Manage Emotions to Reduce Aggression - MERA: A Brief Aggression Treatment for Veterans with PTSD Symptoms

这项随机临床试验（RCT）测试了情绪调节治疗的疗效， 减少攻击性情绪（MERA），以减少创伤后应激退伍军人的攻击性 创伤后应激障碍（PTSD）和改善PTSD治疗的启动。背景：有PTSD症状的退伍军人 报告说，他们很难控制自己的攻击性，这可能导致破坏性的人际和社会关系。 这些后果包括监禁、家庭暴力和社会支持中断。退伍军人 PTSD主要参与冲动性攻击（情绪化，反应性和不受控制），而不是 有预谋的侵略（蓄意的，工具性的和计划性的）。情绪失调，或 情感意识、情感接受、行为控制和/或内容方面的技能不发达， 适当的调节策略，完全中介PTSD严重程度和冲动之间的关系， 退伍军人的侵略。此外，退伍军人报告说，他们担心自己的情绪是他们不这样做的一个原因。 启动创伤后应激障碍循证心理治疗情绪调节似乎会影响攻击性和 和创伤后应激障碍退伍军人的治疗启动。因此，这项研究的目标是情绪调节， 减少冲动性攻击和准备退伍军人创伤后应激障碍的目标， psychotherapy.研究计划：我们的目标是测试创新情绪调节的功效 训练，MERA，与204名患有创伤后应激障碍和冲动性攻击的阿富汗和伊拉克退伍军人的随机对照试验。 MERA分三次提供，以解决年轻退伍军人面临的后勤障碍， 重新融入他们的社区。MERA包括教育，认知行为和接受- 基础技能培训。它还包括关于创伤后应激障碍的情感体验的信息 治疗。三个疗程的以现在为中心的治疗将作为一个积极的对照组， 与常规治疗一致。将比较MERA和目前的中心治疗在以下方面的变化： 从第1阶段到治疗后2个月的攻击变化。我们预测退伍军人谁完成 MERA将有更大的减少IA和情绪失调相比，退伍军人， 完整的以现在为中心的治疗。最后，PTSD循证心理治疗启动率 （参加1次会议），将在治疗后6个月通过病历审查进行检查。我们预测退伍军人 一个完整的MERA将启动PTSD循证心理治疗的比率高于退伍军人， 完整的以现在为中心的治疗。意义：这项研究支持2退伍军人事务部的任务： 减少攻击性并增加创伤后应激障碍治疗的开始。创伤后应激障碍是最常见的 和昂贵的精神疾病。患有创伤后应激障碍的退伍军人更有可能参与 攻击性行为比患有创伤后应激障碍的平民或没有创伤后应激障碍的退伍军人。减少攻击性是一个关键 需要退伍军人，他们的家人和社会。此外，还有一些有效的治疗方法可以减少 PTSD症状，但很少有退伍军人接受基于证据的PTSD心理治疗。的一个原因 治疗开始率低是因为退伍军人担心他们将无法控制自己的情绪 当他们开始治疗时。为退伍军人提供情绪调节技能和知识 关于创伤后应激障碍治疗的信息可以帮助他们开始治疗创伤后应激障碍。

This randomized clinical trial (RCT) tests the efficacy of an emotion regulation treatment, Manage Emotions to Reduce Aggression (MERA), to decrease aggression in Veterans with posttraumatic stress disorder (PTSD) and improve PTSD treatment initiation. Background: Veterans with PTSD symptoms report difficulty controlling their aggression which can lead to devastating interpersonal and societal consequences, such as incarceration, family violence, and disruption of social support. Veterans with PTSD primarily engage in impulsive aggression (emotional, reactive, and uncontrolled) rather than premeditated aggression (deliberate, instrumental, and planned). Emotion dysregulation, or underdeveloped skills in emotional awareness, emotional acceptance, behavioral control, and/or content- appropriate regulation strategies, fully mediates the relationship between PTSD severity and impulsive aggression in Veterans. Additionally, Veterans report fearing their emotions as one reason they do not initiate PTSD evidence-based psychotherapy. Emotion regulation appears to influence both aggression and treatment initiation for Veterans with PTSD. Thus, this proposed study targets emotion regulation with the goal of reducing impulsive aggression and preparing Veterans for PTSD evidence-based psychotherapy. Research Plan: Our goal is to test the efficacy of an innovative emotion regulation training, MERA, with a RCT of 204 Afghanistan and Iraq Veterans with PTSD and impulsive aggression. MERA is provided in three sessions to address logistical barriers faced by younger Veterans who are reintegrating into their communities. MERA incorporates education, cognitive-behavioral and acceptance- based skills training. It also includes information about what emotional experiences to expect from PTSD treatments. Three sessions of present centered therapy will serve as an active control group which is consistent with treatment as usual. MERA and present centered therapy will be compared on changes in aggression from Session 1 to the 2-month posttreatment changes. We predict Veterans who complete MERA will have greater reductions in IA and emotion dysregulation as compared to Veterans who complete present centered therapy. Finally, rates of PTSD evidence-based psychotherapy initiation (attend 1 session), will be examined via a chart review 6 months post treatment. We predict Veterans who complete MERA will initiate PTSD evidence-based psychotherapies at a greater rate than Veterans who complete present centered therapy. Significance: This study supports 2 Veterans Affairs missions: reduce aggression and increase PTSD treatment initiation. PTSD is one of the most commonly occurring and costly psychiatric conditions among Veterans. Veterans with PTSD are more likely to engage in aggressive behavior than civilians with PTSD or Veterans without PTSD. Reducing aggression is a critical need for Veterans, their families, and society. Additionally, there are effective treatments that reduce PTSD symptoms, yet few Veterans receive evidence based psychotherapies for PTSD. One reason for the low rate of treatment initiation is that Veterans fear they will not be able to control their emotional responses when they begin treatment. Equipping Veterans with emotion regulation skills and knowledge about PTSD treatments may help them initiate treatment for PTSD.