Exposure and Response Prevention to Improve Functioning in Veterans with Obsessive Compulsive Disorder

暴露和反应预防以改善患有强迫症的退伍军人的功能

• 批准号: 10623218
• 负责人: Terri Lynn Fletcher
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10623218
• 关键词: Address; Administrator; Adoption; Affect; Aftercare; Anxiety; Caring; Case Study; Child; Child Care; Chronic; Clinical; Clinical Trials; Cognitive Therapy; Communities; Complex; Compulsive Behavior; Data; Distress; Educational Intervention; Effectiveness; Eligibility Determination; Ensure; Evidence based treatment; Exercise; Exposure to; Face; Family; Home; Home environment; Hospitals; Illness impact; Individual; Intervention; Interview; Knowledge; Learning; Life; Logistics; Mental Health; Mental disorders; Meta-Analysis; Methods; Obsession; Obsessive-Compulsive Disorder; Outcome; Participant; Patient Self-Report; Perception; Persons; Pilot Projects; Population; Post-Traumatic Stress Disorders; Prevention; Prevention trial; Provider; Psychotherapy; Publishing; Quality of life; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recording of previous events; Research; Sampling; Schizophrenia; Severities; Site; Societies; Suicide attempt; Symptoms; Testing; Training; Transportation; Trauma; Veterans; Veterans Health Administration; Work; Workplace; clinically significant; comorbidity; coping; effective therapy; effectiveness evaluation; evidence base; experience; follow up assessment; formative assessment; functional improvement; future implementation; habituation; implementation evaluation; implementation outcomes; improved; military veteran; recruit; response; satisfaction; social; stress management; telehealth

Project Background Exposure and Response Prevention (ERP) is the gold standard evidence-based psychotherapy for OCD; however, few Veterans receive ERP and no randomized controlled trials (RCTs) have been published examining the effectiveness of ERP among Veterans or in individuals with comorbid OCD and posttraumatic stress disorder (PTSD). OCD impacts work, social, and family functioning, such that 38% of people with OCD are unable to work due to the severity of symptoms and 25% attempt suicide at some point in their lives (Mancebo et al., 2008). It is essential to examine the effectiveness of ERP in Veteran specific trials because Veterans are a complex, highly comorbid population, and have significant trauma histories which can complicate ERP treatment. Many Veterans face logistic barriers to accessing therapy including transportation, distance, childcare, and work, in addition to challenges leaving the home due to OCD symptoms. Video telehealth (VTH) can increase Veterans’ access to ERP and may enhance the generalizability of exposures since in-home exposure exercises can focus on OCD triggers that people encounter in their home environment. This may mean more direct impact to the Veteran’s daily life functioning and quality of life. Project Objectives The proposed 4-year multisite RCT will compare outcomes of VTH-delivered ERP to those of a stress management training control condition among 160 Veterans with OCD. Half of the sample with have comorbid PTSD. The primary aim will examine whether participants’ functioning, quality of life, and OCD symptoms differ as a function of the intervention (ERP vs. control). The secondary aim will examine these outcomes among the half of the sample with comorbid OCD and PTSD. The tertiary aim is to conduct a mixed-methods formative evaluation of the implementation potential of ERP in VA mental health settings. Project Methods Eligible Veteran participants will be randomized to ERP or to the control condition. Veterans randomized to ERP will receive 16 weekly ERP sessions delivered via VTH. Control participants will receive 16 weekly sessions of a stress management training intervention delivered via VTH. Participants in both conditions will complete assessments at post-treatment and 6 months after completing treatment. Participants in the ERP condition will also complete an assessment of treatment satisfaction and a qualitative exit interview assessing the Veterans’ perceptions of the impact of treatment on multiple domains of functioning, including the impact on PTSD symptoms. Providers and VA administrators will participate in qualitative interviews regarding the implementation potential of ERP in VA. Contribution to VHA This work addresses RR&D clinical priorities related to cognitive-behavioral interventions for improving Veterans’ functioning, participation in society, and quality of life. Establishing ERP as an evidence-based treatment in the complex Veteran population has the potential to impact the 170,000 Veterans in VHA with OCD and assist them in living more functional lives, which will affect their families, children, workplaces, and communities.

项目背景 暴露与反应预防（ERP）是强迫症循证心理治疗的金标准; 然而，很少有退伍军人接受ERP，也没有随机对照试验（RCT）发表 检查ERP在退伍军人或患有强迫症和创伤后精神障碍的个体中的有效性。 应激障碍（PTSD）。强迫症影响工作，社会和家庭功能，例如38%的强迫症患者 由于症状严重而无法工作，25%的人在生命中的某个时候试图自杀 （Mancebo等人，2008年）。在退伍军人特定试验中检查ERP的有效性至关重要，因为 退伍军人是一个复杂的，高度共病的人群，并有显着的创伤史，可以 复杂ERP治疗。许多退伍军人面临后勤障碍，以获得治疗，包括交通， 距离，儿童保育和工作，以及由于强迫症症状而离开家的挑战。视频 远程医疗（VTH）可以增加退伍军人获得ERP的机会，并可能提高暴露的普遍性 由于家庭暴露练习可以集中在人们在家中遇到的强迫症触发点上， 环境这可能意味着更直接的影响退伍军人的日常生活功能和生活质量。 项目目标 拟议的4年多中心随机对照试验将比较VTH提供的ERP与压力的结局 160例退伍军人强迫症患者管理培训控制状况调查一半的样本有共病 创伤后应激障碍主要目的是检查参与者的功能，生活质量和强迫症症状是否不同 作为干预的函数（ERP与对照）。第二个目标将检查这些结果， 有一半的样本患有强迫症和创伤后应激障碍第三个目标是进行混合方法的形成 评估ERP在VA心理健康环境中的实施潜力。 项目方法 合格的退伍军人受试者将被随机分配至ERP或对照组。退伍军人随机分配至 ERP将通过VTH接收16次每周ERP会议。对照组受试者每周接受16次 通过VTH提供的压力管理培训干预课程。这两种情况的参与者将 在治疗后和完成治疗后6个月完成评估。ERP参与者 条件还将完成治疗满意度评估和定性离职面谈评估 退伍军人对治疗对多个功能领域的影响的看法，包括 创伤后应激障碍症状供应商和VA管理员将参加有关定性访谈， ERP在VA中应用潜力。 对VHA的贡献 这项工作解决了RR&D临床优先事项相关的认知行为干预，以改善 退伍军人的功能，参与社会和生活质量。将企业资源规划系统作为一个循证的 在复杂的退伍军人群体中的治疗有可能影响VHA中的17万退伍军人， 强迫症，帮助他们过上更有功能的生活，这将影响他们的家庭，孩子，工作场所， 社区.