Development of a Mobile Mindfulness Intervention for Alcohol Use Disorder and PTSD among OEF/OIF Veterans

开发针对 OEF/OIF 退伍军人酒精使用障碍和 PTSD 的移动正念干预措施

• 批准号: 10263953
• 负责人: Jordan P Davis
• 金额: $ 25.98万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10263953
• 关键词: Address; Affect; Afghanistan; Alcohol consumption; Alcohols; American; Awareness; Behavioral; Caring; Communities; Conflict (Psychology); Development; Diagnosis; Disease; Distress; Eligibility Determination; Ethnic Origin; Evidence based intervention; Face; Feedback; Freedom; Gender; Goals; Health Services Accessibility; Healthcare; Healthcare Systems; Heavy Drinking; Impulsivity; Individual; Informal Social Control; Intervention; Intervention Studies; Iraq; Knowledge; Methods; Occupational; Outcome; Patient Recruitments; Persons; Pharmaceutical Preparations; Phase; Population; Post-Traumatic Stress Disorders; Public Health; Race; Randomized Controlled Trials; Reporting; Research; Resistance; Risk; Sampling; Services; Stress; Substance Use Disorder; Symptoms; Technology; Testing; Trauma; Treatment outcome; Underserved Population; United States Department of Veterans Affairs; Veterans; Work; acceptability and feasibility; alcohol consequences; alcohol misuse; alcohol use disorder; base; behavioral health; care seeking; comparison intervention; craving; disorder later incidence prevention; efficacy testing; emotion regulation; evidence base; experience; feasibility testing; high risk; high risk drinking; improved; innovation; intervention effect; male; meetings; mindfulness; mindfulness intervention; mobile application; mobile computing; novel; operation; physical conditioning; post intervention; post-traumatic symptoms; preventive intervention; programs; recruit; reduce symptoms; skills; social media; social stigma; stress reduction; substance use; substance use treatment; success; symptom treatment; traumatic event; treatment as usual; usability

PROJECT SUMMARY/ABSTRACT The long-term goal of this proposal is to improve treatment outcomes for OEF/OIF veterans with alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) who are not currently accessing care through the Veterans Affairs Healthcare System (VA) or other settings. Many OEF/OIF veterans struggle with heavy drinking and related consequences and this can be especially pronounced with the co-occurrence of PTSD. Prior research has found aspects of self-regulation (emotion regulation, impulse control), stress, and craving to be important putative targets in AUD and PTSD symptom reduction. However, with upwards of 50% of veterans who have behavioral health needs not seeking treatment, it is imperative to utilize advances in technology to develop and test interventions that can reach non-treatment seeking veterans and target both symptoms of PTSD and AUD. As the proposed mechanisms (e.g., self-regulation) are becoming better understood regarding how they affect PTSD and AUD outcomes, approaches should focus on targeting these mechanisms and evaluating if they are essential facilitators of change. Mindfulness-based interventions (MBI) can target such mechanisms, but a gap in the knowledge persists regarding the utility of MBIs with veterans who screen positive for PTSD and AUD. Therefore, we propose to improve treatment outcomes for OEF/OIF veterans with PTSD and AUD by targeting self-regulation, stress, and cravings. We will develop and test a novel mobile MBI, Mobile Mindfulness Based Relapse Prevention (mMBRP), that will improve upon evidence- based in-person and group MBRP by reaching veterans outside of treatment settings. The engaging and easy- to-use mobile MBI integrates relapse prevention, stress reduction, and self-regulation skills and is relevant to issues surrounding stigma and barriers that veterans face when seeking services. The central hypothesis will be tested through a focus on three specific aims: (1) refine and add MBRP content to the popular VA- developed Mindfulness Coach mobile application through a beta testing phase where we test for feasibility and acceptability of the app, (2) pilot test the efficacy of the mMBRP mobile app on alcohol use and PTSD outcomes compared to control, and (3) assess mechanisms of change such as self-regulation, stress, and cravings, as well as exploratory moderators of gender, race/ethnicity, and recency of discharge, on mMBRP effects. The unique strengths of this proposal are its focus on an underserved population, utilization of mobile technology for intervention delivery, and use of a novel intervention known to effectively target self-regulation and stress. The expected results will define a viable and easy-to-access treatment that can improve both AUD and PTSD symptoms. Results of this study will have a positive impact on substance use outcomes for those who have experienced traumatic events and will identify mechanism of action for treatment success. The app can be disseminated through our partners in the VA and through targeted sharing on social media.

项目概要/摘要 该提案的长期目标是改善 OEF/OIF 酗酒退伍军人的治疗结果 目前未通过医疗机构获得护理的精神障碍 (AUD) 和创伤后应激障碍 (PTSD) 退伍军人事务医疗保健系统 (VA) 或其他机构。许多 OEF/OIF 退伍军人都在与沉重的负担作斗争 饮酒和相关后果，这在同时发生 PTSD 的情况下尤其明显。 先前的研究已经发现了自我调节（情绪调节、冲动控制）、压力和渴望的各个方面。 是减轻 AUD 和 PTSD 症状的重要假定目标。然而，超过 50% 有行为健康问题的退伍军人不需要寻求治疗，必须利用先进的技术 开发和测试干预措施的技术，可以覆盖未寻求治疗的退伍军人，并针对两者 PTSD 和 AUD 的症状。随着提议的机制（例如自我监管）变得更好 了解它们如何影响 PTSD 和 AUD 结果，方法应侧重于针对这些 机制并评估它们是否是变革的重要促进者。基于正念的干预措施（MBI） 可以针对此类机制，但对于退伍军人 MBI 的效用仍然存在知识差距 PTSD 和 AUD 筛查呈阳性的人。因此，我们建议改善 OEF/OIF 的治疗结果 通过针对自我调节、压力和渴望来帮助患有 PTSD 和 AUD 的退伍军人。我们将开发并测试 新型移动 MBI，基于移动正念的复发预防 (mMBRP)，这将改进证据- 通过接触治疗环境之外的退伍军人，开展基于个人和团体的 MBRP。引人入胜且简单- 使用移动 MBI 集成了预防复发、减轻压力和自我调节技能，并且与 退伍军人在寻求服务时面临的耻辱和障碍问题。中心假设将 通过关注三个具体目标进行测试：(1) 完善 MBRP 内容并将其添加到流行的 VA- 通过 Beta 测试阶段开发了正念教练移动应用程序，我们测试可行性和 应用程序的可接受性，(2) 试点测试 mMBRP 移动应用程序对饮酒和 PTSD 的功效 与对照相比的结果，以及（3）评估变化机制，例如自我调节、压力和 mMBRP 上的渴望以及性别、种族/民族和出院新近程度的探索性调节因素 影响。该提案的独特优势在于它关注服务不足的人群、移动电话的利用 提供干预措施的技术，以及使用已知可有效针对自我调节的新型干预措施 和压力。预期结果将确定一种可行且易于获得的治疗方法，可以提高 AUD 和创伤后应激障碍症状。这项研究的结果将对那些物质使用结果产生积极影响 经历过创伤事件并会确定治疗成功的作用机制的人。该应用程序 可以通过我们在 VA 的合作伙伴以及通过社交媒体上的有针对性的分享进行传播。