Using mindfulness-based cognitive therapy to manage pain and mitigate suicide risk in Veterans

使用基于正念的认知疗法来控制退伍军人的疼痛并降低自杀风险

• 批准号: 10589748
• 负责人: LISHAM ASHRAFIOUN
• 金额: $ 24.21万
• 依托单位: VETERANS HEALTH RESEARCH INSTITUTE OF CENTRAL NEW YORK, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-10 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589748
• 关键词: Accounting; Address; Adherence; Aftercare; Cause of Death; Clinical Trials; Combined Modality Therapy; Consensus; Data; Development; Diagnostic Factor; Education; Elements; Feasibility Studies; Feeling suicidal; Goals; Grant; Individual; Intervention; Manuals; Mental Depression; Mental disorders; Meta-Analysis; Methods; Mind-Body Intervention; National Center for Complementary and Integrative Health; Opioid; Outcome; Outcome Measure; Overdose; Pain; Pain Measurement; Pain intensity; Pain interference; Pain management; Participant; Patients; Phase; Premature Mortality; Process; Protocols documentation; Public Health; Quality of life; Randomized; Reporting; Research; Research Design; Research Priority; Risk; Risk Factors; Sampling; Severities; Suicide; Testing; Therapeutic Intervention; Thinking; Treatment Efficacy; United States; Veterans; Vulnerable Populations; acceptability and feasibility; chronic pain; design; efficacy trial; evidence base; experience; follow-up; functional disability; functional improvement; ideation; innovation; military veteran; mind/body; mindfulness based cognitive therapy; mindfulness intervention; neural; non-opioid analgesic; novel; opioid use; pain catastrophizing; pain outcome; programs; psychologic; randomized, clinical trials; recruit; reducing suicide; response; satisfaction; suicidal; suicidal behavior; suicidal risk; treatment duration

The proposed study will develop a mindfulness-based cognitive therapy (MBCT) manual to address both functional impairment and suicide risk (MBCT-S/P). We will examine the feasibility of the study design and ask participants if the found the treatment to be acceptable. We expect this smaller study will provide critical information for a larger trial. Suicide is the 10th leading cause of death. Chronic pain is a leading cause of functional impairment in the United States and is a risk factor of suicide even after accounting for psychiatric disorders. Veterans are a vulnerable population for both suicide and chronic pain; however, there is little research examining ways to reduce functional impairment and suicide risk in a combined treatment. Therefore, this proposal examines the use of MBCT as a novel way to simultaneously address functional impairment and suicide risk. Research on patients at risk of suicide and on patients experiencing chronic pain supports the utility of MBCT separately. However, there is limited evidence investigating a combined treatment that addresses both functional impairment and suicide risk. Application of MBCT on veterans at risk for suicide who are experiencing functionally-impairing chronic pain provides a unique opportunity to simultaneously address these interactive factors. The overall goal of the broader program is to enhance functioning and to reduce veteran suicide, and the proposed project will provide data to guide the development of a larger trial. The objectives of the current proposal are to (1) combine existing MBCT intervention protocols to develop an MBCT manual aimed at addressing the unique needs of veterans experiencing functional impairment from chronic pain who are at risk for suicide, (2) examine if the recruitment, retention, and treatment delivery is feasible and if MBCT-S/P acceptable to participants, and (3) assess parameters of key outcomes among participants randomized to receive MBCT-S/P versus an Education control to inform a subsequent larger clinical trial. To achieve these objectives, we will develop a manual through an evidence-based, iterative process then conduct a randomized clinical trial in Veterans with chronic pain reporting suicidal ideation. We will randomize a total of 76 participants to receive either MBCT-S/P or Education. We will assess pain and suicide risk outcomes such as suicidal ideation, depression, and interpersonal factors at baseline and after the treatment period. We will also track participant flow, therapist adherence to the manual, participant homework completion and participant satisfaction with the treatment.

这项拟议的研究将开发一个基于正念的认知疗法（MBCT）手册，以解决这两个问题。 功能障碍和自杀风险（MBCT-S/P）。我们会研究研究设计的可行性， 如果参与者认为治疗是可以接受的。我们希望这项规模较小的研究将提供关键的 为更大规模的审判提供信息。 自杀是第十大死亡原因。慢性疼痛是老年人功能障碍的主要原因。 在美国，即使考虑到精神疾病，自杀也是一个危险因素。退伍军人是一个 易受自杀和慢性疼痛影响的人群;然而，很少有研究探讨如何 在联合治疗中减少功能障碍和自杀风险。因此，本提案审查了 使用正念认知疗法作为同时解决功能障碍和自杀风险的新方法。研究 有自杀风险的患者和经历慢性疼痛的患者分别支持MBCT的效用。 然而，有有限的证据调查联合治疗，解决两个功能， 损伤和自杀风险。正念认知疗法在有自杀危险的退伍军人中的应用 功能受损的慢性疼痛提供了一个独特的机会，同时解决这些互动 因素 更广泛的计划的总体目标是加强功能，减少退伍军人自杀， 拟议项目将提供数据，以指导更大规模试验的开展。当前的目标 建议是（1）结合联合收割机现有MBCT干预协议，以开发MBCT手册，旨在 满足因慢性疼痛而出现功能障碍的退伍军人的独特需求， 对于自杀，（2）检查招募、保留和治疗是否可行，以及MBCT-S/P （3）评估随机分配至 接受MBCT-S/P与教育对照，以告知后续更大的临床试验。 为了实现这些目标，我们将通过基于证据的迭代过程制定一份手册， 在有慢性疼痛报告有自杀意念的退伍军人中进行随机临床试验。我们会随机 共有76名参与者接受MBCT-S/P或教育。我们会评估疼痛和自杀风险 基线和治疗后的结局，如自杀意念、抑郁和人际因素 期我们还将跟踪参与者的流程，治疗师对手册的遵守情况，参与者家庭作业的完成情况 参与者对治疗的满意度。