Developing a Mobile Intervention for Veterans with Posttraumatic Stress Disorder and Problematic Anger

为患有创伤后应激障碍和问题性愤怒的退伍军人开发移动干预措施

• 批准号: 10322672
• 负责人: Kirsten Hawkins Dillon
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10322672
• 关键词: Address; Afghanistan; Aggressive behavior; Anger; Benign; Caring; Client satisfaction; Clinical Management; Clinical Trials; Computers; Data; Development; Diagnosis; Dropout; Ecological momentary assessment; Evidence based treatment; Family; Family Relationship; Feasibility Studies; Foundations; Funding; Goals; Grant; Health Technology; High Prevalence; Individual; Intervention; Iraq; Knowledge; Maiden Name; Measures; Medical; Mentors; Methodology; Methods; Modification; Monitor; Occupational; Outcome; Patient Self-Report; Patients; Pilot Projects; Post-Traumatic Stress Disorders; Procedures; Psychophysiology; Qualitative Research; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Rehabilitation therapy; Reporting; Research; Research Personnel; Research Project Grants; Research Training; Sampling; Series; Services; Surveys; Techniques; Testing; Time; Training; Unemployment; Veterans; Writing; anger management; base; career; clinical trial analysis; cohort; combat veteran; community reintegration; cost; design; diaries; effective therapy; effectiveness testing; efficacy evaluation; experience; functional disability; functional outcomes; improved; innovation; mHealth; mHealth methodology; mobile application; pilot test; portability; psychosocial; recruit; rehabilitation research; research and development; retention rate; skills; social; suicidal risk; theories; therapy development; trait

Difficulty controlling anger is the most commonly reported reintegration concern among combat Veterans, especially those with a diagnosis of posttraumatic stress disorder (PTSD). In Veterans, problematic anger is associated with numerous negative psychosocial outcomes, including poor functional outcomes (both social and occupational), family discord, aggression, road rage, and suicide risk. Anger can also impede successful outcomes from PTSD treatment. Given the high prevalence of anger problems among Veterans with PTSD and the associated functional impairments, there is a clear need to develop innovative and effective anger interventions to improve functional outcomes of Veterans. The use of mobile health (mHealth) technology could provide a low-cost method to increase the reach of anger management treatments to this high-need group of Veterans. One of the mechanisms associated with problematic anger and aggression is hostile interpretation bias, i.e., a tendency to interpret ambiguous interpersonal situations as hostile. By reducing hostile interpretation bias, it may be possible to significantly reduce problematic anger and aggression and improve functional outcomes. The applicant has developed and piloted a computer-based interpretation bias modification intervention that successfully reduces hostile interpretation bias and anger outcomes. The goal of this project is to further develop this intervention for Veterans with PTSD, using mHealth technology to increase the portability of this promising approach to reduce anger and enhance occupational and psychosocial functioning. The Research Plan proposes to develop, refine, and pilot-test a mobile application version of the existing computer-based interpretation bias modification intervention for individuals with PTSD and problematic anger. The central hypothesis is that patients with PTSD and problematic anger will find this mobile intervention acceptable and will be willing to use it to reduce their anger difficulties and improve psychosocial and occupational functioning. The proposed research project will address the following Specific Aims: Aim 1(a): To develop a mobile interpretation bias modification intervention entitled Mobile Intervention for Reducing Anger (MIRA) for Veterans with PTSD and problematic anger; Aim 1(b): To use a successive cohort design to refine the MIRA intervention for Veterans with PTSD and problematic anger; and Aim 2: To: a) evaluate the feasibility of recruitment, randomization, and retention procedures in a pilot study comparing MIRA to a contact control condition, focusing on community reintegration and functional outcomes, and b) conduct an exploratory aim utilizing psychophysiological and electronic diary monitoring to determine whether this assessment could be utilized as an outcome or mechanistic variable in a subsequent randomized clinical trial application focused on evaluating the efficacy of the MIRA intervention. The results generated will guide the design of a sufficiently-powered RCT to test the effectiveness of the MIRA intervention to be funded by the end of the CDA-2 funding period. The Training and Mentoring Plans outline coursework, training, and experiences that will provide the applicant with the foundation to establish a career focused on developing innovative and effective treatments that improve functional outcomes and community reintegration in Veterans with PTSD. The following Training Goals have been formulated: 1) To acquire additional knowledge of mHealth methodologies; 2) To acquire expertise conducting and analyzing qualitative research; 3) To acquire additional expertise in the design and management of clinical trials; 4) To expand knowledge and skills in analyzing clinical trials data; 5) To extend understanding of rehabilitation theory and methods; and 6) To acquire additional skills in grant-writing and general professional development. The research, training, and mentoring plans outlined in this application will provide the foundation for the PI’s transition to an independent VA research career.

难以控制愤怒是战斗中最常见的重新整合问题 退伍军人，特别是那些患有创伤后应激障碍（PTSD）诊断的人。在退伍军人中，有问题 愤怒与许多负面的社会心理结局有关，包括功能不良（两者都 社会和职业），家庭不和谐，侵略性，道路愤怒和自杀风险。愤怒也会阻碍 PTSD治疗的成功结果。鉴于退伍军人之间的愤怒问题很高 有了PTSD和相关的功能障碍，显然需要开发创新有效 愤怒的干预措施以改善退伍军人的功能结果。移动健康的使用（MHealth） 技术可以提供一种低成本的方法来增加愤怒管理治疗的影响 高需求的退伍军人。 与问题愤怒和侵略性相关的机制之一是敌对的解释偏见， 即，一种将模棱两可的人际态情况解释为敌对的趋势。通过减少敌对解释 偏见，有可能显着减少有问题的愤怒和侵略性并提高功能 结果。申请人已经开发并试行了基于计算机的解释偏差修改 成功减少敌对的解释偏见和愤怒结果的干预措施。这个项目的目标是 为了进一步开发使用PTSD退伍军人的干预措施，使用MHealth技术来增加 这种承诺方法的可移植性，以减少愤怒和增强占据和社会心理功能。 研究计划计划的提案要开发，完善和进行试验，请测试一个移动应用程序版本 现有的基于计算机的解释偏置修改干预PTSD和有问题的人 愤怒。中心假设是PTSD和有问题的愤怒的患者会发现此手机 干预可以接受，并愿意利用它来减少他们的愤怒难度并改善社会心理 和占据功能。拟议的研究项目将解决以下特定目的：目标1（a）： 开发移动解释偏见修改干预措施，标题为减少移动干预措施 愤怒（Mira）为有PTSD和有问题的愤怒的退伍军人；目标1（b）：使用成功的队列设计 优化具有PTSD和有问题愤怒的退伍军人的MIRA干预；目标2：to：a）评估 试点研究中的招聘，随机化和保留程序的可行性，将MIRA与接触进行比较 控制条件，专注于社区重返社会和功能结果，b）进行 利用心理生理和电子日记监测的探索性目的 该评估可以用作随后随机的结果或机械变量 临床试验申请的重点是评估MIRA干预的效率。结果 生成的将指导设计足够动力的RCT的设计以测试MIRA干预的有效性 在CDA-2融资期结束时资助。 培训和指导计划概述课程，培训以及将提供的经验 基金会的申请人建立专注于开发创新和有效治疗的职业 这可以改善具有PTSD的退伍军人的功能结果和社区重返社区。以下培训 已经制定了目标：1）获取有关MHealth方法的更多知识； 2）获取 进行和分析定性研究的专家； 3）获得设计方面的其他专家 临床试验管理； 4）在分析的临床试验数据中扩大知识和技能； 5）延伸 理解康复理论和方法； 6）获得授予写作的其他技能和 一般专业发展。本应用程序中概述的研究，培训和心理计划将 为PI过渡到独立VA研究生涯的基础。