The COVID-19 pandemic facilitated simultaneous paradigm shifts in healthcare delivery: virtual care (telehealth and videoconferencing) and the need for “Whole Person” healthcare that targets mind, body, and spirit, per recent US Surgeon General1 and National Academy of Medicine2 calls-to-action. The pandemic also highlighted treatment delivery inequities involving rural Veterans. The current proposal will address these trends, assessing virtual VA Whole Health care use in Primary Care-Mental Health Integration (PC-MHI) for rural and non-rural Veterans with chronic pain and co-occurring posttraumatic stress disorder (PTSD).
Targeted Condition: PTSD
Complementary and integrative health stepped care for co-occurring chronic pain and PTSD
The aim of the project is to conduct a pragmatic pilot trial of a CIH-based stepped care approach v. treatment as usual in two primary care settings (one rural and one urban). The pilot trial will focus on feasibility, acceptability, and appropriateness for providers and patients (e.g., randomization, retention, and treatment satisfaction) of the stepped care approach versus usual care (n=30 per site, N=60 total). Primary clinical outcomes are pain interference and PTSD symptoms at 6-months.
Event- related potential (ERP) as a biomarker for subtyping neurobiology of PTSD: A pilot study
This PTSD-focused methods-development EEG project aims to develop new tools for a) predicting PTSD treatment response, b) understanding the underlying biological process, and c) supporting the development of new treatments for PSTD. We are using an event-related potential (ERP) paradigm to develop non-invasive, easily implemented in clinic biomarker to provide useful information about the neurobiology of PTSD. The specific goals are to 1) collect ERP data within a veteran population before and after treatment with methylphenidate, 2) design data analysis methods that maximize available data, and 3) add to ongoing effort of translating technological advancements for PTSD research.
Willow Study
The goal of this study is to understand the impact of stigma on mental health and recovery from trauma in different parts of the country.
Sequenced Treatment Effectiveness for Posttraumatic Stress (STEPS)
The proposed research will determine whether primary care clinics should offer medications or talk therapy first to treat posttraumatic stress. In addition, for patients who do not respond to the first treatment, the STEPS trial will determine what treatment should be offered next. More information on our info sheet.
Biomarkers in the retina for prognosticating mental health treatments (BRIGHT)
This clinical trial is designed to pilot an electroretinogram (ERG) biomarker for predicting treatment response to SSRIs in PTSD. Serotonergic brain centers project to the retina, and ERG allows assessment of brain serotonergic signals via retinal signals. In this study we are characterizing the ERG waveform in veterans with PTSD before and after SSRI administration. Patients then enter an open label phase of the study, with those who have initiated an SSRI through routine medication management invited back for a follow up study visit. This pilot data will: 1)be valuable as a feasibility study for assessing the practical application of ERG in the setting of a mental health clinic and 2)serve as a foundation for a long-term goal of developing physiologic biomarkers to match veterans to corresponding pharmacological treatments in PTSD and other mental health disorders.
Alcohol-focused Support of Survivors In Sororities Training (ASSIST)
The purpose of this study is to develop and evaluate a new online program called ASSIST – Alcohol-focused Support of Survivors In Sororities Training. The training is designed to help sorority members learn how to support friends who have had an unwanted sexual experience, both during the initial discussion of the experience and when navigating recovery in the longer-term. This multiphase study involves (1) developing the training in collaboration with students and campus stakeholders, (2) improving the training content and design through individual interviews with sorority members, (3) conducting an open trial of the training within one chapter, and then (4) conducting a pilot cluster randomized trial to evaluate feasibility and initial efficacy of the training. If found to be effective, this training could be widely disseminated and facilitate positive change in social contexts where survivors recover.
Identity, Resilience, and Interconnection after Stress (IRIS)
The IRIS Study is a longitudinal examination of young adults who have experienced an unwanted sexual experience in the past year, and those who have never had an unwanted sexual experience. This study aims to prospectively examine how young adults’ thoughts about a recent unwanted sexual experience are shaped by and influence social relationships and health-related behaviors over time. To do so, this multimethod study involves in-depth interviews, social network assessments, ecological momentary assessments, transdermal alcohol biosensors, and online surveys over one year. This study is conducted by researchers at both the University of Washington and the University of Nebraska-Lincoln.
THRIVE Study
This is a study of an app intended to support recent sexual assault survivors, called THRIVE. In a prior grant, we pilot tested THRIVE and found that it reduced risk for alcohol misuse and posttraumatic stress. In the first year of this grant, we aim to revise the app to increase usability and inclusivity. In the second through fifth years of the grant, we will conduct a larger randomized controlled trial of multiple versions of the app among college students who have experienced sexual assault in the past 12 weeks. This will allow us to identify the most effective and low-burden version of THRIVE. If we are successful in identifying a highly effective and efficient version of THRIVE, this intervention would represent a highly-scalable strategy to reduce the substantial burden of posttraumatic stress and alcohol misuse on student survivors and campus service systems.
Patient Readiness for Improvement through Motivation, Engagement, and Decision-making for PTSD (PRIMED-PTSD)
PTSD is one of the most common mental health conditions affecting Veterans and is associated with significant burden. Highly effective treatments exist for PTSD, evidence-based psychotherapies, but very few Veterans receive them. Although VA has trained over 8,500 providers in evidence-based psychotherapies for PTSD over the past 10 years, only 6% of the 650,000 VHA patients with PTSD receive an evidence-based psychotherapy. It is critical that we connect Veterans with our most effective PTSD treatments and that we do so in a way that is Veteran-centered. Shared decision making is a patient-centered approach to choosing healthcare treatment options. It has been shown to increase patients’ motivation for treatment and ability to stay in treatment long enough to get benefit. It has also been shown to help providers align their practice with evidence-based guidelines. This proposal will refine and pilot test a shared decision making intervention for PTSD to be used in VA primary care clinics, where the vast majority of Veterans with PTSD are treated.
