Thriving in the Midst of Moral Pain: The Acceptability and Feasibility of Acceptance and Commitment Therapy for Moral Injury (ACT-MI) Among Warzone Veterans

在道德痛苦中茁壮成长：战区退伍军人对道德伤害接受和承诺疗法（ACT-MI）的可接受性和可行性

• 批准号: 10554088
• 负责人: SEAN BARNES
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10554088
• 关键词: Address; Aftercare; Behavior; Belief; Caring; Client satisfaction; Clinical; Cognition; Consent; Data; Development; Disease; Distress; Dose; Emotions; Enrollment; Esthesia; Evaluation; Event; Evidence based intervention; Evidence based treatment; Exposure to; Feeling suicidal; Future; Goals; Impairment; Individual; Information Systems; Injury; Intervention; Interview; Learning; Literature; Maintenance; Manuals; Measurement; Measures; Mental Depression; Military Personnel; Morals; Nature; Outcome; Outcome Measure; Pain; Participant; Pathologic; Patient Outcomes Assessments; Patient Self-Report; Patients; Performance; Pilot Projects; Population; Post-Traumatic Stress Disorders; Psychotherapy; Questionnaires; Randomized; Randomized Controlled Trials; Recovery; Recovery of Function; Refractory; Reporting; Research; Research Design; Risk Factors; Sample Size; Self Care; Shame; Social Functioning; Specific qualifier value; Structure; Substance abuse problem; Symptoms; Syndrome; Testing; Thinking; Time; United States National Institutes of Health; Veterans; Visit; Work; acceptability and feasibility; active control; arm; authority; base; clinically significant; community reintegration; depressive symptoms; design; efficacy study; efficacy testing; efficacy trial; evidence base; experience; follow up assessment; follow-up; functional disability; high risk behavior; improved; in vivo; injury recovery; interest; intervention refinement; military veteran; power analysis; provider adherence; psychologic; psychosocial; randomized controlled design; recruit; reduce symptoms; rehabilitation research; research and development; response; retention rate; skills; social; social learning; substance use; suicidal behavior; suicidal risk; trial design

Warzone Veterans exposed to morally injurious events frequently experience numerous difficulties in functioning. These Veterans often report suicidal ideation and behavior, substance abuse, symptoms of depression and PTSD, and problems in resuming valued living (e.g., spiritual practice, close relationships).1-7 Despite the transdiagnostic nature of moral injury, there are no moral injury-specific transdiagnostic interventions. Existing interventions tend to be focused on treating moral injury in the context of PTSD.10-11 In addition to an emphasis on PTSD, these interventions target beliefs associated with moral injury as causal factors in the development and maintenance of suffering.10-12 An emphasis on altering beliefs associated with moral injury may not optimally facilitate functional recovery as moral pain from moral violations may be justified. As one third of warzone Veterans endorse exposure to morally injurious events, it is vital to develop interventions that can be efficiently disseminated in VHA to facilitate functional recovery.8-9 The ideal intervention must simultaneously address moral emotions and promote values consistent behavior in the face of these emotions. Acceptance and Commitment Therapy for moral injury (ACT-MI) is a recovery-based, psychosocial treatment ideally suited for Veterans endorsing difficulties in functioning related to moral injury.15 ACT teaches skills to help Veterans relate differently to painful thoughts, emotions, urges, and sensations.40 Rather than focusing on symptom reduction, ACT is an evidence-based intervention that directly targets functional recovery by assisting Veterans in identifying and engaging in values-consistent behavior even in the presence of distress. In Veteran populations specifically, ACT has been demonstrated effective in treating suicidal ideation and depression and as a result, has been “rolled-out” as an evidence based psychotherapy for depression within VHA.59-60 ACT-MI operates on the principles of ACT, with an explicit focus on the social functions of moral emotions.13-14 ACT-MI is the only intervention for moral injury that is based on social functionalism which purports that moral emotions (e.g., shame, pride) serve evolutionary purposes essential to group survival.15 Thus learning to interact with moral emotions differently is crucial to recovery. In ACT-MI, a group-based intervention is used to facilitate in-vivo exposure to moral emotions in the context of values. The proposed two arm randomized controlled pilot study will evaluate the acceptability of ACT-MI and an active control treatment, and determine the feasibility of the randomized controlled trial design for a future full-scale efficacy study. To accomplish this goal we will continue to refine ACT-MI. Veterans enrolled will be randomized to: (a) Present Centered Therapy (PCT) or (b) ACT-MI, both of which will consist of 12, 90-minute group sessions. The specific aims of this study are to: (1) Evaluate the acceptability of the ACT-MI intervention for Veterans experiencing impairment in functioning associated with moral injury, (2) Determine the feasibility of the efficacy study design, and to (3) Select measures and calculate the necessary sample size for a future efficacy study. The performance of validated scales will be measured, in addition to selected NIH Patient Reported Outcomes Measurement Information System modules.78 All participants will complete a baseline assessment, post treatment, and follow-up assessment one and three months after completion of ACT-MI or PCT. Participants in both groups will also complete a post-treatment assessment on the acceptability of the intervention. The proposed study represents a crucial first step in a line of research likely to yield a recovery- oriented, empirically-supported intervention for moral injury among Veterans. The objectives of ACT-MI directly align with Rehabilitation Research and Development's goal to improve Veteran functioning, increase community reintegration, and to facilitate Veteran centered care.

遭受道德上有害事件的战区退伍军人经常遇到许多困难 功能。这些退伍军人经常报告自杀的思想和行为，滥用药物，症状 抑郁和PTSD以及恢复有价值的生活的问题（例如，精神实践，亲密关系）.1-7 尽管道德伤害具有转诊性质，但没有道德损伤特异性的转诊 干预措施。现有干预措施往往专注于在PTSD的背景下治疗道德伤害。10-11 除了强调PTSD外，这些干预措施的目标是与道德伤害相关的因果关系 苦难发展和维持的因素。10-12强调改变的信念 道德伤害可能无法最佳地促进功能恢复，因为道德侵犯的道德痛苦可能是 有理由。作为战区退伍军人的三分之一认可道德上有害事件的暴露，发展至关重要 可以在VHA中有效传播以促进功能恢复的干预措施。8-9理想 干预必须简单地解决道德情绪并促进价值观一致的行为 这些情绪。 道德伤害的接受和承诺疗法（ACT-MI）是基于恢复的， 理想的社会心理治疗非常适合认可与功能相关的困难的退伍军人 15 ACT教授技巧，以帮助退伍军人与痛苦的思想，情感，冲动， 40而不是专注于减轻症状，而是基于证据的干预措施 通过协助退伍军人识别和参与价值一致的人，直接针对功能恢复 即使在遇到困境的情况下，行为也是如此。特别是在资深人口中，已证明了行为 有效地治疗自杀念头和抑郁症，因此被“推出”作为证据 VHA内抑郁症的心理治疗。59-60ACT-MI根据ACT原则运作，并明确 关注道德情感的社会功能。13-14ACT-MI是道德伤害的唯一干预措施 基于社会功能主义，声称道德情绪（例如，羞耻，骄傲）服务于进化 15学习与道德情感互动的目的是不同的。 恢复。在ACT-MI中，使用基于小组的干预措施来促进体内暴露于道德情绪 价值观的上下文。拟议的两个手臂随机对照试验研究将评估 ACT-MI的可接受性和主动控制处理，并确定 未来全尺度效率研究的随机对照试验设计。为了实现这一目标 将继续完善ACT-MI。入学的退伍军人将被随机分为：（a）目前的中心疗法（PCT） 或（b）ACT-MI，两者均由12个，90分钟的小组会议组成。 这项研究的具体目的是：（1）评估ACT-MI干预的可接受性 经历与道德伤害相关的功能障碍的退伍军人（2）确定可行性 效率研究设计，以及（3）选择措施并计算未来的必要样本量 效率研究。除选定的NIH患者外，还将测量经过验证的量表的性能 报告结果测量信息系统模块。78所有参与者将完成基线 ACT-MI或 pct。两组的参与者还将完成有关该治疗后的评估 干涉。拟议的研究代表了一项可能产生恢复的研究方面的关键第一步 - 面向退伍军人道德伤害的方向，经验支持的干预。 ACT-MI的目标 直接与康复研发的目标保持一致，以提高退伍军人功能，增加 社区重返社会，并促进老兵中心护理。