Manage Emotions to Reduce Aggression - MERA: A Brief Aggression Treatment for Veterans with PTSD Symptoms

管理情绪以减少攻击性 - MERA：针对患有 PTSD 症状的退伍军人的简短攻击性治疗

• 批准号: 10426041
• 负责人: Shannon R. Miles
• 金额: --
• 依托单位: JAMES A. HALEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10426041
• 关键词: Address; Affect; Afghanistan; Aftercare; Aggressive behavior; Awareness; Behavior Control; Behavioral; Cessation of life; Charge; Cognitive; Communities; Control Groups; Dropout; Drops; Education; Emotional; Emotions; Family; Family Violence; Frequencies; Fright; Goals; Gold; Imprisonment; Impulsivity; Iraq; Knowledge; Lead; Learning; Length; Logistics; Measures; Mediating; Mental Health; Mental disorders; Methods; Mission; Modeling; Population; Post-Traumatic Stress Disorders; Psychotherapy; Randomized Clinical Trials; Regulation; Reporting; Research; Research Support; Sampling; Severities; Site; Social support; Societies; Symptoms; Testing; Time; Training; Trauma; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; Wait Time; active control; active method; anger management; base; brief intervention; combat veteran; combat zone; cost; effective therapy; efficacy testing; emotion dysregulation; emotion regulation; emotional experience; evidence base; experience; follow-up; improved; innovation; male; novel; response; skill acquisition; skills; skills training; standard of care; treatment as usual

This randomized clinical trial (RCT) tests the efficacy of an emotion regulation treatment, Manage Emotions to Reduce Aggression (MERA), to decrease aggression in Veterans with posttraumatic stress disorder (PTSD) and improve PTSD treatment initiation. Background: Veterans with PTSD symptoms report difficulty controlling their aggression which can lead to devastating interpersonal and societal consequences, such as incarceration, family violence, and disruption of social support. Veterans with PTSD primarily engage in impulsive aggression (emotional, reactive, and uncontrolled) rather than premeditated aggression (deliberate, instrumental, and planned). Emotion dysregulation, or underdeveloped skills in emotional awareness, emotional acceptance, behavioral control, and/or content- appropriate regulation strategies, fully mediates the relationship between PTSD severity and impulsive aggression in Veterans. Additionally, Veterans report fearing their emotions as one reason they do not initiate PTSD evidence-based psychotherapy. Emotion regulation appears to influence both aggression and treatment initiation for Veterans with PTSD. Thus, this proposed study targets emotion regulation with the goal of reducing impulsive aggression and preparing Veterans for PTSD evidence-based psychotherapy. Research Plan: Our goal is to test the efficacy of an innovative emotion regulation training, MERA, with a RCT of 204 Afghanistan and Iraq Veterans with PTSD and impulsive aggression. MERA is provided in three sessions to address logistical barriers faced by younger Veterans who are reintegrating into their communities. MERA incorporates education, cognitive-behavioral and acceptance- based skills training. It also includes information about what emotional experiences to expect from PTSD treatments. Three sessions of present centered therapy will serve as an active control group which is consistent with treatment as usual. MERA and present centered therapy will be compared on changes in aggression from Session 1 to the 2-month posttreatment changes. We predict Veterans who complete MERA will have greater reductions in IA and emotion dysregulation as compared to Veterans who complete present centered therapy. Finally, rates of PTSD evidence-based psychotherapy initiation (attend 1 session), will be examined via a chart review 6 months post treatment. We predict Veterans who complete MERA will initiate PTSD evidence-based psychotherapies at a greater rate than Veterans who complete present centered therapy. Significance: This study supports 2 Veterans Affairs missions: reduce aggression and increase PTSD treatment initiation. PTSD is one of the most commonly occurring and costly psychiatric conditions among Veterans. Veterans with PTSD are more likely to engage in aggressive behavior than civilians with PTSD or Veterans without PTSD. Reducing aggression is a critical need for Veterans, their families, and society. Additionally, there are effective treatments that reduce PTSD symptoms, yet few Veterans receive evidence based psychotherapies for PTSD. One reason for the low rate of treatment initiation is that Veterans fear they will not be able to control their emotional responses when they begin treatment. Equipping Veterans with emotion regulation skills and knowledge about PTSD treatments may help them initiate treatment for PTSD.

这项随机临床试验 (RCT) 测试了情绪调节治疗的功效，即管理 减少攻击性情绪 (MERA)，减少患有创伤后应激障碍的退伍军人的攻击性 障碍（PTSD）并改善 PTSD 治疗的开始。背景：有 PTSD 症状的退伍军人 报告难以控制自己的攻击性，这可能导致毁灭性的人际关系和社会 后果，例如监禁、家庭暴力和社会支持中断。退伍军人与 PTSD 主要表现为冲动攻击（情绪化、反应性和不受控制），而不是 有预谋的侵略（蓄意的、工具性的和有计划的）。情绪失调，或 情绪意识、情绪接受、行为控制和/或内容方面的技能欠发达- 适当的调节策略，充分介导PTSD严重程度与冲动之间的关系 退伍军人的攻击性。此外，退伍军人表示，担心自己的情绪是他们不这样做的原因之一。 启动 PTSD 循证心理治疗。情绪调节似乎会影响攻击行为 以及患有创伤后应激障碍 (PTSD) 的退伍军人的治疗开始。因此，这项研究的目标是情绪调节 减少冲动攻击并让退伍军人做好应对创伤后应激障碍 (PTSD) 的目标 心理治疗。研究计划：我们的目标是测试创新情绪调节的功效 MERA 培训，对 204 名患有创伤后应激障碍 (PTSD) 和冲动攻击性的阿富汗和伊拉克退伍军人进行了随机对照试验。 MERA 分三场提供，旨在解决年轻退伍军人面临的后勤障碍。 重新融入他们的社区。 MERA 融合了教育、认知行为和接受度 基础技能培训。它还包括有关 PTSD 的情感体验的信息 治疗。三个疗程的当前中心治疗将作为主动对照组 与平常治疗一致。 MERA 和目前的集中治疗将在变化方面进行比较 从第 1 节到治疗后 2 个月的攻击性变化。我们预测退伍军人完成 与退伍军人相比，MERA 的 IA 和情绪失调的减少幅度更大 完整的以当下为中心的治疗。最后，PTSD 循证心理治疗启动率 （参加 1 次会议），将在治疗后 6 个月通过图表审查进行检查。我们预测退伍军人 完整的 MERA 将比退伍军人更快地启动 PTSD 循证心理治疗 完整的以当下为中心的治疗。意义：本研究支持 2 个退伍军人事务部任务： 减少攻击性并增加 PTSD 治疗的开始时间。 PTSD 是最常见的一种 以及退伍军人中昂贵的精神疾病。患有创伤后应激障碍 (PTSD) 的退伍军人更有可能参与 比患有 PTSD 的平民或没有 PTSD 的退伍军人有攻击性行为。减少攻击性是关键 退伍军人、他们的家人和社会的需要。此外，还有一些有效的治疗方法可以减少 创伤后应激障碍症状，但很少有退伍军人接受针对创伤后应激障碍的循证心理治疗。原因之一是 治疗开始率低是退伍军人担心他们无法控制自己的情绪 当他们开始治疗时的反应。为退伍军人提供情绪调节技能和知识 关于 PTSD 治疗的信息可能会帮助他们开始治疗 PTSD。