Overview: I am applying for a five-year Career Development Award (CDA) to accelerate my growth as an independent VA Health Services researcher through mentored training and research activities. During the course of my award, I will develop and test an innovative intervention, promoting veterans'adherence to Prolonged Exposure (PE), through systematically involving intimate partners in veterans'care (i.e., Partner Enhanced PE, PE2). Career Plan: My graduate work and experiences as a VA HSR&D fellow focused on trauma, intimate relationships, and intervention research with intimate partner violence offenders. To successfully achieve my career goals, I need further mentored training and expertise in PE, qualitative research, randomized clinical trials, survey methodology, and examining family concerns among veterans with PTSD. I will achieve these objectives through formal coursework, seminars, clinical training, developing manuscripts for publication, and mentorship from Melissa Polusny, PhD (primary mentor;Minneapolis VA Health Care System, MVAHCS), Christopher Erbes, PhD (MVAHCS), Michele Spoont, PhD (MVAHCS), and Shelley MacDermid Wadsworth, MBA, PhD (Military Family Research Institute, Purdue University). Research Plan: Sequential research objectives will be used to develop PE2 and will cumulate in the submission of a HSR&D Investigator-Initiated Research (IIR) proposal to conduct a randomized clinical trial comparing standard PE to PE2. Objectives include, 1) Acquire insiders'perspectives to, (A) refine and expand a conceptual model of how intimate relationships facilitate or hinder adherence to PE, (B) develop hypotheses for best methods for involving intimate partners in PE. 2) Survey veterans referred for evidence based treatments for PTSD and their intimate partners to (A) assess patient adherence to exposure therapies, (B) describe veterans'and significant others'preferences for various types of adjunctive intervention components for enhancing adherence, and (C) test associations between conceptual model elements and treatment adherence and outcome. 3) Develop a Stage I treatment manual and pilot PE2 to refine the treatment protocol, identify strengths and flaws of the intervention, and assess feasibility, acceptability, and initial effect sizes of the treatment. These objectives will lead to an HSR&D IIR proposal submitted year 3 of my award, new knowledge advancing interventions for veterans with PTSD, and launching my career as an independent VA HSR&D investigator committed to veterans'health. Significance: Research evidence and opinion in the field highlight the urgent need for incorporating family members in treatments for PTSD. Untreated, symptoms of PTSD persist chronically for many, and for those who attend empirically supported treatments, poor adherence can greatly handicap participants'potential for recovery. Including partners in PE may provide a compelling means to promote adherence and optimize treatment response. Such family-centered approaches may promote better overall health, quality of life, and successful reintegration through maximizing treatment response and facilitating family adjustment. The agenda set in motion by this CDA supports a pivotal shift within the VA from a restrictive focus on traditional individual-level mental health treatments to family-centered, evidence based approaches that promote adherence, quality of life, family adjustment, and ultimately, better comprehensive care for veterans.
I am applying for 5 years of mentored training and research to develop a systematic method of involving intimate partners in Prolonged Exposure (PE) for PTSD (Partner Enhanced PE) to optimize treatment adherence and treatment outcome. During the course of this award, I will pursue a series of sequential research objectives to develop an evidence-based method of involving intimate partners in PE and obtain mentored training in conducting PE, qualitative research, randomized clinical trials, survey methodology, and examining family concerns among veterans with PTSD. This award will launch the pursuit of my larger career goal to lead a shift within the VA towards family-centered, evidence-based mental health care that promotes treatment adherence, quality of life, family adjustment, and ultimately, better comprehensive care.