce symptoms; rehabilitation management; screening; skills; social; social situation; therapy design; therapy development; treatment optimization; treatment response

Impacts. We aim to improve the mental health, family functioning, and well-being of veterans with posttraumatic stress disorder (PTSD) through developing and evaluating a trauma-focused, couple therapy for PTSD. We will use strategies from Integrative Behavioral Couple Therapy (ICBT) to help intimate partners support veterans during exposure therapy for PTSD (Prolonged Exposure; PE). We anticipate this approach will increase veterans’ engagement in PE, but also improve relationship functioning, family functioning, and social functioning. Family involvement has been highlighted as a fertile avenue for improving the outcomes for patients with PTSD, yet families are infrequently integrated into evidence-based psychotherapies (EBPs). Our goals are highly is consistent with RR&D’s mission to promote research that leverages family support as a pathway to reintegration and optimizes meaningful recovery and functioning. Background. PTSD occurs in as many as 17% of US military veterans and is associated with a host of negative, long-term consequences to the individual, their families, and society at large. EBPs, such as PE, result in clinically significant symptom relief for many. Yet, these therapies have proven less effective for military personnel and veterans and treatment dropout rates are high. Our team surveyed veterans initiating EBPs for PTSD and a family member across four VA medical centers (N = 598; Project HomeFront). We found that veterans were more than twice as likely to complete EBPs when loved ones encouraged them to confront distress and that veterans experienced greater treatment gains when they shared more with their loved ones about their treatment. A couples-based, exposure therapy for PTSD that integrates intimate partners into every session of PE could provide the opportunity to mobilize the whole household in the service of EBP engagement, while extending the goals of therapy beyond symptom reduction to family functioning. We anticipate this intervention will teach couples to embrace a lifestyle that supports confronting trauma-related distress, so the veteran and his/her family can achieve optimal functional outcomes. Objectives. We will complete stages 1A and 1B of the Stage Model of Treatment Development. Specifically, we will: (1) Expand our treatment outline using content experts and feedback from key stakeholders (veterans, intimate partners, providers, and VA mental health leadership). (2) Conduct a pilot open trial to assess (a) the acceptability of treatment components, structure, and materials, (b) the feasibility of the intervention (retention and intervention fidelity), and (c) the study approach (screening, recruitment, and assessment process). (3) Explore the preliminary effects of the intervention on select outcomes including overall functioning, mental health functioning, social functioning, family functioning, and potential mechanisms (social control, subjective norms, and the degree to which veterans rely on their partners for support). Methods: To accomplish Aim 1, we will expand the outline for the intervention into an initial treatment manual through meetings with content experts and stakeholder feedback. Next, we will develop fidelity checklists and revise the treatment manual through conducting the intervention with 2-3 couples. To accomplish Aims 2 and 3, we will evaluate the intervention in a non-randomized, open trial with 10 veterans diagnosed with PTSD and their intimate partners. Veterans will complete baseline and posttreatment structured diagnostic interviews. Both members of the couple will complete baseline surveys, posttreatment surveys, and posttreatment qualitative exit interviews. Using data obtained from the open trial, we will assess the intervention’s acceptability, feasibility, mechanisms, and outcomes. Upon completion of this proposal, we will be well positioned to apply for Merit funding for a randomized clinical trial (Stage 2 of the Stage Model of Treatment Development) of this innovative, exposure based, couple therapy.

影响。我们的目标是改善退伍军人的心理健康、家庭功能和福祉 创伤后应激障碍(PTSD)通过开发和评估以创伤为重点的夫妇疗法 创伤后应激障碍。我们将使用整合行为夫妻疗法(ICBT)的策略来帮助亲密伴侣 在创伤后应激障碍(长期暴露；PE)暴露治疗期间为退伍军人提供支持。我们期待着这种方法 将增加退伍军人在体育方面的参与度，但也会改善关系功能、家庭功能和 社交功能。家庭参与被强调为改善以下方面成果的肥沃途径 然而，家庭很少被纳入循证心理治疗(EBPS)。我们的 目标与RR&D的使命高度一致，即促进利用家庭支持作为 为重返社会铺平道路，并优化有意义的恢复和运作。 背景资料。多达17%的美国退伍军人会发生创伤后应激障碍，并与许多 对个人、他们的家庭和整个社会产生长期的负面影响。EBP，如PE， 为许多人带来临床上显著的症状缓解。然而，事实证明，这些疗法对 军事人员、退伍军人和治疗辍学率很高。我们团队对退伍军人进行了调查 创伤后应激障碍的EBPS和四个退伍军人医疗中心的一名家庭成员(N=598；Homefront计划)。我们发现 当亲人鼓励退伍军人面对挑战时，他们完成EBPS的可能性是他们的两倍 当退伍军人与他们所爱的人分享更多时，他们会体验到更大的治疗收益 关于他们的治疗方法。以夫妻为基础的创伤后应激障碍暴露疗法，将亲密伴侣整合到每一个 PE会议可以提供机会动员全家为EBP服务 参与，同时将治疗目标从减少症状扩展到家庭功能。我们 预计这一干预将教会夫妇接受一种支持面对创伤相关的生活方式 因此，退伍军人和他/她的家人可以达到最佳的功能效果。 目标。我们将完成治疗发展阶段模式的第1A阶段和第1B阶段。具体来说， 我们将：(1)使用内容专家和关键利益攸关方(退伍军人、 亲密伙伴、提供者和退伍军人精神健康领导层)。(2)进行试点公开试验，以评估(A) 治疗成分、结构和材料的可接受性，(B)干预的可行性(保留 以及(C)研究方法(筛选、招募和评估过程)。(3) 探索干预对选定结果的初步影响，包括总体功能、精神状态 健康功能、社会功能、家庭功能和潜在机制(社会控制、主观 标准，以及退伍军人依赖其伙伴支持的程度)。 方法：为了实现目标1，我们将把干预大纲扩展为初始治疗手册 通过与内容专家的会议和利益相关者的反馈。接下来，我们将制定忠诚度检查表和 通过对2-3对夫妇进行干预，修订治疗手册。实现目标2和 3，我们将在一项非随机开放试验中评估干预措施，试验对象为10名被诊断为创伤后应激障碍的退伍军人和 他们的亲密伴侣。退伍军人将完成基线和治疗后结构化诊断访谈。 夫妇两人都将完成基线调查、治疗后调查和治疗后调查 定性的离职面谈。使用从公开试验中获得的数据，我们将评估干预的 可接受性、可行性、机制和结果。在完成这项提议后，我们将会很好 准备为随机临床试验(治疗阶段模型的第二阶段)申请奖励资金 这种创新的、以暴露为基础的夫妇疗法)。