An adjunctive family intervention for individual PTSD treatment

创伤后应激障碍（PTSD）是一种毁灭性的疾病，对退伍军人来说， 家庭和社会。尽管存在有效的PTSD个体治疗方法，但治疗退出率很高 并且通常次优响应率仍然很常见。治疗中的家庭成员 代表了改善结果的一种潜在途径，但现有的PTSD家庭包容性治疗方法 对家庭和临床医生来说是漫长和负担的。为了解决这一关键限制，申请人提出了一种 一项简短的家庭干预（BFI）的试点有效性试验，将作为退伍军人个人的辅助手段提供 创伤后应激障碍治疗两个会话BFI协议，这已经过测试，并发现是有效的 与强迫症患者的家庭成员，侧重于两个主要的家庭行为： 增加对治疗的积极支持，减少PTSD症状的适应，或家庭成员的 试图改变自己的行为或环境，以减少退伍军人的痛苦。虽然经常 善意的，住宿直接与情绪暴露的目标相冲突，这是当前的核心目标 金标准的创伤后应激障碍治疗;有效地减少住宿，因此有可能增加 治疗的“剂量”。 在拟议的研究中，BFI将被修改，以增加其与PTSD的相关性，然后将 通过一项随机对照试验在退伍军人的家庭成员中进行测试，这些家庭成员正在开始一个 PE或CPT。我们建议，《家庭融合倡议》将通过减少家庭成员的住宿来发挥其作用 以及增加家庭成员对治疗的积极支持（例如，协助交通预约 或提供口头鼓励）;我们进一步建议，家庭成员的这些变化将导致 患者参与治疗的程度增加，“接触机会”水平增加（ 在日常生活中容忍强烈的情绪）。 我们对BFI有效性的主要衡量标准是PTSD症状和治疗参与度 在那些家庭成员接受它的退伍军人中，与家庭成员没有接受它的退伍军人相比， 接受BFI。将使用临床医生-管理员PTSD量表（CAPS-5）评估PTSD症状， 将使用现有的家庭作业完成情况和报告来评估治疗参与情况 参加的会议，都将由治疗临床医生完成。我们将利用生态瞬间 评估，一种先进的评估策略，允许通过智能手机实时采集数据， 探讨BFI在家庭成员和退伍军人中的作用的假设机制。我们还将 收集实施前的定性和定量数据，以研究 由经过培训的常规护理临床医生提供的常规护理环境中的BFI。这些临床医生将接受培训， PI（BFI的开发者）提供干预措施，以及他们的反馈（沿着 退伍军人和家庭成员参与者）将允许对方案进行迭代修订，以增强其 适应这个新的系统和人口。 这项研究通过检查一个简短的有效性来解决一个重要的公共卫生问题。 家庭干预治疗创伤后应激障碍在一个典型的VA临床设置。没有这样简短的家庭包容性 创伤后应激障碍的治疗目前存在，无论是内部或外部的VA。此外，拟议的研究 目标将补充一个全面的培训计划，以准备申请人成为一个独立的 具有基于机制研究设计专业知识的研究人员，沿着高级评估和 未来以家庭为中心的PTSD研究的分析方法。研究结果将提供重要的 关于这种有效治疗是否有效的信息，并准备进一步 在常规护理环境中的执行工作。

Post-traumatic stress disorder (PTSD) is a devastating illness that has substantial costs to Veterans, their families, and society. Although effective individual treatments for PTSD exist, high rates of treatment dropout and generally sub-optimal response rates remain common. Incorporating family members in treatment represents one potential avenue for improving outcomes, but existing family-inclusive treatments for PTSD are lengthy and burdensome to families and clinicians. To address this critical limitation, the applicant proposes a pilot effectiveness trial of a brief family intervention (BFI), to be delivered as an adjunct to Veterans’ individual PTSD treatment. The two-session BFI protocol, which has been previously tested and found to be efficacious with family members of patients with obsessive-compulsive disorder, focuses on two primary family behaviors: increasing active support for treatment and reducing PTSD symptom accommodation, or family members’ attempts to modify their own behavior or the environment in order to reduce Veterans’ distress. Although often well-intentioned, accommodation directly conflicts with the goal of emotional exposure, a core target of current gold-standard PTSD treatments; effectively reducing accommodation therefore holds the potential to increase the “dose” of treatment. In the proposed study, the BFI will be modified to increase its relevance to PTSD and will then be tested via a randomized controlled trial among family members of Veterans who are beginning a course of either PE or CPT. We propose that the BFI will exert its effects by reducing family member accommodation and increasing family members’ active support for treatment (e.g., assisting with transportation to appointments or providing verbal encouragement); we further propose that these changes in family members will result in increased treatment engagement by patients and increased levels of “exposure opportunities” (experiences of tolerating strong emotions in daily life). Our primary measures of the BFI’s effectiveness will be PTSD symptoms and treatment engagement among those Veterans whose family members receive it, compared to Veterans whose family members do not receive the BFI. PTSD symptoms will be assessed using the Clinician-Administered PTSD Scale (CAPS-5), and treatment engagement will be assessed using an existing measure of homework completion and a report of sessions attended, both to be completed by the treating clinician. We will use ecological momentary assessment, an advanced assessment strategy that allows for real-time data capture via smartphones, to explore the hypothesized mechanisms of the BFI’s effects in both family members and Veterans. We will also collect qualitative and quantitative pre-implementation data to examine the feasibility and acceptability of the BFI in a routine-care setting when delivered by trained usual care clinicians. These clinicians will be trained by the PI, who is the developer of the BFI, to deliver the intervention, and their feedback (along with that of the Veteran and family member participants) will allow for iterative revisions to the protocol in order to enhance its fit within this novel system and population. This study addresses an important public health concern by examining the effectiveness of a brief family intervention for the treatment of PTSD in a typical VA clinical setting. No such brief family-inclusive treatment for PTSD currently exists, either within or outside of the VA. Furthermore, the proposed research aims will complement a comprehensive training plan to prepare the applicant to become an independent investigator with expertise in mechanisms-based research design, along with advanced assessment and analytic approaches for future family-focused PTSD research. Results from the study will provide important information about whether or not this efficacious treatment can be effective and ready for further implementation efforts in routine-care settings.