Reducing Internalized Stigma among Veterans with PTSD: A Pilot Trial

描述（由申请人提供）： 背景资料：污名化和对污名化的恐惧在PTSD退伍军人中普遍存在1 -2，两者都对退伍军人的福祉和参与心理健康治疗产生有害影响。内化的耻辱是社会耻辱的有害后果，并已与减少的希望，自尊，个人动机，士气，自尊，以及对患有一系列精神疾病的个人的疾病管理的持久性5 -14。内化的耻辱感也对创伤后应激障碍退伍军人的康复和福祉产生负面影响，特别是15，但目前没有循证干预措施可用于帮助创伤后应激障碍退伍军人对抗内化的耻辱感的影响。因此，本提案的目的是开发和试点测试干预措施，为患有创伤后应激障碍的退伍军人提供技能， 有效科普污名化问题，减少污名化信念和定型观念的内化。为此，我们将修改结束自我污名（ESS），一项由基于证据的策略组成的干预措施，用于打击精神疾病的内在污名16，以专门满足患有创伤后应激障碍的退伍军人的需求。目的：这项为期两年的试点计划的两个目标是：1）修改现有的ESS干预措施，以解决患有创伤后应激障碍的退伍军人所经历的内化和社会耻辱，2）对64名患有创伤后应激障碍的退伍军人进行ESS-P的随机试点试验，以测试我们的假设：a）ESS-P的可行性将是令人满意的，如足够的招募率，初始干预参与，干预会议的出席情况，以及参与者报告的干预措施的可接受性; B）当与接受信息手册的对照组相比时，ESS-P参与者在治疗后立即具有显著减少的内化耻辱，c）当与接受信息手册的对照组相比时，ESS-P参与者将显示出显著增加的自我效能，在治疗后立即增加的归属感和增加的恢复定向，和d）与对照相比，ESS-P参与者将在治疗后三个月期间与基线前三个月相比表现出增加的心理健康治疗参与。方法：我们的建议将分两个阶段进行，映射到我们的两个研究目标。在第一阶段，我们将根据现有ESS干预的策略和结构，为ESS的PTSD版本（ESS-P）制作干预和配套手册。为此，我们将采访退伍军人与创伤后应激障碍诊断，以了解更多关于他们的经验与社会和内化的耻辱与创伤后应激障碍，加上其他考虑和问题，在解决内化的耻辱与这样的退伍军人。在这些定性访谈中收集的信息将构成我们调整ESS干预措施的基础，以专门解决患有创伤后应激障碍的退伍军人的需求。在第二阶段，我们将对患有PTSD的退伍军人进行ESS-P的试点测试，以评估干预的可行性和可接受性。此外，我们将通过与对照组进行比较，初步估计ESS-P的效果，对照组接受与PTSD相关的内化耻辱的信息手册。这些可行性、实施和试点结果数据将用于进一步完善干预措施，以实现未来在VA系统内进行更大规模ESS-P研究的目标。影响：鉴于社会和内化的耻辱的严重影响，以及缺乏干预措施来帮助患有创伤后应激障碍的退伍军人克服与创伤后应激障碍症状，经历，诊断或治疗相关的耻辱，这项建议具有高度和持久的影响潜力。与核心ESS课程的试点效果保持一致，我们预计，退伍军人参与量身定制的ESS创伤后应激障碍（ESS-P）可能会经历有关各种生活目标的增强权能和行为激活。这些好处将进一步促进退伍军人事务部的承诺，以改善心理健康，恢复，并在2010年至2014年VHA战略计划42详细退伍军人重返社区。

DESCRIPTION (provided by applicant): Background: Stigma and fear of stigma are widespread among Veterans with PTSD1-2 and both have pernicious effects on Veterans' well-being and participation in mental health treatment2-4. Internalized stigma is a harmful consequence of societal stigma, and has been associated with decreased hope, self-esteem, personal motivation, morale, self-regard, and persistence regarding illness management among individuals with a range of mental illnesses5-14. Internalized stigma also has negative impacts on the recovery and well- being of Veterans with PTSD specifically15, but no evidence-based interventions are currently available to assist Veterans with PTSD in combatting the impact of internalized stigma. Therefore, the purpose of this proposal is to develop and pilot-test an intervention to provide Veterans with PTSD the skills to cope effectively with stigma and to mitigate the internalization of stigmatizing beliefs and stereotypes. To that end, we will modify Ending Self Stigma (ESS), an intervention composed of evidence-based strategies for combating internalized stigma for mental illness16, to specifically serve the needs of Veterans with PTSD. Aims: The two aims of this proposed two-year pilot are to 1) modify the existing ESS intervention to address internalized and societal stigma experienced by Veterans with PTSD and 2) conduct a randomized pilot trial of ESS-P for 64 Veterans with PTSD diagnoses, to test our hypotheses that a) feasibility of ESS-P will be satisfactory, as demonstrated by adequate rates of recruitment, initial intervention engagement, attendance at intervention sessions, and acceptability of the intervention reported by participants; b) when compared to a control group receiving an informational brochure, ESS-P participants will have significantly reduced internalized stigma at immediate post-treatment, c) when compared to a control group receiving an informational brochure, ESS-P participants will show significantly increased self-efficacy, increased sense of belonging, and increased recovery orientation at immediate post-treatment, and d) compared to controls, ESS-P participants will demonstrate increased participation in mental health treatment during the three months post-treatment versus the three months before baseline. Methods: Our proposal will be conducted in two phases that map onto our two study Aims. In Phase I, we will produce an intervention and accompanying manual for the PTSD version of ESS (ESS-P), based upon the strategies and structure of the existing ESS intervention. To this end, we will interview Veterans with a PTSD diagnosis to learn more about their experience with societal and internalized stigma associated with PTSD, plus other considerations and issues in addressing internalized stigma with such Veterans. Information gleaned in these qualitative interviews will form the basis of our adaption of the ESS intervention to specifically address the needs of Veterans with PTSD. In Phase II, we will pilot-test ESS-P with Veterans who have PTSD, to evaluate the feasibility and acceptability of the intervention. In addition, we will preliminarily estimate the effects of ESS-P through comparison to a control group receiving an informational brochure on internalized stigma associated with PTSD. These feasibility, implementation and pilot outcome data will be used to further refine the intervention, towards the goal of conducting a future larger scale study of ESS-P within the VA system. Impact: Given the severe effects of societal and internalized stigma and the lack of interventions to help Veterans with PTSD overcome stigmas associated with PTSD symptoms, experiences, diagnoses or treatment, this proposal has the potential for high and lasting impact. In keeping with pilot effects of the core ESS curriculum, we anticipate that Veterans participating in the tailored ESS for PTSD (ESS-P) may experience increased empowerment and behavioral activation regarding a variety of life goals. Such benefits would further the VA's commitment to improving the mental health, Recovery, and community reintegration of Veterans detailed in the 2010-2014 VHA Strategic Plan42.