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疾病，与慢性病发生率高、生活质量差以及人际、职业和社会功能严重受损有关。虽然治疗创伤后应激障碍的循证心理疗法已经在退伍军人管理局系统内开发和传播，但没有任何治疗方法显示出普遍有效性，并且人们对退伍军人群体中治疗反应减弱和治疗退出率升高感到非常担忧。因此，评估患有 PTSD 的退伍军人的替代治疗方式是一个重要的优先事项。自 2001 年以来，明尼阿波利斯退伍军人管理局医疗保健系统 (MVAHCS) 一直向退伍军人临床人群教授基于正念的减压 (MBSR)，这是一种以团体为基础的干预措施，专注于正念冥想，来自被诊断患有 PTSD 的退伍军人的试点数据令人鼓舞。尽管人们支持将 MBSR 应用于其他心理健康和身体问题，但 MBSR 尚未被系统地评估为 PTSD 的治疗方法。此外，现有的 MBSR 文献受到方法论缺陷的限制。如果通过科学合理的试验证明 MSBR 有效，MSBR 可以为患有 PTSD 且无法参与或完成传统暴露疗法的退伍军人提供有效、可接受和可耐受的干预措施。该提案的主要目标是开展一项方法学上严格的 MBSR 随机对照试验 (RCT)，用于治疗退伍军人的 PTSD，检查症状结果和随后的卫生服务利用情况。鉴于我们令人信服的试点数据，我们提出初步步骤来评估假定的变化机制（自我报告和电生理学标记，即脑电图），通过这些机制，MBSR 可能与 PTSD 症状改善相关，并检查 MBSR 对退伍军人群体的可接受性。 MVAHCS 和组建的团队将 PTSD 治疗和研究、临床试验和神经科学方面的专业知识与 MBSR 方面的临床专业知识和令人信服的试点数据相结合，以支持当前项目的可行性和范围。 MBSR 的疗效将相对于以目前为中心的团体治疗 (PCGT)（一个非特异性治疗对照组）进行检查。诊断患有 PTSD 的退伍军人将被随机分配接受 MBSR 或 PCGT，为期 9 周。每项干预措施都将以小组形式进行，并由经过培训的临床医生在专家监督下进行手动操作。治疗的完整性将受到独立监控。将独立评估治疗后的临床结果和 2 个月的随访。将使用自我报告和电生理学标记来评估正念冥想的假定机制。我们的目标如下： 主要目标 1：通过 9 周的治疗和 2 个月的随访，评估 MBSR 与 PCGT 相比，MBSR 治疗退伍军人 PTSD 的疗效。次要目标 1：确定基于治疗的 PTSD 结果的潜在预测因素。次要目标 2：确定退伍军人在不同治疗条件下后续利用 VA 卫生服务的差异。探索性目标： 1. 评估 MBSR 的退出率、合规性和消费者满意度。 2. 评估患有轻度创伤性脑损伤的退伍军人治疗的可接受性和结果。 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疾病，会导致人际、职业和社会功能严重受损。对于创伤后应激障碍（PTSD）有有效的治疗方法，但并不适合所有人。需要替代治疗来帮助那些目前可用治疗无法帮助的退伍军人。基于正念的减压（MBSR）是一种专注于正念冥想的团体治疗方法。 MBSR 被发现可以有效帮助人们解决疼痛和焦虑问题。尚未对患有 PTSD 的退伍军人进行 MBSR 研究。拟议的研究将针对患有 PTSD 的退伍军人进行 MBSR 与标准心理治疗的比较。这项研究与退伍军人的健康相关，因为需要为患有创伤后应激障碍（PTSD）的退伍军人开发替代疗法，这些退伍军人对目前可用的治疗没有反应。