Empowering Veterans to Self-Manage PTSD Symptoms Following Completion of Trauma-Focused Therapy

帮助退伍军人在完成创伤焦点治疗后自我管理 PTSD 症状

• 批准号: 10538850
• 负责人: Shannon M. Kehle-Forbes
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538850
• 关键词: Appointment; Area; Behavior; Caring; Clinic; Clinical; Cognitive; Data; Dependence; Effectiveness; Evaluation; Fright; Goals; Health Personnel; Health Services Accessibility; Health system; Hour; Hybrids; Improve Access; Intervention; Interview; Learning Skill; Maintenance; Manuals; Measures; Mental Depression; Mental Health; Mental Health Services; Methodology; Methods; Modeling; Outcome; Outpatients; Participant; Patient Discharge; Patient Self-Report; Patient-Focused Outcomes; Patients; Perception; Personal Satisfaction; Post-Traumatic Stress Disorders; Preparation; Probability; Provider; Psychotherapy; Randomized; Randomized, Controlled Trials; Relapse; Reporting; Resources; Role; Sample Size; Self Efficacy; Self Management; Self Perception; Services; Signal Transduction; Site; Structure; Suicide prevention; Symptoms; Time; Trauma; Treatment Effectiveness; Treatment outcome; Veterans; Work; cohort; design; effective therapy; empowerment; experience; feasibility testing; feasibility trial; future implementation; health care service utilization; health service use; implementation barriers; impression; improved; improved outcome; innovation; interest; meetings; post-trauma; primary outcome; reduce symptoms; satisfaction; self-management program; service utilization; success; symptom management; symptomatic improvement; treatment as usual; treatment planning; work-study

Background. Nearly 90% of Veterans who complete trauma-focused therapy (TFT) for PTSD have remaining treatment needs. In the six-months following TFT, successful completers remain some of the highest utilizers of VA mental health services despite clinically meaningful symptom improvement. Our prior work demonstrated that Veterans who benefitted from TFT's primary post-TFT treatment needs were the practice and application of skills learned during therapy, with the goal of maintaining or building upon treatment gains. Veterans expressed low self-efficacy for meeting these goals without the support of their therapists and feared stagnation or relapse without ongoing contact. As such, we developed and feasibility-tested a therapist- assisted self-management program for TFT completers (EMPOWER) designed as a step down from active psychotherapy. The feasibility open trial demonstrated that EMPOWER is feasible and highly acceptable to patients. Further, findings suggest that the intervention was successful in helping Veterans maintain or enhance PTSD-related gains while reducing their mental health service utilization. These promising findings warrant a randomized evaluation. Significance. Interventions that meet Veterans' post-TFT treatment needs are urgently needed. Mental health providers are delivering ongoing treatment to this high priority cohort of Veterans without evidence to guide their treatment plan. Further, higher than expected levels of post-TFT mental health care utilization threatens the continued implementation of these highly effective treatments. For all Veterans to have access to the most effective treatments for PTSD, we must evaluate and implement interventions that prepare and enable successful TFT completers to step down from active therapy. Innovation. The proposed study is the first large-scale study of post-TFT care and the first to rigorously evaluate a self-management program to step-down from active to maintenance mental health services following a course of active psychotherapy. More broadly, we believe it to be the first intervention to directly facilitate an episodic model of mental health care. Specific Aims: 1) Estimate posterior probability distributions of EMPOWER's effects and establish likely ranges for those effects as compared to post-TFT TAU for Veterans' MH service utilization and self-reported PTSD symptoms. The subsequent Hybrid RCT will be designed after assessing the likelihood of detecting an effect for EMPOWER across a range of sample sizes using Go/No Go and Overall Power methods. 2) Explore the impact of EMPOWER compared to post-TFT TAU on Veterans'(a) self-efficacy for managing PTSD symptoms, (b) satisfaction with post-TFT care, (c) well-being & functioning (d) depression, and (e) secondary utilization outcomes. 3) Conduct semi-structured interviews with Veterans and providers to contextualize quantitative findings and identify potential barriers, facilitators, and strategies to facilitate future implementation of EMPOWER. Methodology: We are proposing a pragmatic randomized control trial (RCT) in which 36 PE and CPT providers will be randomized to support Veterans as they participate in the EMPOWER self-management program or facilitate TAU. Participants will be patients of the study providers who recently completed a course of PE/CPT during which they experienced clinically meaningful reductions in PTSD symptoms (n=90). Primary outcomes will be mental health service utilization (overall and with PE/CPT providers) and self-reported PTSD symptoms measured four times over a 9-month period. Qualitative interviews with providers (n=18) and Veterans (n=24) focused on providers' impressions of treatment effectiveness, implementation challenges/potential strategies, and Veterans' perception of treatment effectiveness. Next Steps: With partners at the National Center for PTSD and the Office of Mental Health & Suicide Prevention, we will determine whether a subsequent Hybrid Type I or II RCT is warranted.

背景。近 90% 完成针对 PTSD 的创伤聚焦治疗 (TFT) 的退伍军人仍保留 治疗需要。在 TFT 之后的六个月中，成功完成者仍然是利用率最高的用户之一 尽管临床上有意义的症状有所改善，但退伍军人管理局的心理健康服务仍然存在。我们之前的工作表明 受益于 TFT 后主要治疗需求的退伍军人是实践和应用 治疗过程中学到的技能，目的是维持或巩固治疗成果。退伍军人 在没有治疗师的支持的情况下实现这些目标的自我效能感很低，并且感到害怕 如果没有持续接触，就会停滞或复发。因此，我们开发并测试了治疗师- TFT 完成者辅助自我管理计划 (EMPOWER) 旨在从主动 心理治疗。可行性公开试验表明，EMPOWER是可行的，并且高度接受 患者。此外，研究结果表明，干预措施成功地帮助退伍军人维持或 提高与创伤后应激障碍（PTSD）相关的收益，同时减少他们的心理健康服务利用率。这些有希望的发现 需要进行随机评估。意义。满足退伍军人 TFT 后治疗需求的干预措施 是迫切需要的。心理健康服务提供者正在为这一高度优先群体提供持续的治疗 退伍军人没有证据来指导他们的治疗计划。此外，后 TFT 的水平高于预期 精神卫生保健的利用威胁着这些高效治疗的持续实施。为了 为了让所有退伍军人都能获得最有效的创伤后应激障碍治疗方法，我们必须评估和实施 为成功的 TFT 完成者做好准备并使其能够放弃积极治疗的干预措施。 创新。拟议的研究是第一个关于 TFT 后护理的大规模研究，也是第一个严格的研究 评估自我管理计划，从主动心理健康服务转向维持性心理健康服务 经过一个积极的心理治疗过程。更广泛地说，我们认为这是第一次直接干预 促进精神卫生保健的情景模式。具体目标：1）估计后验概率分布 EMPOWER 的影响并确定与后 TFT TAU 相比这些影响的可能范围 退伍军人的 MH 服务利用率和自我报告的 PTSD 症状。后续的混合 RCT 将是 在评估在一系列样本量中检测到 EMPOWER 效果的可能性后设计 使用 Go/No Go 和整体功率方法。 2) 探索 EMPOWER 与后 TFT TAU 相比的影响 退伍军人 (a) 管理 PTSD 症状的自我效能，(b) 对 TFT 后护理的满意度，(c) 幸福感 和功能（d）抑郁，以及（e）二次利用结果。 3）进行半结构化访谈 与退伍军人和提供者一起将定量研究结果置于背景中并确定潜在的障碍、促进因素、 以及促进 EMPOWER 未来实施的战略。方法论：我们提出一种务实的方法 随机对照试验 (RCT)，其中 36 名 PE 和 CPT 提供者将被随机分配以支持退伍军人 他们参与 EMPOWER 自我管理计划或促进 TAU。参与者将是以下患者 最近完成 PE/CPT 课程的研究提供者，在此期间他们经历了临床 PTSD 症状显着减少 (n=90)。主要结果将是心理健康服务的利用 （总体以及与 PE/CPT 提供者一起）和自我报告的 PTSD 症状在 9 个月内测量四次 时期。对提供者 (n=18) 和退伍军人 (n=24) 的定性访谈重点关注提供者对以下方面的印象： 治疗效果、实施挑战/潜在策略以及退伍军人对治疗的看法 效力。后续步骤：与国家创伤后应激障碍中心和心理健康办公室的合作伙伴一起 预防自杀，我们将确定是否有必要进行后续的 I 型或 II 型混合随机对照试验。