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Innovations in Military Stress and Trauma Research

Innovations in Military Stress and Trauma Research. Overview of Litz Lab Research. Major Research Areas. Longitudinal epidemiology of the mental health toll long wars PTSD treatment innovation Making care more accessible / effective Early intervention trials in military.

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Innovations in Military Stress and Trauma Research

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  1. Innovations in Military Stress and Trauma Research Overview of Litz Lab Research

  2. Major Research Areas • Longitudinal epidemiology of the mental health toll long wars • PTSD treatment innovation • Making care more accessible / effective • Early intervention trials in military

  3. Epidemiological Issues: US Military / VA • No population studies in US • Sampling and context problems • Major methodological problems: • Cross-sectional designs • Mon0-method bias • Very narrow band of predictors • Exposure is conceptualized narrowly

  4. Marine Resilience Study • Prospective study of ~3K ground combat Marines • Study of risk and protective factors within and across systems: • Psychological and psychiatric • Genetic, biological and psychophysiological • Social (unit and family) • Environmental (stressor exposures) • PTSD evaluated with clinical interview (CAPS) • Rich set of predictors and outcomes • Extensive contact information \ permission • Funded by: Navy, VA, Marine Corps, VA HSR&D

  5. What Data Does MRS Collect? Four data collection time points: • Pre-deployment (4 hrs) • 1 week post-deployment (1.5 hrs) • 3 months post-deployment (4 hrs) • 6 months post-deployment (4 hrs)

  6. Trajectories of Adaptation to Combat and Operational Stress and Trauma Severe Moderate Very Low PTSD SYMPTOM BURDEN Chronic Course Delayed Course Recovery / Resilience Course Resistance Course Pre-Deployment 1-week 3-months 6-months Post-Deployment Post-Deployment Post-Deployment

  7. Adaptation To Frequent High Magnitude COS Over The Lifespan SYMPTOM BURDEN HIGH MODERATE LOW MRS CHRONIC DELAYED HIGH CHRONIC DELAYED MODERATE CHRONIC ENDURING RECOVERY / RESILIENCE Pre-militaryMilitary Career Retirement Very Old Age T I M E

  8. The Need For Treatment Innovation in Military Existing Evidence-Based Treatments • Failure to appreciate military culture • Need to show incremental validity: • Selection • Leadership • Training / preparation • Peer / family support • Trials among war veterans are poor • Few RCT’s with service members

  9. Innovations • Adaptive Disclosure Trial • Internet-based cognitive- behavioral therapies • Therapist-assisted / self- management • Self-help

  10. Adaptive Disclosure (AD) Therapy • Developed for Marines • A hybrid and extension of CBT • Designed to target life-threat, traumatic loss, and moral injury (shame, guilt, inner-conflict) • 6 sessions of exposure and a modified empty chair technique to activate and process emotions and meanings • Open Trial (N=65): PTSD symptom change d=.80 • RCT funded by DoD

  11. INTERVENTION: DESTRESSDElivery of Self-TRaining and Education for Stressful Situations • Internet-based, self-management CBT • 6-week, therapist-assisted, 18 logons • Self-monitoring; stress and affect management ; trigger management, trauma narrative, planning for long haul • Check-in, report, homework • Ad lib education, e-mail, phone-calls • Back-end oversight

  12. INITIAL TRIAL RESULTS Differential effect size =.95

  13. Internet-based Therapy Trials / Projects • DESTRESS-PC (DoD) • Stepped-care consortium in primary care (DoD) • Project HEAL (NIMH) • Wounded Warrior Project • Prevail • ….

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