Development of a Mobile Mindfulness Intervention for Alcohol Use Disorder and PTSD among OEF/OIF Veterans

项目概要/摘要 该提案的长期目标是改善OEF/OIF退伍军人饮酒的治疗结果 精神障碍（AUD）和创伤后应激障碍（PTSD），目前没有通过 退伍军人事务医疗保健系统（VA）或其他设置。许多OEF/OIF退伍军人与沉重的 饮酒和相关的后果，这可能是特别明显的创伤后应激障碍的共同发生。 先前的研究发现，自我调节（情绪调节，冲动控制），压力和渴望的方面， 是减少AUD和PTSD症状的重要假定靶点。然而，随着50%以上的 有行为健康的退伍军人不需要寻求治疗，必须利用进步， 技术开发和测试干预措施，可以达到非寻求治疗的退伍军人和目标， PTSD和AUD的症状。作为提议的机制（例如，自我调节）变得更好 了解它们如何影响PTSD和AUD结果，方法应侧重于针对这些 机制，并评估它们是否是变革的重要推动者。基于正念的干预（MBI） 我可以瞄准这样的机制，但在知识上的差距仍然存在，关于退伍军人的MBIs的效用 创伤后应激障碍和听力障碍的人因此，我们建议改善OEF/OIF的治疗结局 退伍军人与创伤后应激障碍和AUD针对自我调节，压力，和渴望。我们将开发和测试一种 新的移动的MBI，移动的基于正念的复发预防（mMBRP），这将改善证据- 通过接触治疗环境之外的退伍军人，以个人和团体MBRP为基础。易，易。 使用型移动的MBI整合了预防复发、减轻压力和自我调节技能， 退伍军人在寻求服务时面临的耻辱和障碍。核心假设将 通过对三个具体目标的关注进行测试：（1）完善并将MBRP内容添加到流行的VA中- 开发正念教练移动的应用程序通过beta测试阶段，我们测试的可行性， 应用程序的可接受性，（2）试点测试mMBRP移动的应用程序对酒精使用和PTSD的疗效 与对照组相比的结果，以及（3）评估变化机制，如自我调节，压力， 对mMBRP的渴望，以及性别、种族/民族和出院时间的探索性调节因素 方面的影响.该提案的独特优势在于其重点关注服务不足的人群，利用移动的 用于干预递送的技术，以及已知有效针对自我调节的新型干预的使用 和压力预期结果将确定一种可行且易于获得的治疗方法，可以改善AUD 和创伤后应激障碍症状这项研究的结果将对物质使用的结果产生积极的影响， 他们经历过创伤事件，并将确定治疗成功的作用机制。该应用程序 可以通过我们在退伍军人事务部的合作伙伴和通过社交媒体上的有针对性的分享进行传播。

PROJECT SUMMARY/ABSTRACT The long-term goal of this proposal is to improve treatment outcomes for OEF/OIF veterans with alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) who are not currently accessing care through the Veterans Affairs Healthcare System (VA) or other settings. Many OEF/OIF veterans struggle with heavy drinking and related consequences and this can be especially pronounced with the co-occurrence of PTSD. Prior research has found aspects of self-regulation (emotion regulation, impulse control), stress, and craving to be important putative targets in AUD and PTSD symptom reduction. However, with upwards of 50% of veterans who have behavioral health needs not seeking treatment, it is imperative to utilize advances in technology to develop and test interventions that can reach non-treatment seeking veterans and target both symptoms of PTSD and AUD. As the proposed mechanisms (e.g., self-regulation) are becoming better understood regarding how they affect PTSD and AUD outcomes, approaches should focus on targeting these mechanisms and evaluating if they are essential facilitators of change. Mindfulness-based interventions (MBI) can target such mechanisms, but a gap in the knowledge persists regarding the utility of MBIs with veterans who screen positive for PTSD and AUD. Therefore, we propose to improve treatment outcomes for OEF/OIF veterans with PTSD and AUD by targeting self-regulation, stress, and cravings. We will develop and test a novel mobile MBI, Mobile Mindfulness Based Relapse Prevention (mMBRP), that will improve upon evidence- based in-person and group MBRP by reaching veterans outside of treatment settings. The engaging and easy- to-use mobile MBI integrates relapse prevention, stress reduction, and self-regulation skills and is relevant to issues surrounding stigma and barriers that veterans face when seeking services. The central hypothesis will be tested through a focus on three specific aims: (1) refine and add MBRP content to the popular VA- developed Mindfulness Coach mobile application through a beta testing phase where we test for feasibility and acceptability of the app, (2) pilot test the efficacy of the mMBRP mobile app on alcohol use and PTSD outcomes compared to control, and (3) assess mechanisms of change such as self-regulation, stress, and cravings, as well as exploratory moderators of gender, race/ethnicity, and recency of discharge, on mMBRP effects. The unique strengths of this proposal are its focus on an underserved population, utilization of mobile technology for intervention delivery, and use of a novel intervention known to effectively target self-regulation and stress. The expected results will define a viable and easy-to-access treatment that can improve both AUD and PTSD symptoms. Results of this study will have a positive impact on substance use outcomes for those who have experienced traumatic events and will identify mechanism of action for treatment success. The app can be disseminated through our partners in the VA and through targeted sharing on social media.