Adapting and Piloting Behavioral Activation for Veterans with Co-Occurring AUD and Posttraumatic Stress Disorder

为同时患有 AUD 和创伤后应激障碍的退伍军人调整和试点行为激活

• 批准号: 10644849
• 负责人: Shannon Michelle Blakey
• 金额: $ 24.06万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-10 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10644849
• 关键词: Adult; Aftercare; Alcohol consumption; Alcohols; Anxiety; Assessment tool; Behavior; Behavior Therapy; Behavioral; Benchmarking; Caring; Client satisfaction; Clinical; Clinical Trials; Clinical assessments; Collaborations; Communities; Computer software; Coupled; Crowding; Data; Daughter; Dimensions; Disease; Dropout; Drug Use Disorder; Drug usage; Emotions; Evaluation; Event; Future; Global Positioning System; Goals; Health; Health Promotion; Home; Individual; Intervention; Manuals; Maps; Measurement; Measures; Mediator; Memory; Mental Depression; Methods; Movement; National Institute on Alcohol Abuse and Alcoholism; Nightmare; Outcome; Pamphlets; Participant; Patient Dropouts; Patients; Personal Satisfaction; Persons; Post-Traumatic Stress Disorders; Procedures; Process; Protocols documentation; Randomized; Randomized, Controlled Trials; Recovery; Recovery of Function; Research; Rewards; Sampling; Secure; Severities; Symptoms; Techniques; Technology; Testing; Trauma; Veterans; Veterans Health Administration; Vocation; Walking; Well in self; Work; acceptability and feasibility; active comparator; alcohol abuse therapy; alcohol free; alcohol measurement; alcohol response; alcohol use disorder; avoidance behavior; behavior test; clinical practice; clinically significant; drinking; dual diagnosis; efficacy trial; feasibility testing; high risk; improved; innovation; interest; longitudinal analysis; military veteran; novel; novel strategies; patient handout; pilot test; portability; power analysis; psychiatric comorbidity; psychosocial; recruit; reduce symptoms; rehabilitation research; relapse prevention; response; severe mental illness; social; social determinants; statistics; suicidal risk; sustained recovery; treatment effect; treatment response

Alcohol use disorder (AUD) frequently co-occurs with posttraumatic stress disorder (PTSD) among U.S. military veterans. Compared to veterans with AUD only, veterans with AUD/PTSD have greater symptom severity, more psychosocial functioning difficulties, and higher risk of suicide. Many people with AUD/PTSD perform behaviors aimed at avoiding unpleasant emotions (e.g., drinking to avoid trauma-related nightmares, skipping social events to avoid anxiety-provoking crowds). These “avoidance behaviors” provide temporary relief from unpleasant emotions, but they maintain AUD/PTSD and interfere with long-term functioning. Although treatments for AUD/PTSD exist, they focus on reducing symptoms (not improving functioning) and have dropout rates as high as 50%. Originally developed to treat depression, Behavioral Activation (BA) is an intervention that increases daily participation in rewarding, alcohol-free activities relevant to patients’ social, vocational, and health-related values. Randomized controlled trials (RCTs) adapting BA for other disorders have shown that BA is efficacious for adults with alcohol/drug use disorders and acceptable to veterans with PTSD, but BA has not been used to treat co-occurring AUD/PTSD. Additionally, because RCTs of AUD/PTSD treatments typically emphasize significant mean group differences in AUD/PTSD outcomes, less is known about the degree to which these treatments yield clinically significant improvements at the individual level. Individual-level improvements in AUD/PTSD should be evident not only in subjective clinical assessments, but also in objective measures of geospatial activity. Specifically, patients’ daily geospatial activity is likely to change as they decrease their avoidance behaviors and increase their engagement in various social, vocational, and health-promoting activities. Advances in geospatial methods, coupled with discreet and portable Global Positioning System (GPS) trackers, have made it possible to objectively measure people’s spatial movement within their communities. Yet although geospatial methods have been used to identify social determinants of alcohol use, they have not been used to measure response to AUD or AUD/PTSD treatment. As the long-term objectives of this work are to identify a more acceptable AUD/PTSD treatment option and improve the measurement of AUD/PTSD recovery, this R34 project will address the following specific aims: (1) adapt BA for use with veterans with AUD/PTSD; (2) evaluate the feasibility, acceptability, and preliminary effects of BA (relative to Relapse Prevention) for veterans with AUD/PTSD in a pilot RCT; and (3) explore geospatial analysis of GPS-collected data as a new approach to measuring AUD/PTSD treatment response. This study will advance research and practice by piloting a novel application of BA and a novel measure of AUD/PTSD recovery. This project aligns with the National Institute on Alcohol Abuse and Alcoholism’s special interest in investigating treatments for patients with AUD and co-occurring disorders, dimensions of functioning and well-being associated with recovery, and innovative methods for evaluating AUD treatment and recovery.

在美国，酒精使用障碍（AUD）经常与创伤后应激障碍（PTSD）同时发生。 与仅患有 AUD 的退伍军人相比，患有 AUD/PTSD 的退伍军人症状更严重。 许多患有 AUD/PTSD 的人会出现严重的症状、更多的心理社会功能困难以及更高的自杀风险。 进行旨在避免不愉快情绪的行为（例如，喝酒以避免与创伤相关的噩梦， 跳过社交活动以避免引起焦虑的人群）这些“回避行为”提供了暂时的帮助。 缓解不愉快的情绪，但它们会维持 AUD/PTSD 并干扰长期功能。 尽管存在针对 AUD/PTSD 的治疗方法，但它们的重点是减轻症状（而不是改善功能）和 行为激活 (BA) 最初是为了治疗抑郁症而开发的，其退出率高达 50%。 增加日常参与与患者的社交、无酒精活动相关的干预措施 使 BA 适应其他疾病的随机对照试验 (RCT)。 已经表明，BA 对于患有酒精/药物滥用障碍的成年人有效，并且对于患有酒精/药物滥用障碍的退伍军人来说是可以接受的 PTSD，但 BA 尚未用于治疗同时发生的 AUD/PTSD，因为 AUD/PTSD 的随机对照试验。 治疗通常强调 AUD/PTSD 结果的显着平均组差异，但鲜为人知 关于这些治疗在个体水平上产生临床显着改善的程度。 AUD/PTSD 的个体水平改善不仅在主观临床评估中很明显，而且在 具体而言，患者的日常地理空间活动也可能会影响地理空间活动的客观测量。 随着他们减少回避行为并增加参与各种社交活动， 地理空间方法的进步，以及谨慎和谨慎的活动。 便携式全球定位系统 (GPS) 跟踪器使客观测量人们的 然而，尽管地理空间方法已被用来识别社会。 尽管它们是饮酒的决定因素，但尚未用于衡量对 AUD 或 AUD/PTSD 治疗的反应。 由于这项工作的长期目标是确定一种更可接受的 AUD/PTSD 治疗方案，并且 改进 AUD/PTSD 恢复的衡量，该 R34 项目将实现以下具体目标： (1) 调整 BA 以用于患有 AUD/PTSD 的退伍军人 (2) 评估可行性、可接受性和初步结果； 在试点随机对照试验中，BA（相对于复发预防）对患有 AUD/PTSD 的退伍军人的影响；以及 (3) 探索 GPS 收集的数据的地理空间分析作为测量 AUD/PTSD 治疗反应的新方法。 本研究将通过试点 BA 的新应用和新的测量方法来推进研究和实践 AUD/PTSD 恢复该项目与国家酒精滥用和酒精中毒研究所的特别项目一致。 有兴趣研究 AUD 和并发疾病患者的治疗方法、功能维度 与康复相关的健康和福祉，以及评估 AUD 治疗和康复的创新方法。