One-Day Life Skills Workshop for Veterans with TBI, Pain, and Psychopathology

创伤性脑损伤(TBI)是从伊拉克自由行动归来的老兵的标志性伤口， 持久的自由和新黎明行动(OIF/OEF/OND)，高达20%的人经历了持久的 脑震荡后症状。在那些被诊断为轻度脑损伤(MTBI)的人中，大多数还患有 以压力为基础的精神病理学，包括抑郁症、创伤后应激障碍和其他焦虑 疾病，以及慢性疼痛。对多种疾病管理不善会导致发病率增加和 死亡率增加，自杀风险增加，生活质量显著下降。重要的是，该协会 在退伍军人中，寻求心理健康护理和耻辱之间的比例很高。退伍军人通常不愿寻求 心理健康服务，因为担心接受这种护理会对他们的职业生涯和 相信他们应该能够独立克服心理上的困难。此外，还可以使用 专门服务仅限于生活在农村环境中的退伍军人。因此，治疗提供者面临的挑战 为退伍军人提供统一、高效、可获得和可接受的干预 相互依存的系统性共病担忧。接纳与承诺疗法(ACT)是一种跨性别的治疗方法。 诊断性(即，适用于多个诊断)旨在帮助个人的行为干预 培养在面对生活挑战时追求有价值的目标和方向所需的技能。它提供了一个 行为改变的统一模式，在治疗抑郁和焦虑方面显示出希望，以及 慢性疾病。重要的是，ACT在各种治疗-提供中得到了有效实施 形式，包括为期一天的研讨会。交付格式的这种灵活性使人们能够将重点放在如何最好地 包装和提供干预措施，以满足这一老患者群体的需求，以确保治疗 坚持，也增加了传播到临床环境的机会。提供为期1天的活动 为患有创伤性脑损伤、疼痛和心理健康问题的退伍军人提供统一的综合护理 这些退伍军人经历的情绪、身体和认知症状的范围。介绍 作为“工作坊”而不是“疗法”的治疗也将更适合那些可能不是 明确寻求专门的心理健康护理。最后，为期一天的研讨会确保治疗依从性和 精神卫生服务的完成往往是有效提供精神卫生服务的最大障碍。这个 这项研究的目的是：1)开发一个为期1天(5小时)的“ACT on Life”研讨会，外加一个个人助推器 会议专门为患有创伤性脑损伤、基于压力的精神病理学和疼痛的退伍军人量身定做。一个多- 由临床心理学家、神经精神病学家、认知心理学家、牧师和 人类学家将提供专家意见，用于编制治疗师干预和患者手册；2) 招募10名患有mTBI、基于压力的精神病理学和疼痛的退伍军人参加“ACT on Life”工作坊，以获得 退伍军人对干预的定性和定量反馈；使用退伍军人反馈来完善 治疗程序和手册；并审查干预的可行性和可接受性；以及3) 随机选择30名患有重型颅脑损伤、疼痛和基于应激的精神病理学的退伍军人，对他们进行改良的“ACT生活疗法”。 研讨会或照常治疗(TAU)，以检查干预对质量的初步效果 生活和功能，精神病理学的应激症状，以及疼痛干扰。

Traumatic brain injury (TBI) is the signature wound of Veterans returning from Operations Iraqi Freedom, Enduring Freedom and Operation New Dawn (OIF/OEF/OND), with up to 20 percent experiencing persistent post-concussive symptoms. Among those with a mild TBI (mTBI) diagnosis, the majority also suffers from stress-based psychopathology, including depression, post-traumatic stress disorder, and other anxiety disorders, as well as chronic pain. Poor management of multiple conditions results in increased morbidity and mortality, increased risk for suicide, and significantly decreased quality of life. Importantly, the association between seeking mental health care and stigma among Veterans is high. Veterans are often unwilling to seek mental health services due to concern that receiving such care would negatively impact their careers and the belief that they should be able to overcome psychological difficulties on their own. Furthermore availability of specialty services is limited for Veterans living in rural settings. Thus the challenge for treatment providers is to provide a unified, efficient, accessible, and acceptable intervention for Veterans with these interdependent systemic comorbid concerns. Acceptance and Commitment Therapy (ACT) is a trans- diagnostic (i.e., applies to more than one diagnosis) behavioral intervention aimed at helping individuals develop the skills needed to pursue valued goals and directions in the face of life's challenges. It provides a unified model of behavior change that has shown promise in treating depression and anxiety, as well as chronic medical conditions. Importantly, ACT has been effectively implemented in various treatment-delivery formats, including 1-day workshops. This flexibility in delivery format allows focus to be placed on how best to package and deliver the intervention to meet the needs of this Veteran patient population, to ensure treatment adherence, and also to increase chances of dissemination into clinical settings. Providing a 1-day ACT “workshop” for Veterans with mTBI, pain, and mental health problems will allow unitary comprehensive care for the range of emotional, physical, and cognitive symptoms experienced by these Veterans. Presenting the treatment as a “workshop” rather than “therapy” will also be better suited for the Veterans who may not be explicitly seeking specialized mental health care. Finally, a 1-day workshop ensures treatment adherence and completion, the lack of which is often the greatest obstacle to effective delivery of mental health services. The aims of this study are to 1) develop a 1-day (5-hour) “ACT on Life” workshop plus an individual booster session tailored specifically for Veterans with mTBI, stress-based psychopathology, and pain. A multi- disciplinary team of a clinical psychologist, neuropsychiatrist, cognitive psychologist, chaplain, and anthropologist will provide expert input for use in producing the therapist intervention and patient manual; 2) enroll 10 Veterans with mTBI, stress-based psychopathology, and pain in the “ACT on Life” workshop to obtain qualitative and quantitative feedback from Veterans about the intervention; use Veteran feedback to refine the treatment procedures and manuals; and examine feasibility and acceptability of the intervention; and 3) randomize 30 Veterans with mTBI, pain, and stress-based psychopathology to the refined “ACT on Life” workshop or to Treatment as usual (TAU) to examine the preliminary efficacy of the intervention on quality of life and functioning, stress-based symptoms of psychopathology, and pain interference.