Posttraumatic stress disorder (PTSD), depression, alcohol use disorders (AUD), traumatic brain injury, and chronic pain frequently co-occur among post-9/11 war Veterans and are associated with functional impairment and suicide risk. Yet, no treatment exists [that was specifically designed] to promote functional recovery in Veterans experiencing any combination of these most common mental and physical wounds of war. This is the re-submitted proposal for a second competitive renewal to fund Phase 3 of Project SERVE (Study Evaluating Returning Veterans? Experiences). In Phase 1 (RX000304-01A1), we identified risk and resilience factors for deployment-related mental health conditions regardless of whether those factors were modifiable. In Phase 2 (RX000304-04A1), we refined our approach by focusing on modifiable predictors drawn from the treatment outcomes literature. The over-arching aim of this programmatic line of research is to inform the development of evidence-based prevention and treatment programs designed to assist returning Veterans with achieving optimal functioning upon reintegrating into civilian life. This vision comes to fruition in the proposed Phase 3, which proposes both to extend the longitudinal study (Aim 1) and to adapt, refine, and pilot test an intervention to promote functional recovery (Aim 2). The 2-year longitudinal study (N = 500) will examine novel factors (e.g., mindfulness, perceived burdensomeness, thwarted belongingness, moral injury) and established treatment targets (psychological flexibility, self-compassion, emotion regulation) in relation to latent class trajectories of functional impairment, and as predictors of risk for self-directed violence (SDV; i.e., suicide risk), which is a top priority for VA and RR&D. In the prior Phases, we established psychological inflexibility as a robust risk factor for mental health problems, functional impairment, and SDV. Thus, in Aim 2, using a Successive Cohort Design, we will adapt, refine [based on Veterans? feedback], and pilot-test an adapted evidence-based intervention, Acceptance and Commitment Therapy (ACT) that targets psychological flexibility to promote functional recovery (ACT-FX). We previously demonstrated the promise of ACT, a transdiagnostic, mindfulness and acceptance-based behavior therapy aimed at improving functioning by increasing psychological flexibility with Veterans with co-occurring PTSD-AUD. We will test the feasibility and acceptability of ACT-FX, [an individually-tailored intervention to promote functional recovery related to these commonly co-occurring conditions as compared to mental health treatment as usual (TAU) in 60] Veterans with moderate-to-severe functional impairment. Our ultimate goal is to help shift chronically impaired Veterans to a recovery trajectory. Integrating data from the longitudinal study (Aim 1) with data from the treatment study (Aim 2), we will conduct a preliminary test of whether ACT-FX is associated with functionally impaired Veterans moving to a latent class trajectory characterized by long-term recovery (Aim 3; Exploratory).

Public Health Relevance

While resilience is the norm, many of our nation?s post-9/11 Iraq and Afghanistan war Veterans struggle with impaired social and occupational functioning related to posttraumatic stress disorder, depression, alcohol use disorders, traumatic brain injury, and chronic pain, conditions that frequently co-occur. Crucially, these conditions also increase risk for suicide. We plan to continue following a cohort of post-9/11 Veterans for two additional years to identify novel, modifiable predictors of long-term functional impairment and suicide risk. In addition, we will use what we have learned in our prior research phases to adapt, refine based on Veterans? feedback, and pilot test a psychological treatment specifically designed to promote long-term functional recovery among Veterans experiencing any combination of these mental and physical wounds of war.

Agency
National Institute of Health (NIH)
Institute
Veterans Affairs (VA)
Type
Non-HHS Research Projects (I01)
Project #
2I01RX000304-08A1
Application #
9613560
Study Section
Behavioral Health & Social Reintegration (RRD4)
Project Start
2010-06-01
Project End
2022-09-30
Budget Start
2018-10-01
Budget End
2019-09-30
Support Year
8
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Olin Teague Veterans Center
Department
Type
DUNS #
029847394
City
Temple
State
TX
Country
United States
Zip Code
76504
Kimbrel, Nathan A; Wilson, Laura C; Mitchell, John T et al. (2017) ADHD and nonsuicidal self-injury in male veterans with and without PTSD. Psychiatry Res 252:161-163
Martindale, Sarah L; Morissette, Sandra B; Kimbrel, Nathan A et al. (2016) Neuropsychological functioning, coping, and quality of life among returning war veterans. Rehabil Psychol 61:231-9
Konecky, Brian; Meyer, Eric C; Kimbrel, Nathan A et al. (2016) The structure of DSM-5 posttraumatic stress disorder symptoms in war veterans. Anxiety Stress Coping 29:497-506
Dahm, Katherine A; Meyer, Eric C; Neff, Kristin D et al. (2015) Mindfulness, Self-Compassion, Posttraumatic Stress Disorder Symptoms, and Functional Disability in U.S. Iraq and Afghanistan War Veterans. J Trauma Stress 28:460-4
Elliott, Timothy R; Hsiao, Yu-Yu; Kimbrel, Nathan A et al. (2015) Resilience, traumatic brain injury, depression, and posttraumatic stress among Iraq/Afghanistan war veterans. Rehabil Psychol 60:263-76
Wilson, Laura C; Kimbrel, Nathan A; Meyer, Eric C et al. (2015) Do child abuse and maternal care interact to predict military sexual trauma? J Clin Psychol 71:378-86
Wilson, Laura C; Simmons, Brittany L; Leheney, Emma K et al. (2015) Does military sexual trauma moderate the impact of critical warzone experiences? Psychiatry Res 229:596-8
Hiraoka, Regina; Meyer, Eric C; Kimbrel, Nathan A et al. (2015) Self-Compassion as a prospective predictor of PTSD symptom severity among trauma-exposed U.S. Iraq and Afghanistan war veterans. J Trauma Stress 28:127-33
Kimbrel, Nathan A; Morissette, Sandra B; Meyer, Eric C et al. (2015) Effect of the 5-HTTLPR polymorphism on posttraumatic stress disorder, depression, anxiety, and quality of life among Iraq and Afghanistan veterans. Anxiety Stress Coping 28:456-66
Kimbrel, Nathan A; Gratz, Kim L; Tull, Matthew T et al. (2015) Non-suicidal self-injury as a predictor of active and passive suicidal ideation among Iraq/Afghanistan war veterans. Psychiatry Res 227:360-2

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