Group Cognitive Behavioral Therapy for Anger and Aggression in Veterans with PTSD

针对患有创伤后应激障碍 (PTSD) 退伍军人的愤怒和攻击性的团体认知行为疗法

• 批准号: 9040013
• 负责人: Elizabeth Van Voorhees
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9040013
• 关键词: Address; Afghanistan; Aftercare; Aggressive behavior; Anger; Attention; Behavior Therapy; Clinical; Clinical Trials Cooperative Group; Cognitive Therapy; Data; Development; Effectiveness; Emotional; Emotions; Evaluation; Family; Feasibility Studies; Foundations; Funding; Goals; Guidelines; Hospitals; Intervention; Iraq; Life; Love; Mentors; Methods; Military Personnel; Nature; Outcome; Outcome Measure; Participant; Patient Self-Report; Patients; Pilot Projects; Post-Traumatic Stress Disorders; Procedures; Publishing; Randomized Clinical Trials; Recovery; Rehabilitation therapy; Reporting; Research; Research Personnel; Research Project Grants; Research Training; Sampling; Social support; Specialist; Surveys; Symptoms; Testing; Therapeutic; Time; Training; Trauma; Treatment Efficacy; Treatment Protocols; Veterans; Vietnam; active method; anger management; arm; base; career; clinical practice; cognitive process; combat; community reintegration; comparative effectiveness; design; disorder control; effective therapy; experience; follow-up; functional disability; functional outcomes; group intervention; improved; improved functioning; innovation; male; member; post-traumatic stress; programs; psychosocial; public health relevance; research clinical testing; skills; theories; treatment program; trial comparing; virtual; working group

DESCRIPTION: Posttraumatic stress disorder (PTSD) robustly predicts anger and aggression (Olatunji, Ciesielski, & Tolin, 2010), and U.S. Iraq/Afghanistan-era Veterans report that controlling anger and aggressive urges are primary readjustment concerns (Sayer et al, 2010). Trauma-related anger and aggression are associated with functional impairments that significantly limit community reintegration (Rodriguez, Holowka, & Marx, 2012) and that may persist for decades (Koenen et al, 2003). As more troops return from multiple deployments to Iraq and Afghanistan, there is an urgent and growing need for the development and testing of psychosocial treatment for anger and aggression in combat Veterans with PTSD. VA clinicians are doing their best to be responsive to Veteran's needs by offering anger management treatment to Veterans: A survey of clinical practices within the VA conducted found that 35-65% of VA PTSD specialists report providing anger management to their patients (Rosen et al., 2004). Yet to date only one randomized clinical trial (RCT), published in 1997, has investigated the efficacy of treatment of anger and aggression in Veterans with PTSD (Chemtob et al., 1997). A recent review noted that most researchers who have examined the effects of anger management interventions have not done so as part of a systematic program of research (DiGiuseppe & Tafrate, 2003). The proposed CDA-2 application outlines Training and Mentoring Plans that will provide the applicant with the foundation to establish a career systematically developing, testing, and refining treatments for PTSD-related anger and aggression in Veterans. The following specific Training Goals have been formulated: 1) To acquire the advanced skills in the development and evaluation of clinical interventions necessary to begin an independent research career within the VA; 2) To develop greater expertise in delivery of behavioral interventions to improve functional outcomes and community reintegration in Veterans with PTSD, anger problems, and aggression; 3) To acquire expertise in the development and evaluation of treatment innovations to help Veterans generalize treatment gains beyond the therapy setting; 4) To increase understanding of rehabilitation theory and methods in treatment practices and research; and 5) To achieve critical professional development milestones, including submission of a Merit Review proposal based on the pilot data generated from the CDA-2 project. The Research Plan proposes a pilot feasibility trial for an RCT of Cognitive-Behavioral Therapy for Anger and Aggression in Combat Veterans with PTSD (CBT-A). CBT-A is a 12-week manualized group treatment protocol that has been designed to address the specific needs of combat Veterans whose PTSD-related anger and aggression interfere with effective community reintegration. The group was implemented with 4 male Vietnam Veterans with severe combat-related PTSD who had been referred for anger management treatment, and preliminary data were promising. The active comparison treatment for the pilot RCT will be group Present- Centered Therapy (PCT), a manualized treatment for PTSD that controls for treatment time, social support, and instillation of hope. The proposed research project will address the following Specific Aims: Aim 1: Characterize the differential effects of group CBT-A and group PCT on anger, aggression, and anger/aggression-related limitations to psychosocial functioning and community reintegration in combat Veterans with PTSD; and Aim 2: Evaluate study feasibility and treatment delivery procedures of an RCT comparing CBT-A to a PCT comparison condition. The results generated will guide the design of a full RCT to be funded by the end of the CDA-2 funding period. The research, training, and mentoring plans outlined here will provide the foundation for the PI's independent research career developing a systematic program of research in the treatment of anger and aggression among combat Veterans with PTSD. The availability of empirically-supported anger treatment would benefit the many Veterans with PTSD who return from combat reporting problems with anger and aggression.

产品说明： 创伤后应激障碍（PTSD）强烈预测愤怒和攻击性（Olatunji，Ciesielski，& Tolin，2010），美国伊拉克/阿富汗时代的退伍军人报告说，控制愤怒和攻击性冲动是主要的重新调整问题（Sayer等人，2010）。创伤相关的愤怒和攻击与功能障碍有关，这些功能障碍严重限制了社区重返社会（Rodriguez，Holowka，&马克思，2012），并且可能持续数十年（Koenen et al，2003）。随着越来越多的部队从伊拉克和阿富汗的多次部署中返回，迫切需要开发和测试患有创伤后应激障碍的退伍军人的愤怒和攻击心理治疗。退伍军人管理局临床医生正在尽最大努力通过向退伍军人提供愤怒管理治疗来响应退伍军人的需求：在退伍军人管理局进行的临床实践调查发现，35-65%的退伍军人管理局创伤后应激障碍专家报告向他们的患者提供愤怒管理（罗森等人，2004年）。然而，迄今为止，只有一项1997年发表的随机临床试验（RCT）调查了患有PTSD的退伍军人中愤怒和攻击性治疗的功效（Chemtob等人，1997年）。 最近的一项综述指出，大多数研究人员研究了愤怒管理干预措施的效果，但并没有将其作为系统研究计划的一部分（DiGiuseppe & Tafrate，2003）。拟议的CDA-2申请概述了培训和指导计划，该计划将为申请人提供基础，以建立一个职业生涯，系统地开发，测试和完善退伍军人PTSD相关愤怒和侵略的治疗。制定了以下具体的培训目标：1）获得临床干预措施的开发和评估方面的高级技能，这些干预措施是开始在VA内独立研究职业生涯所必需的; 2）在提供行为干预措施方面发展更多的专业知识，以改善患有创伤后应激障碍、愤怒问题和攻击性的退伍军人的功能结果和社区融合; 3）获得治疗创新开发和评估方面的专业知识，以帮助退伍军人将治疗成果推广到治疗环境之外; 4）加深对治疗实践和研究中康复理论和方法的理解;及5）达致重要的专业发展里程碑，包括根据CDA-2项目所产生的试验数据提交优异评审建议书。 该研究计划提出了一个试点可行性试验的RCT的认知行为疗法的愤怒和侵略的战斗退伍军人与创伤后应激障碍（CBT-A）。CBT-A是一项为期12周的手动小组治疗方案，旨在解决退伍军人的具体需求，这些退伍军人的PTSD相关愤怒和攻击干扰了有效的社区重返社会。该小组由4名患有严重战斗相关创伤后应激障碍的男性越南退伍军人实施，他们已被转诊接受愤怒管理治疗，初步数据很有希望。试点RCT的积极比较治疗将是以现在为中心的治疗（PCT），这是一种治疗PTSD的手动治疗，控制治疗时间，社会支持和希望的灌输。拟议的研究项目将解决以下具体目标：目标1：描述CBT-A组和PCT组对患有创伤后应激障碍的退伍军人的愤怒、攻击性以及愤怒/攻击相关的心理社会功能和社区融合限制的不同影响;和目标2：评估研究可行性和比较CBT-A与PCT比较条件的随机对照试验的治疗提供程序。所产生的结果将指导在CDA-2资助期结束时资助的完整RCT的设计。这里概述的研究，培训和指导计划将为PI的独立研究生涯提供基础，为患有PTSD的退伍军人的愤怒和攻击治疗提供系统的研究计划。获得精神支持的愤怒治疗将使许多患有创伤后应激障碍的退伍军人受益，他们从战斗中返回，报告愤怒和攻击性问题。