Meditation Interventions for Treatment of PTSD in Veterans

冥想干预治疗退伍军人的创伤后应激障碍

• 批准号: 8264481
• 负责人: KELVIN O. LIM
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-01-01 至 2013-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8264481
• 关键词: Address; Aftercare; Anxiety; Attenuated; Clinical; Clinical Trials; Clinical assessments; Consumer Satisfaction; Data; Diagnosis; Drops; Educational process of instructing; Effectiveness; Electroencephalography; Electrophysiology (science); Evaluation; Goals; Group Therapy; Health; Healthcare Systems; Impairment; Intervention; Literature; Measures; Mediation; Meditation; Mental Health; Mental Health Services; Mental disorders; Modality; Monitor; Neurobiology; Neurosciences; Occupational; Outcome; Pain; Patient Self-Report; Population; Post-Traumatic Stress Disorders; Psychotherapy; Quality of life; Randomized; Randomized Controlled Trials; Recording of previous events; Relative (related person); Research; Social Functioning; Supervision; Symptoms; System; Therapeutic; Training; Traumatic Brain Injury; Treatment outcome; Veterans; Work; alternative treatment; base; comparison group; design; effective therapy; evidence base; follow-up; health care service utilization; mindfulness; mindfulness meditation; mindfulness-based stress reduction; physical conditioning; research clinical testing; skills; sound; treatment response

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder associated with high rates of chronicity, poor quality of life, and severe impairments in interpersonal, occupational, and social functioning. While evidence-based psychotherapies for treatment of PTSD have been developed and disseminated within the VA system, no treatment has shown universal effectiveness and there have been great concerns about attenuated treatment response and elevated treatment drop out in veteran populations. The evaluation of alternative treatment modalities for veterans with PTSD is therefore an important priority. The Minneapolis VA Health Care System (MVAHCS) has taught Mindfulness Based Stress Reduction (MBSR), a group-based intervention focused on mindfulness meditation, to veteran clinical populations since 2001, and pilot data from veterans diagnosed with PTSD is promising. Despite support for the application of MBSR to other mental health and physical problems, MBSR has not been systematically evaluated as a treatment for PTSD. Moreover, the existing literature on MBSR is limited by methodological weaknesses. If shown to be efficacious through scientifically sound trials, MSBR may offer an effective, acceptable, and tolerable intervention for veterans suffering PTSD who are unable to engage in or complete traditional exposure-based therapies. The primary goal of this proposal is to conduct a methodologically rigorous randomized controlled trial (RCT) of MBSR in treating PTSD among veterans, examining both symptom outcomes and subsequent health services utilization. Given our compelling pilot data, we propose initial steps to evaluate putative mechanisms of change (self-report and electrophysiology markers, i.e., EEG) through which MBSR may relate to PTSD symptom improvements, and to examine the acceptability of MBSR to the veteran population. The MVAHCS and the assembled team combines expertise in PTSD treatment and research, clinical trials, and neuroscience, with clinical expertise in MBSR and compelling pilot data to support the feasibility and scope of the current project. The efficacy of MBSR will be examined relative to present-centered group therapy (PCGT), a non-specific therapeutic comparison group. Veterans diagnosed with PTSD will be randomized to MBSR or PCGT for 9 weeks. Each intervention will be delivered in group format following manualization by trained clinicians receiving expert supervision. Treatment integrity will be independently monitored. Assessment of clinical outcomes post-treatment and 2 months follow-up will be independently evaluated. Putative mechanisms of mindfulness meditation will be assessed using self-report and electrophysiology markers. We have the following aims: Primary Aim 1: To evaluate the efficacy of MBSR as a treatment for PTSD in veterans compared to PCGT over 9-weeks of treatment and 2-month follow-up. Secondary Aim 1: To identify potential treatment-based predictors of PTSD outcomes. Secondary Aim 2: To identify differences in subsequent VA health services utilization among veterans across treatment conditions. Exploratory Aims: 1. To evaluate rates of drop-out, compliance, and consumer satisfaction with MBSR. 2. To evaluate acceptability and outcomes of treatment with veterans with mild traumatic brain injuries. PUBLIC HEALTH RELEVANCE: Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder which results in serious impairments in interpersonal, occupational and social functioning. Effective treatments are available for PTSD but they do not work for everyone. Alternative treatments are needed to help those veterans not helped by currently available treatments. Mindfulness Based Stress Reduction (MBSR) is a group based treatment focused on mindfulness meditation. MBSR has been found to be effective in helping people with problems with pain and anxiety. MBSR has not yet been studied in veterans with PTSD. The proposed study will compare MBSR with a standard psychotherapy treatment in veterans with PTSD. This research is relevant to Veterans' health because of the need to develop alternative treatments for veterans with PTSD who have not responded to currently available treatments.

描述（由申请人提供）： 创伤后应激障碍（PTSD）是一种使人衰弱的精神障碍，与高慢性，生活质量差以及人际交往，职业和社会功能的严重损害相关。尽管已经开发并在VA系统中开发并传播了基于证据的PTSD治疗的心理治疗，但尚无治疗表现出普遍的有效性，并且人们对减毒的治疗反应和退伍军人人口中的治疗效果升高引起了人们的关注。因此，对具有PTSD的退伍军人的替代治疗方式的评估是重要的优先级。自2001年以来，Minneapolis VA医疗保健系统（MVAHCS）教授了基于正念的压力减轻（MBSR），这是一种基于小组的干预措施，专注于正念冥想，对退伍军人临床人群进行了教学，并且诊断为PTSD的退伍军人的飞行员数据是有希望的。尽管支持将MBSR应用于其他心理健康和身体问题，但MBSR并未系统地评估作为PTSD的治疗方法。此外，现有有关MBSR的文献受方法论弱点的限制。如果通过科学的声音试验证明是有效的，MSBR可能会为无法从事或完成基于传统曝光的疗法的PTSD的退伍军人提供有效，可接受和可容忍的干预措施。该提案的主要目的是在退伍军人中对PTSD进行治疗的方法论严格的随机对照试验（RCT）进行研究，研究症状结果和随后的卫生服务利用。鉴于我们引人注目的飞行员数据，我们提出了初步步骤，以评估推定的变化机制（自我报告和电生理学标志物，即脑电图），MBSR可能与PTSD症状改善有关，并检查MBSR对退伍军人人群的可接受性。 MVAHCS和组装团队结合了PTSD治疗和研究，临床试验和神经科学方面的专业知识，并在MBSR方面提供了临床专业知识，并引人入胜的Pilot数据，以支持当前项目的可行性和范围。相对于以现为中心的组治疗（PCGT），将检查MBSR的功效，这是一个非特异性治疗比较组。被诊断为PTSD的退伍军人将被随机分为MBSR或PCGT 9周。在接受专家监督的训练有素的临床医生手动化后，每种干预措施将以小组格式进行。治疗完整性将受到独立监控。治疗后临床结果和2个月随访的评估将进行独立评估。正念冥想的推定机制将使用自我报告和电生理学标记进行评估。我们具有以下目的：主要目的1：评估MBSR作为PTSD在退伍军人中的治疗的疗效，而PCGT在9周的治疗和2个月的随访中。次要目标1：确定基于治疗的PTSD结果的预测因子。次要目的2：确定在治疗条件下退伍军人随后的VA卫生服务利用情况的差异。探索目的：1。评估辍学率，合规性和消费者对MBSR的满意度。 2。评估与轻度脑损伤的退伍军人的可接受性和治疗结果。 公共卫生相关性： 创伤后应激障碍（PTSD）是一种使人衰弱的精神障碍，导致人际交往，职业和社会功能严重损害。有效的治疗方法可用于PTSD，但它们并不适合所有人。需要替代治疗来帮助那些退伍军人没有目前可用的治疗方法。基于正念的压力减轻（MBSR）是一种基于群体的治疗，重点是正念冥想。已发现MBSR有效地帮助有疼痛和焦虑的人。 MBSR尚未在PTSD的退伍军人中进行研究。拟议的研究将将MBSR与PTSD退伍军人的标准心理治疗进行比较。这项研究与退伍军人的健康有关，因为需要为没有对当前可用治疗的PTSD的退伍军人开发替代治疗。