Teaching Loved Ones to Help Veterans Optimize their PTSD Care and Healing

教导亲人帮助退伍军人优化他们的创伤后应激障碍护理和治疗

• 批准号: 10013653
• 负责人: Laura Meis
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10013653
• 关键词: Address; Baseline Surveys; Behavioral; Caring; Cognitive; Couples; Couples Therapy; Data; Diagnosis; Diagnostic; Distress; Divorce; Dropout; Educational process of instructing; Evolution; Exercise; Exposure to; Family; Family member; Feedback; Funding; Goals; Health; Healthcare; Household; Individual; Intervention; Interview; Leadership; Life; Life Style; Lifting; Manuals; Medical center; Mental Health; Methods; Military Personnel; Mission; Modeling; Outcome; Pain management; Pathway interactions; Patient-Focused Outcomes; Patients; Personal Satisfaction; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Prediction of Response to Therapy; Process Assessment; Provider; Psychotherapy; Quality of life; Randomized Clinical Trials; Recovery; Recovery of Function; Research; Series; Services; Social Controls; Social Functioning; Social Work; Societies; Structure; Suicide; Suicide prevention; Surveys; Symptoms; Techniques; Trauma; Unemployment; Veterans; base; clinically significant; evidence base; experience; family support; functional disability; functional outcomes; healing; improved; improved outcome; in vivo; innovation; interest; intervention effect; loved ones; meetings; member; physical conditioning; recruit; reduce symptoms; rehabilitation management; screening; skills; social; social situation; therapy design; therapy development; treatment optimization; treatment response

Impacts. We aim to improve the mental health, family functioning, and well-being of veterans with posttraumatic stress disorder (PTSD) through developing and evaluating a trauma-focused, couple therapy for PTSD. We will use strategies from Integrative Behavioral Couple Therapy (ICBT) to help intimate partners support veterans during exposure therapy for PTSD (Prolonged Exposure; PE). We anticipate this approach will increase veterans’ engagement in PE, but also improve relationship functioning, family functioning, and social functioning. Family involvement has been highlighted as a fertile avenue for improving the outcomes for patients with PTSD, yet families are infrequently integrated into evidence-based psychotherapies (EBPs). Our goals are highly is consistent with RR&D’s mission to promote research that leverages family support as a pathway to reintegration and optimizes meaningful recovery and functioning. Background. PTSD occurs in as many as 17% of US military veterans and is associated with a host of negative, long-term consequences to the individual, their families, and society at large. EBPs, such as PE, result in clinically significant symptom relief for many. Yet, these therapies have proven less effective for military personnel and veterans and treatment dropout rates are high. Our team surveyed veterans initiating EBPs for PTSD and a family member across four VA medical centers (N = 598; Project HomeFront). We found that veterans were more than twice as likely to complete EBPs when loved ones encouraged them to confront distress and that veterans experienced greater treatment gains when they shared more with their loved ones about their treatment. A couples-based, exposure therapy for PTSD that integrates intimate partners into every session of PE could provide the opportunity to mobilize the whole household in the service of EBP engagement, while extending the goals of therapy beyond symptom reduction to family functioning. We anticipate this intervention will teach couples to embrace a lifestyle that supports confronting trauma-related distress, so the veteran and his/her family can achieve optimal functional outcomes. Objectives. We will complete stages 1A and 1B of the Stage Model of Treatment Development. Specifically, we will: (1) Expand our treatment outline using content experts and feedback from key stakeholders (veterans, intimate partners, providers, and VA mental health leadership). (2) Conduct a pilot open trial to assess (a) the acceptability of treatment components, structure, and materials, (b) the feasibility of the intervention (retention and intervention fidelity), and (c) the study approach (screening, recruitment, and assessment process). (3) Explore the preliminary effects of the intervention on select outcomes including overall functioning, mental health functioning, social functioning, family functioning, and potential mechanisms (social control, subjective norms, and the degree to which veterans rely on their partners for support). Methods: To accomplish Aim 1, we will expand the outline for the intervention into an initial treatment manual through meetings with content experts and stakeholder feedback. Next, we will develop fidelity checklists and revise the treatment manual through conducting the intervention with 2-3 couples. To accomplish Aims 2 and 3, we will evaluate the intervention in a non-randomized, open trial with 10 veterans diagnosed with PTSD and their intimate partners. Veterans will complete baseline and posttreatment structured diagnostic interviews. Both members of the couple will complete baseline surveys, posttreatment surveys, and posttreatment qualitative exit interviews. Using data obtained from the open trial, we will assess the intervention’s acceptability, feasibility, mechanisms, and outcomes. Upon completion of this proposal, we will be well positioned to apply for Merit funding for a randomized clinical trial (Stage 2 of the Stage Model of Treatment Development) of this innovative, exposure based, couple therapy.

我们的目标是改善退伍军人的心理健康、家庭功能和福祉。 通过开发和评估以创伤为中心的夫妻疗法来治疗创伤后应激障碍（PTSD） 我们将使用夫妻行为综合疗法（ICBT）的策略来帮助亲密伴侣。 支持退伍军人接受创伤后应激障碍（PTSD）暴露治疗（长期暴露；PE）。 将增加退伍军人对体育的参与，同时也改善关系功能、家庭功能和 社会功能已被强调为改善结果的肥沃途径。 PTSD 患者，但家人很少参与循证心理治疗 (EBP)。 目标与 RR&D 的使命高度一致，即促进利用家庭支持作为 重新融入社会的途径并优化有意义的恢复和功能。 背景 多达 17% 的美国退伍军人患有创伤后应激障碍 (PTSD)，并且与许多疾病有关。 对个人、其家庭和整个社会产生负面的长期影响，例如PE， 对许多人来说，这些疗法可以显着缓解临床症状，但事实证明这些疗法效果不佳。 我们的团队对开始接受治疗的退伍军人进行了调查。 四个 VA 医疗中心的 PTSD 和一名家庭成员的 EBP（N = 598；我们发现 Project HomeFront）。 当亲人鼓励退伍军人面对问题时，退伍军人完成 EBP 的可能性是其两倍多 退伍军人在与亲人分享更多信息时会获得更大的治疗效果 关于他们的基于夫妻的创伤后应激障碍暴露疗法，将亲密伴侣融入到每个人中。 PE 会议可以提供动员整个家庭为 EBP 服务的机会 参与，同时将治疗目标从减轻症状扩展到家庭功能。 预计这种干预措施将教会夫妻拥抱一种支持面对创伤相关的生活方式 痛苦，以便退伍军人及其家人能够实现最佳的功能结果。 我们将完成治疗开发阶段模型的阶段 1A 和 1B。 我们将：（1）利用内容专家和主要利益相关者（退伍军人、 (2) 开展试点公开试验，以评估 (a) 治疗组件、结构和材料的可接受性，(b) 干预措施的可行性（保留 和干预保真度），以及（c）研究方法（筛选、招募和评估过程）。 探索干预对选定结果的初步影响，包括整体功能、心理 健康功能、社会功能、家庭功能和潜在机制（社会控制、主观 规范，以及退伍军人依赖其合作伙伴支持的程度）。 方法：为了实现目标 1，我们将干预大纲扩展为初始治疗手册 接下来，我们将通过与内容专家的会议和利益相关者的反馈来制定保真度清单和内容。 通过对 2-3 对夫妇进行干预来修改治疗手册以实现目标 2 和 3、我们将在一项非随机、公开试验中评估干预措施，该试验有 10 名被诊断患有 PTSD 的退伍军人 他们的亲密伴侣将完成基线和治疗后结构化诊断访谈。 夫妇双方均将完成基线调查、治疗后调查和治疗后 我们将使用从公开试验中获得的定性退出访谈来评估干预措施的效果。 这个提案完成后，我们的可接受性、可行性、机制和结果都会很好。 准备申请一项随机临床试验的优异资助（治疗阶段模型的第二阶段） 这种创新的、基于暴露的夫妻疗法的开发。