Increasing PTSD Treatment Engagement in Women Veterans: Role of CBT for Insomnia

增加女性退伍军人的创伤后应激障碍 (PTSD) 治疗参与度：认知行为治疗 (CBT) 对失眠的作用

• 批准号: 10533724
• 负责人: Gwendolyn Carlson
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10533724
• 关键词: Address; Aftercare; Appointment; Area; Award; Behavior Therapy; Caring; Clinical Practice Guideline; Cognitive; Cognitive Therapy; Comorbid Insomnia; Data; Development; Diagnosis; Disease remission; Early treatment; Effectiveness; Feedback; Feeling suicidal; Future; Goals; Health Services Accessibility; Individual; Intervention; Intervention Studies; Interview; Knowledge; Learning; Measures; Mental Health; Methodology; Methods; Modeling; Moods; Participant; Patient Care; Patients; Perception; Phase; Post-Traumatic Stress Disorders; Preparation; Process; Protocols documentation; Provider; Psychotherapy; Publishing; Randomized; Readiness; Recommendation; Reporting; Research; Research Priority; Risk Factors; Role; Sampling; Schedule; Services; Severities; Sleep; Sleep Disorders; Sleeplessness; Structure; Symptoms; Time; Training; Training Programs; Trauma; Treatment outcome; Variant; Veterans; Woman; Women' s Health; Work; alternative treatment; brief intervention; comorbidity; diagnostic criteria; effectiveness trial; eligible participant; emotion dysregulation; emotion regulation; emotional experience; evidence base; experience; follow-up; improved; improvement on sleep; innovation; novel; novel strategies; patient engagement; pilot test; pilot trial; preference; primary outcome; programs; provider behavior; psychiatric comorbidity; psychiatric symptom; psychoeducation; psychoeducational; recruit; self help; social stigma; success; symptomatic improvement; treatment as usual; treatment choice; treatment optimization

Background: Posttraumatic stress disorder (PTSD) is the most common psychiatric service-connected condition among women Veterans, yet many women Veterans do not receive evidence-based psychotherapies for PTSD. PTSD and insomnia disorder are highly comorbid in women Veterans and research suggests that insomnia is a risk factor for PTSD development and severity, while healthy sleep is associated with improved mood, daytime functioning, enhanced learning, and increased emotion regulation. Addressing insomnia symptoms in women Veterans may offer an early point of intervention to reduce insomnia and some PTSD symptoms, while also providing a novel approach to improve patient engagement in PTSD treatments. Significance/Impact: Women's health and mental health (specifically PTSD) are research priority areas for VA. Women Veterans experience multiple barriers to PTSD treatments including: perceived stigma, severity of symptoms/emotion dysregulation, and scheduling/time constraints. Providers report delaying PTSD treatments due to perceptions of patients' “unreadiness” to begin PTSD treatments. Cognitive Behavioral Therapy for Insomnia (CBT-I; first-line treatment for insomnia) is perceived as highly acceptable to women Veterans, improves sleep in individuals with comorbid psychiatric conditions, offers a brief intervention alternative to psychotherapy protocols for PTSD, and is widely disseminated within VA. Innovation: No previous studies have examined the impact of trauma-informed CBT-I on sleep and psychiatric symptoms among women Veterans with comorbid insomnia disorder and PTSD. The project will utilize a mixed methods approach, gathering novel information from women Veterans to identify facilitators of and barriers to PTSD and insomnia treatments among women Veterans. While there are indications that CBT-I may serve as a preparatory treatment to other evidence-based psychotherapies, this would be the first study to utilize a trauma-informed CBT-I protocol and examine mental health treatment engagement as a primary outcome. Specific Aims: The specific aims are to: 1) Iteratively refine the structure and materials of trauma-informed CBT-I in preparation for a pilot trial, 2) Pilot test the effects of trauma-informed CBT-I on PTSD treatment readiness and engagement in a sample of women Veterans, and 3) Examine potential mechanisms underlying variations in PTSD treatment readiness and engagement over time among women Veterans. Methodology: The proposed project will be carried out within VAGLAHS. In Aim 1, women Veterans will sequentially receive the trauma-informed CBT-I protocol. We will obtain qualitative feedback from each participant, and make needed refinements before administering the protocol to the next participant (anticipated n=5). In Aim 2, women Veterans with comorbid insomnia disorder and PTSD will be recruited to participate in a behavioral intervention study and eligible participants will be randomly assigned to either trauma-informed CBT-I (n=25) or PTSD psychoeducation modeled after usual care (n=25). Participants will complete measures of sleep, mental health symptoms, and PTSD treatment readiness at baseline, post-treatment, and 6-month follow-up. All participants will be offered a referral to PTSD treatment and treatment engagement will be assessed at 6-month follow-up. In Aim 3, as part of the pilot trial, we will assess known barriers to PTSD treatment engagement at each time point. We will conduct qualitative interviews with pilot trial completers and non-completers (anticipated n=20) to better understand the processes underlying PTSD treatment readiness and engagement among women Veterans with comorbid insomnia and PTSD. Next Steps/Implementation: Findings will directly inform patient care by increasing treatment choices for women Veterans who are not yet ready to begin PTSD treatment. Findings will also generate preliminary data to inform future VA Merit Award applications involving an effectiveness trial of trauma-informed CBT-I and mixed methods to examine treatment preferences among women Veterans with insomnia and PTSD.

背景：创伤后应激障碍（PTSD）是最常见的精神病学服务 女退伍军人的状况，但是许多退伍军人没有接受循证心理治疗 对于PTSD。 PTSD和失眠症在女性退伍军人中是高度合并的，研究表明 失眠是PTSD发展和严重程度的危险因素，而健康的睡眠与改善有关 情绪，白天的功能，增强的学习和增加的情绪调节。解决失眠症 退伍军人的症状可能会提供干预的早期点，以减少失眠和一些PTSD 症状，同时还提供了一种新的方法来改善患者参与PTSD治疗。 意义/影响力：妇女健康与心理健康（特别是PTSD）是研究优先领域 VA。妇女退伍军人经历了PTSD治疗的多个障碍，包括：感知的污名，严重程度 症状/情绪失调以及调度/时间限制。提供者报告延迟PTSD治疗 由于对患者的“不适当”开始PTSD治疗的看法。认知行为疗法 失眠（CBT-1；失眠的一线治疗）被认为是女性退伍军人的高度接受 改善合并精神病患者的睡眠，提供了简短的干预措施 PTSD的心理治疗方案，并在VA内广泛传播。 创新：以前没有研究检查了受创伤信息的CBT-I对睡眠和精神病的影响 患有合并症失眠症和PTSD的女性退伍军人的症状。该项目将使用混合 方法方法，收集女退伍军人的新信息，以确定的促进者和障碍 女退伍军人中的PTSD和失眠治疗。虽然有迹象表明CBT-I可能是 针对其他基于证据的心理治疗的准备治疗方法，这将是第一个利用 创伤信息的CBT-I方案和检查心理健康治疗参与作为主要结果。 具体目的：具体目的是：1）迭代地完善创伤信息的结构和材料 CBT-I为试点试验做准备，2）试验测试创伤性CBT-I对PTSD治疗的影响 准备和参与妇女退伍军人样本，3）检查潜在机制 女退伍军人随着时间的流逝，PTSD治疗准备和参与的基本差异。 方法论：拟议的项目将在Vaglah中进行。在AIM 1中，女退伍军人将 依次收到创伤信息的CBT-I方案。我们将从每个人那里获得定性反馈 参与者，并在对下一个参与者进行协议之前进行改进（预期） n = 5）。在AIM 2中，将招募患有失眠和PTSD的妇女退伍军人参加 行为干预研究和符合条件的参与者将被随机分配给一种受创伤的信息 CBT-I（n = 25）或PTSD心理教育在通常的护理后建模（n = 25）。参与者将完成测量 基线，治疗后和6个月的睡眠，心理健康症状和PTSD治疗准备 后续。所有参与者都将被转介到PTSD治疗中，并且将参与治疗。 在6个月的随访中进行评估。在AIM 3中，作为试点试验的一部分，我们将评估已知的PTSD障碍 每个时间点的治疗参与度。我们将对试验审判完成者和 未完成的人（预期n = 20）可以更好地了解PTSD治疗准备的过程 以及与合并症失眠和PTSD的退伍军人之间的参与。 下一步/实施：调查结果将通过增加治疗选择直接为患者护理提供信息 尚未准备好开始PTSD治疗的女退伍军人。调查结果还将生成初步数据 告知未来的VA绩效裁决申请，涉及对创伤信息的CBT-I和 在失眠和PTSD的女退伍军人中检查治疗偏好的混合方法。