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)、脑外伤 损伤和慢性疼痛经常在 9/11 战争后退伍军人中同时发生，并且相互关联 然而，尚无治疗方法[特别是]。 旨在促进经历这些最严重的任何组合的退伍军人的功能恢复 这是战争中常见的精神和身体创伤。 竞争性更新，为 SERVE 项目（评估归国退伍军人的研究评估）的第三阶段提供资金 在第一阶段 (RX000304-01A1)，我们确定了风险和弹性因素 与部署相关的心理健康状况，无论这些因素是否可以改变。 在第 2 阶段 (RX000304-04A1)，我们通过关注绘制的可修改预测变量来完善我们的方法 来自治疗结果文献。 研究旨在为循证预防和治疗的发展提供信息 旨在帮助返回的退伍军人实现最佳功能的计划 这一愿景在拟议的第三阶段中得以实现。 建议扩大纵向研究（目标 1）并调整、完善和试点测试 促进功能恢复的干预措施（目标 2） 为期 2 年的纵向研究（N = 500）将。 检查新的因素（例如，正念、感知到的负担、受挫的归属感、 道德伤害）和既定的治疗目标（心理灵活性、自我同情、情感） 监管）与功能障碍的潜在类别轨迹相关，并作为风险的预测因子 自我导向暴力（SDV；即自杀风险），这是 VA 和 RR&D 的首要任务。 在之前的阶段，我们将心理僵化确定为心理健康的一个强有力的危险因素 因此，在目标 2 中，我们使用连续队列设计。 将[根据退伍军人的反馈]进行调整、完善并进行试点测试 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) 我们之前展示了 ACT 的前景。 跨诊断、正念和基于接受的行为疗法旨在改善 我们通过提高患有 PTSD-AUD 的退伍军人的心理灵活性来发挥作用。 将测试 ACT-FX 的可行性和可接受性，[一项单独定制的干预措施，以促进 与心理相比，与这些常见同时发生的情况相关的功能恢复 60] 患有中度至重度功能障碍的退伍军人照常接受健康治疗 (TAU)。 我们的最终目标是帮助长期受损的退伍军人步入康复轨道。 纵向研究（目标 1）的数据与治疗研究（目标 2）的数据，我们将进行 初步测试 ACT-FX 是否与功能受损的退伍军人搬迁至 以长期恢复为特征的潜在阶级轨迹（目标 3；探索性）。