The impact of modifiable psychosocial factors on Veteransâ long-term trajectories of functioning and quality of life: Promoting recovery by targeting mindfulness and psychological flexibility

可改变的心理社会因素对退伍军人的长期功能和生活质量轨迹的影响：通过正念和心理灵活性促进康复

• 批准号: 10266064
• 负责人: SUZANNAH K CREECH
• 金额: --
• 依托单位: OLIN TEAGUE VETERANS CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10266064
• 关键词: Accounting; Afghanistan; Award; Behavior Therapy; Chronic; Clinical; Compassion; Complex; Data; Development; Diagnostic; Evidence based intervention; Exhibits; Feedback; Feeling suicidal; Fruit; Funding; Goals; Healthcare; Impairment; Individual; Injury; Intervention; Iraq; Lead; Life; Literature; Longitudinal Studies; Mediating; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; Morals; Occupational; Paper; Peer Review; Phase; Post-Traumatic Stress Disorders; Prevention program; Procedures; Psyche structure; Psychosocial Factor; Qualitative Research; Quality of life; Randomized; Recovery; Recovery of Function; Regulation; Research; Risk; Risk Factors; Self-Direction; Symptoms; Testing; Time; Traumatic Brain Injury; Treatment outcome; Veterans; Violence; Vision; War; acceptability and feasibility; alcohol use disorder; base; behavior change; chronic pain; chronic painful condition; cohort; comorbidity; design; emotion regulation; emotional distress; evidence base; experience; feasibility testing; flexibility; functional disability; functional outcomes; improved; improved functioning; innovation; mindfulness; novel; pilot test; post 9/11; prospective; protective factors; psychologic; resilience; social; suicidal risk; targeted treatment; treatment as usual; treatment program; wound

Posttraumatic stress disorder (PTSD), depression, alcohol use disorders (AUD), traumatic brain injury, and chronic pain frequently co-occur among post-9/11 war Veterans and are associated with functional impairment and suicide risk. Yet, no treatment exists [that was specifically designed] to promote functional recovery in Veterans experiencing any combination of these most common mental and physical wounds of war. This is the re-submitted proposal for a second competitive renewal to fund Phase 3 of Project SERVE (Study Evaluating Returning Veterans’ Experiences). In Phase 1 (RX000304-01A1), we identified risk and resilience factors for deployment-related mental health conditions regardless of whether those factors were modifiable. In Phase 2 (RX000304-04A1), we refined our approach by focusing on modifiable predictors drawn from the treatment outcomes literature. The over-arching aim of this programmatic line of research is to inform the development of evidence-based prevention and treatment programs designed to assist returning Veterans with achieving optimal functioning upon reintegrating into civilian life. This vision comes to fruition in the proposed Phase 3, which proposes both to extend the longitudinal study (Aim 1) and to adapt, refine, and pilot test an intervention to promote functional recovery (Aim 2). The 2-year longitudinal study (N = 500) will examine novel factors (e.g., mindfulness, perceived burdensomeness, thwarted belongingness, moral injury) and established treatment targets (psychological flexibility, self-compassion, emotion regulation) in relation to latent class trajectories of functional impairment, and as predictors of risk for self-directed violence (SDV; i.e., suicide risk), which is a top priority for VA and RR&D. In the prior Phases, we established psychological inflexibility as a robust risk factor for mental health problems, functional impairment, and SDV. Thus, in Aim 2, using a Successive Cohort Design, we will adapt, refine [based on Veterans’ feedback], and pilot-test an adapted evidence-based intervention, Acceptance and Commitment Therapy (ACT) that targets psychological flexibility to promote functional recovery (ACT-FX). We previously demonstrated the promise of ACT, a transdiagnostic, mindfulness and acceptance-based behavior therapy aimed at improving functioning by increasing psychological flexibility with Veterans with co-occurring PTSD-AUD. We will test the feasibility and acceptability of ACT-FX, [an individually-tailored intervention to promote functional recovery related to these commonly co-occurring conditions as compared to mental health treatment as usual (TAU) in 60] Veterans with moderate-to-severe functional impairment. Our ultimate goal is to help shift chronically impaired Veterans to a recovery trajectory. Integrating data from the longitudinal study (Aim 1) with data from the treatment study (Aim 2), we will conduct a preliminary test of whether ACT-FX is associated with functionally impaired Veterans moving to a latent class trajectory characterized by long-term recovery (Aim 3; Exploratory).

创伤后应激障碍（PTSD），抑郁症，酒精使用障碍（AUD），创伤性大脑 受伤和慢性疼痛经常在9/11后退伍军人之间同时发生，并且是相关的 有功能障碍和自杀风险。但是，没有治疗[特别是 设计]，以促进在经历这些最多组合的退伍军人中的功能恢复 战争的常见心理和身体伤口。这是一秒钟的重新提议的建议 竞争性更新资助项目服务的第3阶段（研究评估退伍军人的研究 经验）。在第1阶段（RX000304-01A1）中，我们确定了风险和弹性因素 与部署有关的心理健康状况，无论这些因素是否可修改。 在第2阶段（RX000304-04A1）中，我们通过关注可修改的预测变量来完善我们的方法 从治疗结果文献中。该程序线的整理目标 研究是为了开发基于证据的预防和治疗 旨在协助返回退伍军人实现最佳功能的计划 重新融入平民生活。该愿景在拟议的第3阶段中流向 提出延长纵向研究（AIM 1）的建议，并适应，完善和试点测试 干预以促进功能恢复（AIM 2）。 2年的纵向研究（n = 500）将 检查新的因素（例如正念，感知到的野性，挫败的归属感， 道德伤害）和建立的治疗目标（心理灵活性，自我同情，情感 法规）与功能障碍的潜在类别轨迹有关，并作为风险的预测因素 为了自我指导的暴力（SDV；即自杀风险），这是VA和RR＆D的重中之重。在 先前的阶段，我们确立了心理僵化，成为心理健康的强大风险因素 问题，功能障碍和SDV。在AIM 2中，使用连续的队列设计，我们 将适应，改进[基于退伍军人的反馈]，并进行调查 干预，接受和承诺疗法（ACT），以心理灵活性为目标 促进功能恢复（ACT-FX）。我们以前证明了行为的希望，一个 经诊断，正念和基于接受的行为疗法旨在改善 通过与同时发生的PTSD aud一起增加对退伍军人的心理灵活性来发挥作用。我们 将测试ACT-FX的可行性和可接受性，[促进的单独限制干预措施 与精神相比 像往常一样的健康治疗（TAU）在60]中具有中度至重度功能障碍的退伍军人。 我们的最终目标是帮助将长期受损的退伍军人转移到恢复轨迹上。整合 纵向研究（AIM 1）的数据与治疗研究的数据（AIM 2），我们将进行 对ACT-FX是否与功能受损的退伍军人相关的初步测试 具有长期恢复的潜在类轨迹（AIM 3；探索性）。