Exposure and Response Prevention to Improve Functioning in Veterans with Obsessive Compulsive Disorder

暴露和反应预防以改善患有强迫症的退伍军人的功能

• 批准号: 10426818
• 负责人: Terri Lynn Fletcher
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10426818
• 关键词: Address; Administrator; Adoption; Affect; Aftercare; Anxiety; Caring; Case Study; Child; Chronic; Clinical; Clinical Trials; Cognitive Therapy; Communities; Complex; Compulsive Behavior; Data; Distress; Educational Intervention; Effectiveness; Ensure; Evidence based treatment; Exercise; Exposure to; Face; Family; Gold; Home; Home environment; Hospitals; Illness impact; Individual; Intervention; Interview; Knowledge; Learning; Life; Logistics; Mental Health; Mental disorders; Meta-Analysis; Methods; Obsession; Obsessive-Compulsive Disorder; Outcome; Participant; Patient Self-Report; Perception; Persons; Pilot Projects; Population; Post-Traumatic Stress Disorders; Prevention; Prevention trial; Provider; Psychotherapy; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Recording of previous events; Research; Sampling; Schizophrenia; Severities; Site; Societies; Suicide attempt; Symptoms; Testing; Training; Transportation; Trauma; Veterans; Veterans Health Administration; Work; Workplace; base; clinically significant; comorbidity; effective therapy; evidence base; experience; follow up assessment; formative assessment; future implementation; implementation evaluation; implementation outcomes; improved; improved functioning; military veteran; recruit; response; satisfaction; social; stress management; telehealth

Project Background Exposure and Response Prevention (ERP) is the gold standard evidence-based psychotherapy for OCD; however, few Veterans receive ERP and no randomized controlled trials (RCTs) have been published examining the effectiveness of ERP among Veterans or in individuals with comorbid OCD and posttraumatic stress disorder (PTSD). OCD impacts work, social, and family functioning, such that 38% of people with OCD are unable to work due to the severity of symptoms and 25% attempt suicide at some point in their lives (Mancebo et al., 2008). It is essential to examine the effectiveness of ERP in Veteran specific trials because Veterans are a complex, highly comorbid population, and have significant trauma histories which can complicate ERP treatment. Many Veterans face logistic barriers to accessing therapy including transportation, distance, childcare, and work, in addition to challenges leaving the home due to OCD symptoms. Video telehealth (VTH) can increase Veterans’ access to ERP and may enhance the generalizability of exposures since in-home exposure exercises can focus on OCD triggers that people encounter in their home environment. This may mean more direct impact to the Veteran’s daily life functioning and quality of life. Project Objectives The proposed 4-year multisite RCT will compare outcomes of VTH-delivered ERP to those of a stress management training control condition among 160 Veterans with OCD. Half of the sample with have comorbid PTSD. The primary aim will examine whether participants’ functioning, quality of life, and OCD symptoms differ as a function of the intervention (ERP vs. control). The secondary aim will examine these outcomes among the half of the sample with comorbid OCD and PTSD. The tertiary aim is to conduct a mixed-methods formative evaluation of the implementation potential of ERP in VA mental health settings. Project Methods Eligible Veteran participants will be randomized to ERP or to the control condition. Veterans randomized to ERP will receive 16 weekly ERP sessions delivered via VTH. Control participants will receive 16 weekly sessions of a stress management training intervention delivered via VTH. Participants in both conditions will complete assessments at post-treatment and 6 months after completing treatment. Participants in the ERP condition will also complete an assessment of treatment satisfaction and a qualitative exit interview assessing the Veterans’ perceptions of the impact of treatment on multiple domains of functioning, including the impact on PTSD symptoms. Providers and VA administrators will participate in qualitative interviews regarding the implementation potential of ERP in VA. Contribution to VHA This work addresses RR&D clinical priorities related to cognitive-behavioral interventions for improving Veterans’ functioning, participation in society, and quality of life. Establishing ERP as an evidence-based treatment in the complex Veteran population has the potential to impact the 170,000 Veterans in VHA with OCD and assist them in living more functional lives, which will affect their families, children, workplaces, and communities.

项目背景 暴露和反应预防（ERP）是强迫症循证心理治疗的黄金标准； 然而，很少有退伍军人接受 ERP，并且尚未发表随机对照试验 (RCT) 检查 ERP 在退伍军人或患有强迫症和创伤后共病的个体中的有效性 压力障碍 (PTSD) 会影响工作、社交和家庭功能，38% 的人患有强迫症。 由于症状严重而无法工作，25% 的人在生命中的某个时刻试图自杀 （Mancebo 等人，2008）有必要检查 ERP 在退伍军人特定试验中的有效性，因为 退伍军人是一个复杂的、高度共病的人群，并且有显着的创伤史，可能会 许多退伍军人在接受治疗时面临后勤障碍，包括交通、 距离、育儿和工作，以及由于强迫症症状而离开家的挑战。 远程医疗 (VTH) 可以增加退伍军人获得 ERP 的机会，并可能提高暴露的普遍性 因为家庭暴露练习可以集中于人们在家中遇到的强迫症触发因素 这可能意味着对退伍军人的日常生活功能和生活质量产生更直接的影响。 项目目标 拟议的 4 年多站点随机对照试验将比较 VTH 提供的 ERP 的结果与压力的结果 管理培训控制 160 名患有强迫症的退伍军人的状况，其中一半的样本患有合并症。 主要目的是检查参与者的功能、生活质量和强迫症症状是否不同。 作为干预的函数（ERP 与控制）。次要目标将检查这些结果。 一半的样本患有强迫症和创伤后应激障碍第三个目标是进行混合方法形成。 评估 ERP 在 VA 心理健康环境中的潜力。 项目方法 符合条件的退伍军人参与者将被随机分配到 ERP 或随机分配到对照条件的退伍军人。 ERP 将每周接收 16 次通过 VTH 提供的 ERP 会话，控制参与者将每周接收 16 次。 两种情况下的参与者都将通过 VTH 进行压力管理培训干预课程。 ERP 参与者在治疗后和完成治疗后 6 个月完成评估。 病情还将完成治疗满意度评估和定性离职面谈评估 退伍军人对治疗对多个功能领域影响的看法，包括 提供者和 VA 管理人员将参加有关 PTSD 症状的定性访谈。 VA 中 ERP 的实施潜力。 对VHA的贡献 这项工作解决了与认知行为干预相关的 RR&D 临床优先事项，以改善 退伍军人的功能、社会参与和生活质量建立循证的 ERP。 复杂退伍军人群体的治疗有可能影响 VHA 中的 170,000 名退伍军人 强迫症并帮助他们过上更实用的生活，这将影响他们的家庭、孩子、工作场所和 社区。