Development of a Mobile Mindfulness Intervention for Alcohol Use Disorder and PTSD among OEF/OIF Veterans

项目摘要/摘要 该提案的长期目标是改善酗酒的OEF/OIF退伍军人的治疗结果 精神障碍(AUD)和创伤后应激障碍(PTSD)目前没有通过 退伍军人事务部医疗系统(VA)或其他设置。许多OEF/OIF退伍军人与沉重的 饮酒和相关后果，这一点在创伤后应激障碍的共同发生时尤其明显。 先前的研究已经发现，自我调节(情绪调节、冲动控制)、压力和渴望 是AUD和PTSD症状减轻的重要推定靶点。然而，超过50%的 有行为健康的退伍军人不需要寻求治疗，当务之急是利用 开发和测试干预措施的技术，可以接触到不寻求治疗的退伍军人，并针对两者 创伤后应激障碍和AUD症状。由于拟议的机制(例如，自律)正在变得更好 了解它们如何影响创伤后应激障碍和AUD结果，方法应侧重于针对这些 并评估这些机制是否为变革的重要促进者。基于正念的干预(MBI) 可以针对这种机制，但关于mbi对退伍军人的效用的知识差距仍然存在。 世卫组织对创伤后应激障碍和澳大利亚疾病筛查呈阳性。因此，我们建议改善OEF/OIF的治疗结果 通过针对自我调节、压力和渴望，为患有创伤后应激障碍和澳门氏症的退伍军人提供帮助。我们将开发和测试一种 新的移动MBI，基于移动正念的复发预防(MMBRP)，将根据证据改进- 通过接触治疗环境之外的退伍军人，以面对面和团体MBRP为基础。迷人而轻松的- 使用移动MBI集预防复发、减轻压力和自我调节技能于一身，并与 退伍军人在寻求服务时面临的耻辱和障碍问题。中心假说将 通过集中于三个具体目标进行测试：(1)提炼并添加MBRP内容到流行的VA- 通过Beta测试阶段开发Mindness Coach移动应用程序，我们在该阶段测试可行性和 APP的可接受性，(2)初步测试mMBRP移动APP对酒精使用和创伤后应激障碍的疗效 结果与对照的比较，以及(3)评估改变的机制，如自我调节、压力和 渴望，以及性别、种族/民族和最近出院的探索性调节因素，关于mMBRP 效果。这项提议的独特优势是它关注服务不足的人口，利用移动电话 用于提供干预的技术，以及使用已知的有效针对自我调节的新型干预 和压力。预期结果将定义一种可行且易于获得的治疗方法，可以改善AUD和AUD 和创伤后应激障碍症状。这项研究的结果将对这些人的药物使用结果产生积极影响 他们经历过创伤性事件，并将确定治疗成功的行动机制。应用程序 可以通过我们在退伍军人管理局的合作伙伴和在社交媒体上有针对性的分享来传播。

PROJECT SUMMARY/ABSTRACT The long-term goal of this proposal is to improve treatment outcomes for OEF/OIF veterans with alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) who are not currently accessing care through the Veterans Affairs Healthcare System (VA) or other settings. Many OEF/OIF veterans struggle with heavy drinking and related consequences and this can be especially pronounced with the co-occurrence of PTSD. Prior research has found aspects of self-regulation (emotion regulation, impulse control), stress, and craving to be important putative targets in AUD and PTSD symptom reduction. However, with upwards of 50% of veterans who have behavioral health needs not seeking treatment, it is imperative to utilize advances in technology to develop and test interventions that can reach non-treatment seeking veterans and target both symptoms of PTSD and AUD. As the proposed mechanisms (e.g., self-regulation) are becoming better understood regarding how they affect PTSD and AUD outcomes, approaches should focus on targeting these mechanisms and evaluating if they are essential facilitators of change. Mindfulness-based interventions (MBI) can target such mechanisms, but a gap in the knowledge persists regarding the utility of MBIs with veterans who screen positive for PTSD and AUD. Therefore, we propose to improve treatment outcomes for OEF/OIF veterans with PTSD and AUD by targeting self-regulation, stress, and cravings. We will develop and test a novel mobile MBI, Mobile Mindfulness Based Relapse Prevention (mMBRP), that will improve upon evidence- based in-person and group MBRP by reaching veterans outside of treatment settings. The engaging and easy- to-use mobile MBI integrates relapse prevention, stress reduction, and self-regulation skills and is relevant to issues surrounding stigma and barriers that veterans face when seeking services. The central hypothesis will be tested through a focus on three specific aims: (1) refine and add MBRP content to the popular VA- developed Mindfulness Coach mobile application through a beta testing phase where we test for feasibility and acceptability of the app, (2) pilot test the efficacy of the mMBRP mobile app on alcohol use and PTSD outcomes compared to control, and (3) assess mechanisms of change such as self-regulation, stress, and cravings, as well as exploratory moderators of gender, race/ethnicity, and recency of discharge, on mMBRP effects. The unique strengths of this proposal are its focus on an underserved population, utilization of mobile technology for intervention delivery, and use of a novel intervention known to effectively target self-regulation and stress. The expected results will define a viable and easy-to-access treatment that can improve both AUD and PTSD symptoms. Results of this study will have a positive impact on substance use outcomes for those who have experienced traumatic events and will identify mechanism of action for treatment success. The app can be disseminated through our partners in the VA and through targeted sharing on social media.