CAP - Using Emotion Regulation to Decrease Aggression in Veterans with PTSD

 描述(由申请人提供)： 这项初步研究测试了情绪调节训练、管理情绪以减少攻击性(MERA)的可行性，以减少患有创伤后应激障碍(PTSD)的退伍军人的攻击性，并改善PTSD的治疗结果。背景：攻击性在患有创伤后应激障碍的退伍军人中很常见，并可导致毁灭性的人际和社会后果，如监禁、家庭暴力和社会支持等促进治疗的因素中断。患有创伤后应激障碍的退伍军人主要是冲动攻击(情绪、反应和失控)，而不是有预谋的攻击(故意的、工具的和有计划的)。情绪调节障碍，或在情绪意识、情绪接受、行为控制和/或内容适当的调节策略方面发展不足的技能，完全中介了退伍军人创伤后应激障碍严重程度和冲动性攻击之间的关系。此外，对焦虑的恐惧预测退伍军人未能完成以创伤后应激障碍为基础的循证心理治疗。情绪调节似乎影响患有创伤后应激障碍的退伍军人的攻击性和治疗结果；因此，这项拟议的研究以情绪调节为目标，目的是减少冲动性攻击，并为退伍军人进行创伤后应激障碍循证心理治疗做好准备。研究计划：我们的目标是测试一种创新的情绪调节训练MERA的可行性，对20名患有创伤后应激障碍和冲动性攻击性的阿富汗和伊拉克退伍军人进行公开试验。MERA以3个疗程的精简时间框架提供，以解决年轻退伍军人面临的后勤障碍，他们的职业、学校和家庭与治疗时间竞争。培训以小组形式进行，包括情感教育、认知行为和基于接受的技能培训，以及关于应从创伤后应激障碍治疗中获得哪些情绪体验的信息。退伍军人每周将完成情绪调节和攻击性测量。这项研究的可行性将使用退伍军人对MERA的判断进行审查，此外还包括招募(转介人数与选择退出的人数)、招生(筛选与录取的比例)、启动(参加1次会议)和完成率(参加所有3次会议)。梅拉的初步效果将通过训练前到训练后1个月在攻击性和情绪调节方面的变化来评估。我们预测，完成MERA的退伍军人将减少IA和情绪调节障碍。最后，创伤后应激障碍循证心理治疗开始(参加1个疗程)、参与率(参加至少2个疗程)和完成率(治疗师表示终止是合适的)将在MERA后6个月进行检查。我们预测，完成MERA的退伍军人将比没有完成MERA的退伍军人更快地启动、参与和完成基于创伤后应激障碍的循证心理治疗。意义：这项研究支持两个退伍军人事务部任务：减少攻击性和增加创伤后应激障碍的治疗开始。首先，创伤后应激障碍是退伍军人中最常见、最昂贵的精神疾病之一，患有创伤后应激障碍的退伍军人比患有创伤后应激障碍的平民更有可能从事攻击性行为。减少攻击性是退伍军人、他们的家人和社会减少人际暴力、监禁和伤害的迫切需要。其次，已经有有效的治疗方法被证明可以减少创伤后应激障碍的症状，但很少有患有创伤后应激障碍的退伍军人接受以创伤后应激障碍为基础的循证心理治疗。治疗启动率低的一个原因可能是退伍军人担心他们在开始治疗时无法控制自己的情绪反应。让退伍军人掌握情绪调节技能和创伤后应激障碍治疗知识，可以帮助他们开始、完成创伤后应激障碍循证心理治疗，并从中受益。

 DESCRIPTION (provided by applicant): This pilot study tests the feasibility of an emotion regulation training, Manage Emotions to Reduce Aggression (MERA), to decrease aggression in Veterans with posttraumatic stress disorder (PTSD) and improve PTSD treatment outcomes. Background: Aggression is common among Veterans with PTSD and can lead to devastating interpersonal and societal consequences, such as incarceration, family violence, and disruption of treatment-facilitating factors, such as social support. Veterans with PTSD primarily engage in impulsive aggression (emotional, reactive, and uncontrolled) rather than premeditated aggression (deliberate, instrumental, and planned). Emotion dysregulation, or underdeveloped skills in emotional awareness, emotional acceptance, behavioral control, and/or content-appropriate regulation strategies, fully mediates the relationship between PTSD severity and impulsive aggression in Veterans. Additionally, fear of anxiety predicts which Veterans failed to complete PTSD evidence-based psychotherapy. Emotion regulation appears to influence both aggression and treatment outcomes in Veterans with PTSD; thus, this proposed study targets emotion regulation with the goal of reducing impulsive aggression and preparing Veterans for PTSD evidence-based psychotherapy. Research Plan: Our goal is to test the feasibility of an innovative emotion regulation training, MERA, with an open trial of 20 Afghanistan and Iraq Veterans with PTSD and impulsive aggression. MERA is provided in a 3-session condensed time frame to address logistical barriers faced by younger Veterans who have careers, school, and families that compete with treatment time. The training is delivered in a group format and incorporates emotion education, cognitive-behavioral and acceptance-based skills training, and information about what emotional experiences to expect from PTSD treatments. Veterans will complete emotion regulation and aggression measures weekly. The study's feasibility will be examined using Veterans' judgments of MERA, in addition to recruitment (number of referrals versus those who opt-out), enrollment (proportion screened versus enrolled), initiation (attend 1 session), and completion (attend all 3 sessions) rates. MERA's preliminary effectiveness will be estimated with pre- to 1-month post training changes in aggression and emotion regulation. We predict Veterans who complete MERA will have reductions in IA and emotion dysregulation. Finally, rates of PTSD evidence-based psychotherapy initiation (attend 1 session), engagement (attend at least 2 sessions), and completion (therapist indicates termination is appropriate) will be examined 6 months post MERA. We predict Veterans who complete MERA will initiate, engage, and complete PTSD evidence-based psychotherapies at a greater rate than Veterans who do not complete MERA. Significance: This study supports 2 Veterans Affairs missions: reduce aggression and increase PTSD treatment initiation. First, PTSD is one of the most commonly occurring and costly psychiatric conditions among Veterans, and Veterans with PTSD are more likely to engage in aggressive behavior than civilians with PTSD. Reducing aggression is a critical need for Veterans, their families, and society to reduce interpersonal violence, incarceration, and injury. Secondly, there are effective treatments that have been shown to reduce PTSD symptoms, yet few Veterans with PTSD receive PTSD evidence-based psychotherapies. One reason for the low rate of treatment initiation may be that Veterans fear they will not be able to control their emotional responses when they begin treatment. Equipping Veterans with emotion regulation skills and knowledge about PTSD treatments may help them initiate, complete, and benefit from PTSD evidence-based psychotherapies.