Innovative multimodal and attention training to improve emotion communication in Veterans with TBI and PTSD

背景情绪识别缺陷在创伤性脑损伤（TBI）和创伤后脑损伤中很常见。 创伤后应激障碍（PTSD），但这些缺陷还没有得到很好的研究，在退伍军人与轻度TBI（mTBI）， 创伤后应激障碍情绪识别能力差与人际关系质量差、缺乏沟通和沟通能力有关。 就业，行为问题，减少重返社会，社会孤立，甚至自杀。目前 没有针对患有mTBI和PTSD的退伍军人的情绪识别缺陷的干预措施， 在患有严重TBI的平民中进行的研究缺乏面部和声音情感识别的训练。中 面部和声音模态的创新组合，多模态情感识别的初步研究 训练（MMART）显示出在佛罗里达情感成套测验（FAB）上有显著改善的希望，但缺乏 注意力训练是识别日常生活中快速变化的情绪的重要组成部分 生活使用Brain HQ™的注意力训练针对情绪识别所需的注意力因素。 考虑到需要改善mTBI和PTSD退伍军人的关系和生产力， 需要对照试验来确定创新的MMART与注意力相结合的有效性 训练以改善情绪识别和日常功能。 目标与假设。这项随机对照试验的目的是确定治疗效果 多模态情感识别训练（MMART）与退伍军人的注意力训练相结合 创伤性脑损伤/创伤后应激障碍。 假设1. MMART与注意力训练相结合将显着提高测试的表现， 情绪识别 假设2：治疗收益将转化为功能活动。 主要措施。佛罗里达影响电池（FAB）和社区重返服务成员（CRIS）。 二级措施。情绪识别任务（ERT），可重复电池的注意力指数， 神经心理状态评估（RBANS），持续性能任务和TBI质量 生活（TBI-QOL）参与社会角色和活动的能力。 方法. 20名患有mTBI和PTSD的退伍军人将随机接受联合训练或非活动训练。 对照组这两个小组将在8周内参加16个一小时的面对面会议。成果将 在治疗前、治疗后、治疗后3个月进行评估。将使用线性回归确定显著性 治疗组相对于对照组的改善，组内t检验证明 改进.效应量计算将用于确定未来Merit提案所需的把握度。 意义这项研究使用了一种新的组合的创新治疗，MMART+注意力训练， 恢复有效情感沟通所需的情感识别和注意力过程， 患有mTBI/PTSD的退伍军人这项工作符合VA RR&D的一个关键优先事项，即为退伍军人提供优质护理。 积极的研究结果将指导未来Merit的发展，以提高退伍军人的生活质量， 情绪识别缺陷

Background. Deficits in emotion recognition are common in traumatic brain injury (TBI) and in post-traumatic stress disorder (PTSD) but these deficits have not been well studied in Veterans with both mild TBI (mTBI) and PTSD. Poor emotion recognition has been associated with poor quality of interpersonal relationships, loss of employment, behavioral problems, reduced social reintegration, social isolation and even suicide. Currently there are no interventions for emotion recognition deficits in Veterans with mTBI and PTSD, and interventions conducted in civilians with severe TBI have lacked training of both facial and vocal emotion recognition. In a preliminary study of an innovative combination of facial and vocal modalities, a multimodal affect recognition training (MMART) showed promise with significant improvement on the Florida Affect Battery (FAB) but lacked attention training that is an essential component in recognizing rapidly changing emotions in our everyday lives. Attention training using Brain HQ™ targets the required attention factors underlying emotion recognition. Given the need to improve relationships and productivity in Veterans with mTBI and PTSD, a randomized controlled trial is needed to determine the effectiveness of an innovative MMART combined with attention training to improve emotion recognition and everyday function. Objective & Hypotheses. The objective of this randomized controlled trial is to determine the treatment effect of a MultiModal Affect Recognition Training (MMART) combined with attention training in Veterans with TBI/PTSD. Hypothesis 1. MMART combined with attention training will significantly improve performance on tests of emotion recognition. Hypothesis 2: Treatment gains will translate to functional activities. Primary measures. Florida Affect Battery (FAB) and the Community Reintegration in Service members (CRIS). Secondary measures. Emotion Recognition Task (ERT), attention index of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Continuous Performance Task and the TBI Quality of Life (TBI-QOL) Ability to Participate in Social Roles and Activities. Methods. 20 Veterans with mTBI and PTSD will be randomized to either the combined training or an inactive control group. Both groups will attend 16, one-hour in-person sessions over 8 weeks. Outcomes will be assessed at pre-, post-, 3 month-post-treatment. A linear regression will be used to determine significant improvement of the treatment group over the control group, with t-tests to demonstrate within group improvement. Effect size calculations will be used to determine the power needed for a future Merit proposal. Significance. This study uses a novel combination of an innovative treatment, MMART+ Attention Training to restore the emotion recognition and attentional processes required for effective emotion communication in Veterans with mTBI/PTSD. This work meets a key VA RR&D priority of providing quality care to Veterans. Positive study results will guide the development of a future Merit to improve the quality of life for Veterans with emotion recognition deficits.