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，对退伍军人来说代价巨大，他们的 家庭和社会。尽管存在对创伤后应激障碍有效的个体化治疗，但治疗中途退出的比率很高。 总体来说，次优的应答率仍然很常见。将家庭成员纳入治疗 是改善预后的一个潜在途径，但现有的包括家庭在内的创伤后应激障碍治疗是 对家庭和临床医生来说既冗长又繁重。为了解决这一关键限制，申请人提出了 短暂家庭干预(BFI)的试点有效性试验，作为退伍军人个人的辅助服务 创伤后应激障碍治疗。两个会话的BFI协议，该协议之前已经过测试并被发现是有效的 与强迫症患者的家人一起，重点介绍了两种主要的家庭行为： 增加对治疗的积极支持，减少创伤后应激障碍症状的适应，或家庭成员 试图改变自己的行为或环境，以减少退伍军人的痛苦。尽管经常 善意的迁就直接与情感暴露的目标相冲突，情感暴露是当前 黄金标准的创伤后应激障碍治疗；因此有效地减少适应能力具有增加的潜力 治疗的“剂量”。 在拟议的研究中，BFI将进行修改，以增加其与创伤后应激障碍的相关性，然后将 通过一项随机对照试验在退伍军人家庭成员中进行测试，这些家庭成员正在开始一个疗程 PE或CPT。我们建议BFI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，协助运送到预约 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 增加患者的治疗参与度和增加“暴露机会”(经验 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创伤后应激障碍症状和治疗参与度 在那些家人领取的退伍军人中，相比之下，家人没有领取的退伍军人 收到BFI。创伤后应激障碍症状将使用临床医生管理的创伤后应激障碍量表(CAPS-5)进行评估， 治疗参与度将使用现有的家庭作业完成情况和一份报告进行评估 参加会议的次数，均由治疗临床医生完成。我们将用生态瞬间 评估是一种高级评估策略，允许通过智能手机实时捕获数据，以 探索BFI对家庭成员和退伍军人影响的假设机制。我们还将 收集实施前的定性和定量数据，以检查以下项目的可行性和可接受性 在常规护理环境中由训练有素的常规护理临床医生提供的BFI。这些临床医生将接受以下培训 PI是BFI的开发者，负责提供干预和他们的反馈(以及 退伍军人和家庭成员)将允许对议定书进行反复修订，以加强其 符合这一新的制度和人口。 这项研究通过检查一种简单的 家庭干预在典型退伍军人事务部临床环境中治疗创伤后应激障碍。没有这样短暂的家庭包罗万象 目前存在创伤后应激障碍的治疗方法，无论是在退伍军人事务部内部还是外部。此外，拟议的研究 AIMS将补充一项全面的培训计划，为申请者成为独立的 在基于机制的研究设计方面具有专业知识的调查员，以及高级评估和 未来以家庭为中心的创伤后应激障碍研究的分析方法。这项研究的结果将提供重要的 关于这种有效治疗是否有效并为进一步治疗做好准备的信息 在常规护理环境中的实施努力。

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.