One-day Life Skills Workshop for Veterans with TBI, pain, and Psychopathology: Evaluating efficacy and mechanism of change

为患有 TBI、疼痛和精神病理学的退伍军人举办的一日生活技能研讨会：评估功效和变化机制

• 批准号: 10348672
• 负责人: Lilian Nazar Dindo
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10348672
• 关键词: Address; Afghanistan; Aftercare; Anxiety; Anxiety Disorders; Area; Behavior; Behavioral; Belief; Brain Concussion; Caring; Characteristics; Chronic; Communities; Conflict (Psychology); Coping Skills; Diagnosis; Diagnostic; Distress; Educational workshop; Ensure; Evidence based intervention; Exhibits; Exposure to; Face; Family; Feedback; Freedom; Functional disorder; Generalized Anxiety Disorder; Goals; Grant; Health; Health Status; Intervention; Iraq; Life; Logistics; Long-Term Effects; Mediating; Mediator of activation protein; Medical; Mental Depression; Mental Health; Military Personnel; Minority; Mission; Modeling; Multiple Trauma; Occupational; Outcome; Pain; Pain interference; Participant; Patients; Pattern; Pharmaceutical Preparations; Phase; Post-Concussion Syndrome; Post-Traumatic Stress Disorders; Psyche structure; Psychopathology; Questionnaires; Randomized; Randomized Controlled Trials; Recording of previous events; Severities; Societies; Stigmatization; Stress; Symptoms; Time; Traumatic Brain Injury; Treatment Effectiveness; Treatment Efficacy; Triad Acrylic Resin; Veterans; Visit; Work; active method; barrier to care; base; career; chronic pain; community reintegration; comorbidity; comparative efficacy; coping; demographics; education resources; efficacy evaluation; emotional distress; evidence base; experience; follow-up; improved; mild traumatic brain injury; operation; primary outcome; psychologic; psychosocial; secondary outcome; service member; service utilization; skills; social; social stigma; treatment adherence; treatment as usual; treatment comparison; treatment response; wound

Traumatic brain injury (TBI) is the signature wound of Veterans returning from Operations Iraqi Freedom, Operation Enduring Freedom and Operation New Dawn (OIF/OEF/OND), with up to 20 percent exposed to a mild TBI (mTBI) and experiencing persistent post-concussive symptoms. Among those with a mTBI diagnosis, the majority also suffers from stress-based psychopathology (e.g., depression, post-traumatic stress disorder, generalized anxiety disorder), as well as chronic pain. To cope with distress, pain, and other difficulties, Veterans often turn to maladaptive avoidant coping strategies which offer short term relief but exacerbate/maintain mental health problems and have detrimental long-term effects on social, occupational, and community reintegration. Unfortunately, Veterans face significant barriers to engaging in mental health treatment, including stigma, the belief that one should overcome psychological difficulties on his/her own, and concern that receiving such care would negatively impact their careers. Practical barriers, including time constraints, distance from a treatment facility, and competing priorities (e.g., work and family demands), are also barriers to care. Even among Veterans who start mental health treatment, only a small minority complete a recommended course of evidence-based therapy. Acceptance and Commitment Therapy (ACT) is a trans-diagnostic treatment model that helps patients to overcome avoidance by promoting acceptance-based coping and engagement in meaningful life activities. In this context, Veterans are asked to think about their “new mission(s)” after leaving the military and the importance of engaging in actions that fulfill their mission even when it may be difficult. ACT has established efficacy in the treatment of depression, anxiety, and chronic pain, and has been effectively implemented in various treatment-delivery formats, including 1-day group workshops. A 1-day ACT workshop addresses specific needs of Veterans with mTBI, stress-based psychopathology, and chronic pain (polytrauma triad) and important barriers to treatment. It 1) is trans-diagnostic (i.e., applies to more than one condition); 2) targets avoidance-based coping; 3) cultivates acceptance-based coping and builds on Veteran’s values and goals to motivate them to make difficult decisions; 4) is delivered efficiently and thus more accessible; 5) is less stigmatizing and thus acceptable; and 6) address problems with treatment adherence and completion. With the support of an RR&D SPiRE pilot grant, the PIs developed a 1-day ‘ACT on Life’ workshop tailored specifically for the needs of Veterans with mTBI, stress-based psychopathology, and chronic pain. Veterans with this polytrauma were then randomly assigned to the ‘ACT on Life’ workshop (N=20) or to Treatment as Usual (TAU; N=12). All Veterans attending the 1-day ACT workshop completed it, and relative to TAU, exhibited greater improvements in distress and reintegration at the 3-month follow-up (effect sizes .68 and .47, respectively). Building on these promising preliminary findings, we now propose to conduct a more rigorous randomized controlled trial with 212 Veterans to compare the efficacy of the 1-day ACT workshop to an active treatment comparison (Education, Resources, and Support; ERS) on symptoms of distress and social, occupational, and community reintegration. We will also examine mediators and moderators of treatment response to identify which ACT components are directly responsible for treatment effectiveness and whether treatment benefits are constrained by various personal factors. Establishing the efficacy of a 1-day ACT workshop for OEF/OEF/OND Veterans with mTBI and multiple coexistent conditions addresses key priorities of VHA RR&D: 1. developing interventions which will improve the psychological health status of Veterans who have specific needs; and 2. enhancing the community, social, and occupational reintegration and functioning of post-deployment Veterans so that they may function more fully in society.

创伤性脑损伤 (TBI) 是从伊拉克自由行动返回的退伍军人的标志性伤口， 持久自由行动和新黎明行动 (OIF/OEF/OND)，高达 20% 的人受到 轻度 TBI (mTBI) 和持续性脑震荡后症状。 大多数精神病理学也患有基于压力的病理学（例如抑郁症、创伤后应激障碍、 广泛性焦虑症）以及慢性疼痛 为了应对苦恼、疼痛和其他困难， 退伍军人经常转向适应不良的回避型应对策略，这些策略可以提供短期缓解，但 加剧/维持心理健康问题并对社会、职业、 不幸的是，退伍军人在参与心理健康方面面临重大障碍。 治疗，包括耻辱，相信一个人应该自己克服心理困难，以及 担心接受这种护理会对他们的职业生涯产生负面影响，包括时间。 限制因素、距治疗设施的距离以及相互竞争的优先事项（例如工作和家庭需求） 即使在开始心理健康治疗的退伍军人中，也只有少数人完成了障碍。 推荐的循证治疗疗程。 接受与承诺疗法（ACT）是一种跨诊断治疗模式，可以帮助患者 通过促进基于接受的应对方式和参与有意义的生活活动来克服回避。 在这种背景下，退伍军人被要求思考他们离开军队和退役后的“新使命” 即使行动可能很困难，参与履行其使命的行动也很重要。 在治疗抑郁症、焦虑症、慢性疼痛等方面取得了显着的疗效，并已在以下国家得到有效实施： 各种治疗实施形式，包括为期 1 天的小组研讨会 为期 1 天的 ACT 研讨会。 患有 mTBI、基于压力的精神病理学和慢性疼痛（多发伤三联征）的退伍军人的特殊需求 对治疗很重要 1) 是跨诊断障碍（即适用于不止一种情况）； 基于回避的应对方式；3）培养基于接受的应对方式，并以退伍军人的价值观和目标为基础 激励他们做出困难的决定；4) 交付效率高，因此更容易获得；5) 污名化，从而可以接受；6) 解决治疗依从性和完成度方面的问题。 在 RR&D SPiRE 试点拨款的支持下，PI 量身定制了为期 1 天的“ACT on Life”研讨会 专门针对患有 mTBI、基于压力的精神病理学和慢性疼痛的退伍军人的需求。 然后，患有这种多发伤的患者被随机分配到“ACT on Life”研讨会（N = 20）或接受治疗 通常（TAU；N=12）。参加为期 1 天的 ACT 研讨会的所有退伍军人都完成了该任务，并且相对于 TAU， 在 3 个月的随访中显示出在痛苦和重新融入方面有更大的改善（效果大小为 0.68 和 0.47， 基于这些有希望的初步发现，我们现在建议进行更严格的研究 对 212 名退伍军人进行的随机对照试验，比较为期 1 天的 ACT 研讨会与主动研讨会的效果 关于痛苦和社交症状的治疗比较（教育、资源和支持；ERS） 我们还将研究治疗的中介因素和调节因素。 响应以确定哪些 ACT 组成部分直接影响治疗效果以及是否 治疗效果受到各种个人因素的限制。 为患有 mTBI 和多种疾病的 OEF/OEF/OND 退伍军人建立为期 1 天的 ACT 研讨会的有效性 共存条件解决了 VHA RR&D 的关键优先事项： 1. 制定干预措施，改善 2. 有特殊需求的退伍军人的心理健康状况； 部署后退伍军人的职业重新融入和运作，以便他们能够更充分地发挥作用 社会。