The Development of a Transdiagnostic Intervention to Improve Social Functioning and Intimate Relationships Among Veterans

About This Grant

The proposed Career Development Award (CDA-2) would support Dr. Hannah Grigorian, Advanced Postdoctoral Fellow within the VISN 1 New England Mental Illness Research, Education, and Clinical Center (MIRECC) in her transition to independence as VHA researcher with a focus on transdiagnostic interventions for intimate partner violence (IPV) use. Romantic partnerships greatly impact mental and physical wellness. However, these vital relationships are frequently put at risk by the use of IPV by Veterans. In the past year alone, up to 90% of Veterans endorsed psychological IPV use (e.g., threats) and 30% endorsed physical IPV use (e.g., choking). As a prevalent and detrimental problem, interventions are gravely needed that consider primary drivers of IPV use: internal emotional processes and intimate relationship functioning (e.g., intimacy, communication, conflict resolution). Intervention development holds particular importance for Veterans who have few treatment options and present with distinct risk factors. For instance, co-occurring PTSD and alcohol misuse (i.e., hazardous alcohol use or alcohol use disorder; AUD) exacerbate risk for intimate relationship dysfunction and IPV use among Veterans through overlapping processes (e.g., emotional numbing, social erosion, increased threat perception). Despite high prevalence of co-occurrence and well-defined impact on IPV use risk, Veterans with PTSD and alcohol misuse are not well served by current IPV use interventions or evidence-based practices for co-occurring disorders. Existing VHA IPV use interventions either silo Veterans to alcohol use programming before violence intervention or do not provide tailored, individual programming With these limitations, existing referral lines for IPV increase likelihood for dropout and evidence higher rates of IPV use following treatment. Further, while evidenced based interventions for PTSD and alcohol misuse show distinct promise in symptom reduction, they do not necessarily improve psychosocial functioning. A new intervention is needed which can provide individualized treatment for Veterans with PTSD and alcohol misuse targeting intimate relationship functioning and IPV reduction. Acceptance and Commitment Therapy (ACT) is a promising avenue for intervention development. Increasing "psychological flexibility" via ACT, or value-driven functioning in the presence of challenging internal experiences, addresses a transdiagnostic process spanning across PTSD, alcohol misuse, intimate relationship functioning, and IPV use. The proposed five year RR&D CDA The Development of a Transdiagnostic Intervention to Improve Social Functioning and Intimate will adapt existing ACT treatments to Veterans with PTSD and alcohol misuse who use IPV. Over the course of the award period, the applicant will develop, refine, and pilot this individual, manualized treatment called: ACT for Social Health, Achievement, and Relationship Effectiveness (ACT- SHARE). The three aims of the current proposal are informed by Stage 1A of the Behavioral Therapy Development Model. Phase 1 aims to adapt existing ACT protocols in collaboration with Veteran and provider stakeholder feedback while phases 2 and 3 utilize iterative piloting. Phase 2 will serve as an initial field test of ACT-SHARE with an emphasis on ongoing feedback and the development of therapist rating forms and training programs. Phase 3 will pilot the adapted intervention, full trial procedures, and training and rating procedures. Primary aims include feasibility and acceptability with exploratory aims examining change scores (e.g., IPV use) and candidate processes. This CDA-2 will directly support an RR&D MERIT proposal to conduct a fully-powered RCT (Stage 2) and will provide invaluable training and mentorship in the following areas: IPV intervention development, PTSD and alcohol misuse research, qualitative methodologies, conducting clinical trials, and VA leadership. In sum, the current proposal is well suited to transition Dr. Grigorian into an independent, IPV researcher developing tailored interventions within the VHA.