Developing a Mobile Intervention for Veterans with Posttraumatic Stress Disorder and Problematic Anger

难以控制愤怒是战斗中最常见的重返社会问题 退伍军人，特别是那些诊断为创伤后应激障碍（PTSD）的人。在退伍军人，有问题 愤怒与许多负面的心理社会结果有关，包括不良的功能结果（两者都是）。 社会和职业）、家庭不和、攻击性、路怒和自杀风险。愤怒也会阻碍 PTSD治疗的成功结果。鉴于退伍军人中愤怒问题的高发率 与创伤后应激障碍和相关的功能障碍，显然需要开发创新和有效的 愤怒干预，以改善退伍军人的功能结果。使用移动的保健（mHealth） 技术可以提供一种低成本的方法来增加愤怒管理治疗的范围， 急需退伍军人。 与问题愤怒和攻击性相关的机制之一是敌意解释偏见， 也就是说，把模棱两可的人际关系解释为敌对的倾向。通过减少敌意的解释 偏见，它可能会显着减少问题的愤怒和侵略，并改善功能 结果。申请人已开发并试行了基于计算机的解释偏差修正 干预成功地减少了敌意的解释偏见和愤怒的结果。这个项目的目标是 为了进一步发展这种干预与创伤后应激障碍的退伍军人，使用mHealth技术，以增加 这种有希望的方法可以减少愤怒，增强职业和心理社会功能。 研究计划建议开发、完善和试点测试一个移动的应用版本， 现有的基于计算机的解释偏差修正干预PTSD和有问题的个人 愤怒中心假设是，患有创伤后应激障碍和问题愤怒的患者会发现这种移动的 干预是可以接受的，并愿意使用它来减少他们的愤怒困难和改善心理社会 和职业功能。拟议的研究项目将针对以下具体目标：目标1（a）： 制定一项移动的解释偏差修正干预措施，标题为“减少解释偏差的移动的干预措施”。 愤怒（MIRA）的退伍军人与创伤后应激障碍和问题的愤怒;目的1（B）：使用连续队列设计， 完善MIRA对患有PTSD和问题愤怒的退伍军人的干预;目标2：为了：a）评估 在一项比较MIRA与接触的试点研究中招募、随机化和保留程序的可行性 控制条件，重点是社区重返社会和功能成果，以及B）进行 探索性目的：利用心理生理学和电子日记监测， 该评估可用作后续随机化研究中的结果或机制变量。 临床试验应用集中于评估MIRA干预的有效性。结果 将指导设计一个有说服力的随机对照试验，以测试MIRA干预的有效性 将在CDA-2供资期结束时提供资金。 培训和指导计划概述了课程、培训和经验， 申请人与基金会建立职业生涯，专注于开发创新和有效的治疗方法 改善患有PTSD的退伍军人的功能结果和社区重新融合。下列培训 目标已经制定：1）获得更多的mHealth方法的知识; 2）获得 进行和分析定性研究的专业知识; 3）在设计和分析方面获得额外的专业知识， 临床试验管理; 4）扩展临床试验数据分析的知识和技能; 5）扩展 了解康复理论和方法; 6）获得额外的赠款写作技能， 一般专业发展。本申请中概述的研究、培训和指导计划将 为PI过渡到独立的VA研究生涯提供基础。

Difficulty controlling anger is the most commonly reported reintegration concern among combat Veterans, especially those with a diagnosis of posttraumatic stress disorder (PTSD). In Veterans, problematic anger is associated with numerous negative psychosocial outcomes, including poor functional outcomes (both social and occupational), family discord, aggression, road rage, and suicide risk. Anger can also impede successful outcomes from PTSD treatment. Given the high prevalence of anger problems among Veterans with PTSD and the associated functional impairments, there is a clear need to develop innovative and effective anger interventions to improve functional outcomes of Veterans. The use of mobile health (mHealth) technology could provide a low-cost method to increase the reach of anger management treatments to this high-need group of Veterans. One of the mechanisms associated with problematic anger and aggression is hostile interpretation bias, i.e., a tendency to interpret ambiguous interpersonal situations as hostile. By reducing hostile interpretation bias, it may be possible to significantly reduce problematic anger and aggression and improve functional outcomes. The applicant has developed and piloted a computer-based interpretation bias modification intervention that successfully reduces hostile interpretation bias and anger outcomes. The goal of this project is to further develop this intervention for Veterans with PTSD, using mHealth technology to increase the portability of this promising approach to reduce anger and enhance occupational and psychosocial functioning. The Research Plan proposes to develop, refine, and pilot-test a mobile application version of the existing computer-based interpretation bias modification intervention for individuals with PTSD and problematic anger. The central hypothesis is that patients with PTSD and problematic anger will find this mobile intervention acceptable and will be willing to use it to reduce their anger difficulties and improve psychosocial and occupational functioning. The proposed research project will address the following Specific Aims: Aim 1(a): To develop a mobile interpretation bias modification intervention entitled Mobile Intervention for Reducing Anger (MIRA) for Veterans with PTSD and problematic anger; Aim 1(b): To use a successive cohort design to refine the MIRA intervention for Veterans with PTSD and problematic anger; and Aim 2: To: a) evaluate the feasibility of recruitment, randomization, and retention procedures in a pilot study comparing MIRA to a contact control condition, focusing on community reintegration and functional outcomes, and b) conduct an exploratory aim utilizing psychophysiological and electronic diary monitoring to determine whether this assessment could be utilized as an outcome or mechanistic variable in a subsequent randomized clinical trial application focused on evaluating the efficacy of the MIRA intervention. The results generated will guide the design of a sufficiently-powered RCT to test the effectiveness of the MIRA intervention to be funded by the end of the CDA-2 funding period. The Training and Mentoring Plans outline coursework, training, and experiences that will provide the applicant with the foundation to establish a career focused on developing innovative and effective treatments that improve functional outcomes and community reintegration in Veterans with PTSD. The following Training Goals have been formulated: 1) To acquire additional knowledge of mHealth methodologies; 2) To acquire expertise conducting and analyzing qualitative research; 3) To acquire additional expertise in the design and management of clinical trials; 4) To expand knowledge and skills in analyzing clinical trials data; 5) To extend understanding of rehabilitation theory and methods; and 6) To acquire additional skills in grant-writing and general professional development. The research, training, and mentoring plans outlined in this application will provide the foundation for the PI’s transition to an independent VA research career.