Reducing Internalized Stigma among Veterans with PTSD: A Pilot Trial

减少患有创伤后应激障碍 (PTSD) 退伍军人的内在耻辱：试点试验

• 批准号: 9198451
• 负责人: AMY L DRAPALSKI
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2016-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9198451
• 关键词: Address; Aftercare; Behavioral; Belief; Chills; Control Groups; Data; Diagnosis; Educational Curriculum; Evidence based intervention; Fright; Future; Glean; Goals; Individual; Intervention; Interview; Learning; Life; Manuals; Maps; Mental Health; Mental disorders; Methods; Morale; Motivation; Outcome; Pamphlets; Participant; Personal Satisfaction; Phase; Post-Traumatic Stress Disorders; Psyche structure; Randomized; Recovery; Reporting; Research; Self Efficacy; Stereotyping; Structure; Symptoms; System; Testing; Veterans; base; combat; community reintegration; coping; empowerment; evidence base; experience; improved; pilot trial; public health relevance; self esteem; severe mental illness; skills; social stigma

DESCRIPTION (provided by applicant): Background: Stigma and fear of stigma are widespread among Veterans with PTSD1-2 and both have pernicious effects on Veterans' well-being and participation in mental health treatment2-4. Internalized stigma is a harmful consequence of societal stigma, and has been associated with decreased hope, self-esteem, personal motivation, morale, self-regard, and persistence regarding illness management among individuals with a range of mental illnesses5-14. Internalized stigma also has negative impacts on the recovery and well- being of Veterans with PTSD specifically15, but no evidence-based interventions are currently available to assist Veterans with PTSD in combatting the impact of internalized stigma. Therefore, the purpose of this proposal is to develop and pilot-test an intervention to provide Veterans with PTSD the skills to cope effectively with stigma and to mitigate the internalization of stigmatizing beliefs and stereotypes. To that end, we will modify Ending Self Stigma (ESS), an intervention composed of evidence-based strategies for combating internalized stigma for mental illness16, to specifically serve the needs of Veterans with PTSD. Aims: The two aims of this proposed two-year pilot are to 1) modify the existing ESS intervention to address internalized and societal stigma experienced by Veterans with PTSD and 2) conduct a randomized pilot trial of ESS-P for 64 Veterans with PTSD diagnoses, to test our hypotheses that a) feasibility of ESS-P will be satisfactory, as demonstrated by adequate rates of recruitment, initial intervention engagement, attendance at intervention sessions, and acceptability of the intervention reported by participants; b) when compared to a control group receiving an informational brochure, ESS-P participants will have significantly reduced internalized stigma at immediate post-treatment, c) when compared to a control group receiving an informational brochure, ESS-P participants will show significantly increased self-efficacy, increased sense of belonging, and increased recovery orientation at immediate post-treatment, and d) compared to controls, ESS-P participants will demonstrate increased participation in mental health treatment during the three months post-treatment versus the three months before baseline. Methods: Our proposal will be conducted in two phases that map onto our two study Aims. In Phase I, we will produce an intervention and accompanying manual for the PTSD version of ESS (ESS-P), based upon the strategies and structure of the existing ESS intervention. To this end, we will interview Veterans with a PTSD diagnosis to learn more about their experience with societal and internalized stigma associated with PTSD, plus other considerations and issues in addressing internalized stigma with such Veterans. Information gleaned in these qualitative interviews will form the basis of our adaption of the ESS intervention to specifically address the needs of Veterans with PTSD. In Phase II, we will pilot-test ESS-P with Veterans who have PTSD, to evaluate the feasibility and acceptability of the intervention. In addition, we will preliminarily estimate the effects of ESS-P through comparison to a control group receiving an informational brochure on internalized stigma associated with PTSD. These feasibility, implementation and pilot outcome data will be used to further refine the intervention, towards the goal of conducting a future larger scale study of ESS-P within the VA system. Impact: Given the severe effects of societal and internalized stigma and the lack of interventions to help Veterans with PTSD overcome stigmas associated with PTSD symptoms, experiences, diagnoses or treatment, this proposal has the potential for high and lasting impact. In keeping with pilot effects of the core ESS curriculum, we anticipate that Veterans participating in the tailored ESS for PTSD (ESS-P) may experience increased empowerment and behavioral activation regarding a variety of life goals. Such benefits would further the VA's commitment to improving the mental health, Recovery, and community reintegration of Veterans detailed in the 2010-2014 VHA Strategic Plan42.

描述（由申请人提供）： 背景：PTSD1-2的退伍军人普遍存在污名和对污名的恐惧，并且都对退伍军人的福祉和参与心理健康治疗有恶性影响2-4。内部化的污名是社会污名的有害后果，并且与希望，自尊，个人动机，士气，自我责任和持久性的疾病管理有关的人的疾病管理下的疾病管理下降，患有一系列精神疾病的人5-14。内部化的污名也对具有PTSD的退伍军人的恢复和福祉具有负面影响15，但是目前尚无基于证据的干预措施来帮助退伍军人使用PTSD来应对内部化污名的影响。因此，该提案的目的是开发和试点测试干预措施，以向退伍军人提供PTSD技能 有效地应对污名并减轻污名化信念和刻板印象的内在化。为此，我们将修改结束自我污名（ESS），这是一种由基于证据的策略组成的干预措施，用于打击内在的精神疾病污名16，以专门满足PTSD的退伍军人需求。目的：该提议的为期两年的飞行员的两个目标是1）修改现有的ESS干预措施，以解决具有PTSD的退伍军人经历的内部化和社会污名和2）2）2）2）对64名退伍军人进行PTSD诊断的退伍军人的ESS-P随机试验试验，以测试我们的PTIS eSS-P的效率，以表明我们的PRITATION，该假设是满足的，并且可以满足型号的效率，并满足a）a），a）满足了a）a）。干预会议和参与者报告的干预措施的可接受性； b）与接受信息手册的对照组相比，ESS-P参与者将显着降低立即治疗后的内在污名，c）与接受信息小册子的对照组相比，ESS-P参与者将显示自我效能显着提高，在恢复后的恢复症状增加和DEST在ISS的恢复方面增加，而DEST的恢复率会增加，而DEST的恢复率会增加，而DEST又会在对照组中增加和D），并且在对照组中进行了对照组，而DEST的恢复阶段与DEST率相比，与DEST的恢复率相比，与DEST的治疗相比，与DEST的治疗相比，与DEST的治疗相比，与D）相比，与DEST的恢复性相比）治疗后几个月与基线前三个月。方法：我们的提案将分为两个阶段，将其映射到我们的两个研究目的。在第一阶段，我们将根据现有ESS干预措施的策略和结构制作了ESS（ESS-P）的PTSD版本的干预措施和随附的手册。为此，我们将采访具有PTSD诊断的退伍军人，以更多地了解他们与PTSD相关的社会和内部污名的经验，以及其他考虑与此类退伍军人的内在污名方面的考虑和问题。在这些定性访谈中收集的信息将构成我们改编ESS干预措施的基础，以专门满足PTSD的退伍军人需求。在第二阶段，我们将与拥有PTSD的退伍军人进行测试，以评估干预措施的可行性和可接受性。此外，我们将初步估计ESS-P与接受信息册对与PTSD相关的内部污名的对照组进行比较，从而估计ESS-P的影响。这些可行性，实施和试点结果数据将用于进一步完善干预措施，目的是在VA系统中进行ESS-P的未来大规模研究。影响：鉴于社会和内在污名的严重影响以及缺乏干预措施来帮助退伍军人克服与PTSD症状，经验，诊断或治疗相关的污名，因此该提案有可能产生较高和持久的影响。为了与核心ESS课程的试点效应保持一致，我们预计参加PTSD量身定制的ESS（ESS-P）的退伍军人可能会经历有关各种生活目标的增强能力和行为激活。这种好处将进一步提高VA对改善2010 - 2014年VHA战略计划中详细详细介绍的退伍军人的心理健康，恢复和社区重返社会的承诺。