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| ID | Type | Description | Link |
|---|---|---|---|
| W81XWH-12-PHTBI-CA | Other Grant/Funding Number | VA Clincial Science Research and Development |
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Impulsive aggression (IA) is common among Veterans with posttraumatic stress disorder (PTSD), and PTSD is one of the most prevalent post deployment mental health conditions affecting Afghanistan and Iraq Veterans. An inability to manage one's emotions (emotion dysregulation) is an underlying mechanism of IA. Reducing IA and increasing use of PTSD evidence-based psychotherapies are two critical missions for the Veterans Health Administration.
This research supports these missions by providing a 3-session emotion regulation training (Manage Emotions to Reduce Aggression) to Veterans in order to teach them how to manage emotions and prepare for PTSD treatment. This is an open trail, so all Veterans who meet the inclusion criteria will be allowed to receive the treatment. Each Veteran's level of aggression and emotion dysregulation will be measured at the beginning and end to the treatment. By enhancing Veterans' abilities to cope with trauma-related emotions and feel equipped to initiate PTSD treatments, this research aims to help Veterans decrease IA and ultimately recover from PTSD.
In this pilot study for the Consortium to Alleviate PTSD, Shannon Miles, PhD, of the James A. Haley Veterans' Hospital in Tampa, Florida, and her study team will work with post-9/11 combat Veterans with PTSD and impulsive aggression. The Veterans will be identified as having impulsive aggression if they report having engaged in at least three episodes of aggression within the past month. The investigators will provide training in emotion regulation via an innovative three-session training called Managing Emotions to Reduce Aggression, or MERA.
The goal of the pilot study is to test the feasibility of MERA in reducing impulsive aggression. A secondary goal is to prepare Veterans for psychotherapy for PTSD. One reason that too few Veterans seek PTSD treatment may be that they fear that they will not be able to control their emotional responses when they begin treatment. The investigators for this study believe that equipping Veterans with emotion regulation skills and knowledge about PTSD treatments may help them initiate, complete, and benefit from evidence-based psychotherapies.
MERA is provided in a three-session, condensed time frame to make it accessible to Veterans whose careers, school, and families compete with treatment time. The training is delivered in a group format and incorporates emotion education, cognitive-behavioral and acceptance-based skills training, and information about what emotional experiences to expect from PTSD treatments. Study participants will undergo weekly assessments for emotion regulation and aggression. Following the MERA training, study participants will be followed by CAP investigators to monitor whether they seek out, receive, and complete evidence-based psychotherapies for PTSD.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Open Trial | Other | All Veterans will receive the same emotion regulation treatment titled, Manage Emotions to Reduce Aggression. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Manage Emotions to Reduce Aggression (MERA) | Behavioral | MERA is a 3-session group treatment that teaches Veterans the purpose of emotions, how trauma and combat can increase emotions, and how to better regulate them. The skills use cognitive-behavioral and mindfulness techniques to help Veteran better regulate their emotions. These skills are commonly used in clinical practice, but have not been delivered in 3 sessions. |
| Measure | Description | Time Frame |
|---|---|---|
| Overt Aggression Scale | The Overt Aggression Scale (OAS) is a 17-item self-report measure that assesses frequency of different aggression acts, including verbal and physical aggression against self, other, and objects. Theoretical minimum score = 0; there is no bounded maximum value. Higher values = greater frequency of aggression. | Given 3 weeks after last MERA session. Assess aggressive events in past week. |
| Total Score Difficulties in Emotion Regulation Scale | The Difficulties in Emotion Regulation Scale (DERS) is a 36- item self-report measure with 6 different emotion-dysregulation factors: nonacceptance of emotional responses, difficulties engaging in goal-directed behaviors, impulse-control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity. Total score was used in this study. Theoretical minimum value = 36; theoretical maximum value = 180. Higher scores indicate worse emotion regulation. | Given 3 weeks after last MERA session. Assess emotion dysregulation in past month. |
| Emotion Regulation Questionnaire | ERQ is a 10-item self-report measure with 2 factors that assess specific emotion regulation strategies: cognitive reappraisal (6 items; changing the way one thinks about a situation) and expressive suppression (4 items; not expressing the emotion outwardly but feeling it internally). More effective emotion regulation is indicated by higher cognitive reappraisal scores and lower expressive suppression scores. Theoretical minimum score for cognitive reappraisal = 6; theoretical maximum score = 42. Theoretical minimum score for expressive suppression = 4; theoretical maximum score = 28. | Given 3 weeks after last MERA session. Assess emotion regulation strategies used in past week. |
| Exit Interview - Ratings of Therapist and Treatment | The exit interview was created by the study team and has 3 questions that asks: 1.) how understanding the therapist was, 2.) how helpful the therapist was in learning skills, and 3.) how helpful MERA was in managing emotions. Scale for all questions:
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Inclusion Criteria:
Male Veteran who served in Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND)
Currently meets criteria for a PTSD diagnosis, determined by the Clinician-Administered PTSD Scale-5
Engaged in at least 3 self-reported impulsive aggression acts in the last month, measured by the Overt Aggression Scale.58:
Impulsive aggression is his/her primary form of aggression, determined by having a higher Impulsive Aggression subscore than a Premeditated Aggression subscore on the Impulsive Premeditated Aggression Scale
Because aggressors are poor historians when reporting their aggression frequency, each Veteran must agree to allow an independent aggression rater (live-in partner, family member, or roommate) verify the number of aggressive acts, using the Overt Aggression Scale
No psychotropic medication change for six weeks prior to the assessment and agreement not to ask for a medication change for the duration of the study
Exclusion Criteria:
Veterans who meet the following criteria will be excluded:
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| Name | Affiliation | Role |
|---|---|---|
| Shannon R. Miles, PhD | James A. Haley Veterans' Hospital, Tampa, FL | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| James A. Haley Veterans' Hospital, Tampa, FL | Tampa | Florida | 33612 | United States |
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| Label | URL |
|---|---|
| Click here for more information about this study: CAP - Using Emotion Regulation to Decrease Aggression in Veterans with PTSD | View source |
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| ID | Title | Description |
|---|---|---|
| FG000 | Open Trial | All Veterans will receive the same emotion regulation treatment titled, Manage Emotions to Reduce Aggression. Manage Emotions to Reduce Aggression (MERA): MERA is a 3-session group treatment that teaches Veterans the purpose of emotions, how trauma and combat can increase emotions, and how to better regulate them. The skills use cognitive-behavioral and mindfulness techniques to help Veteran better regulate their emotions. These skills are commonly used in clinical practice, but have not been delivered in 3 sessions. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Open Trial | All Veterans will receive the same emotion regulation treatment titled, Manage Emotions to Reduce Aggression. Manage Emotions to Reduce Aggression (MERA): MERA is a 3-session group treatment that teaches Veterans the purpose of emotions, how trauma and combat can increase emotions, and how to better regulate them. The skills use cognitive-behavioral and mindfulness techniques to help Veteran better regulate their emotions. These skills are commonly used in clinical practice, but have not been delivered in 3 sessions. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Overt Aggression Scale | The Overt Aggression Scale (OAS) is a 17-item self-report measure that assesses frequency of different aggression acts, including verbal and physical aggression against self, other, and objects. Theoretical minimum score = 0; there is no bounded maximum value. Higher values = greater frequency of aggression. | 22 participants completed the treatment. 20 participants returned for the post-treatment assessment. | Posted | Mean | Standard Deviation | events | Given 3 weeks after last MERA session. Assess aggressive events in past week. |
|
AE data were collected after the consent form was signed until the post-treatment assessment, an average of 10 weeks.
We considered any clinically significant deterioration in physical, psychological, mental, cognitive, or psychosocial health status of the subject as a change from baseline as an AE. We did not use specific Adverse Event Terms.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Open Trial | All Veterans will receive the same emotion regulation treatment titled, Manage Emotions to Reduce Aggression. Manage Emotions to Reduce Aggression (MERA): MERA is a 3-session group treatment that teaches Veterans the purpose of emotions, how trauma and combat can increase emotions, and how to better regulate them. The skills use cognitive-behavioral and mindfulness techniques to help Veteran better regulate their emotions. These skills are commonly used in clinical practice, but have not been delivered in 3 sessions. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hospitalization | Blood and lymphatic system disorders | Systematic Assessment | Diagnosed with cancer |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Shannon Miles | James A. Haley Veterans' Hospital | 813-972-2000 | 6728 | shannon.miles@va.gov |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jan 8, 2018 | Dec 3, 2018 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D013313 | Stress Disorders, Post-Traumatic |
| D000374 | Aggression |
| D000080103 | Emotional Regulation |
| ID | Term |
|---|---|
| D040921 | Stress Disorders, Traumatic |
| D000068099 | Trauma and Stressor Related Disorders |
| D001523 | Mental Disorders |
| D000096762 | Aberrant Motor Behavior in Dementia |
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| Given 3 weeks after last MERA session. |
| Exit Interview - Use of Skills | The exit interview was created by the study team and has 8 questions that asks: 1.) "Are you using _____skill?". Scores = percentage of the sample that was using the skill during the week before the post treatment assessment. Percentages could range from 0% to 100% of the sample. Higher scores represent more of the sample using the skill. | Given 3 weeks after last MERA session. Assess emotion regulation strategies used in past week. |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Self-reported ethnicity | Count of Participants | Participants |
|
| Number of Overt Aggression Scale | Frequency count of aggressive acts in the past week. Theoretical minimum score = 0; no limit on maximum value. Higher values = greater frequency of aggression | Mean | Standard Deviation | events |
|
| Difficulties in Emotion Regulation | Total score was used in this study. Theoretical minimum value = 36; theoretical maximum value = 180. Higher scores indicate worse emotion regulation. | Mean | Standard Deviation | units on a scale |
|
| Emotion Regulation Questionnaire | The ERQ is a self report measure with 2 factors that assess specific emotion regulation strategies: cognitive reappraisal (6 items; changing the way one thinks about a situation) and expressive suppression (4 items; not expressing the emotion outwardly but feeling it internally). More effective emotion regulation is indicated by higher cognitive reappraisal scores and lower expressive suppression scores. Cognitive reappraisal theoretical minimum score = 6; maximum score = 42. Expressive Suppression theoretical minimum score = 4; maximum score = 28. | Mean | Standard Deviation | units on a scale |
|
|
|
| Primary | Total Score Difficulties in Emotion Regulation Scale | The Difficulties in Emotion Regulation Scale (DERS) is a 36- item self-report measure with 6 different emotion-dysregulation factors: nonacceptance of emotional responses, difficulties engaging in goal-directed behaviors, impulse-control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity. Total score was used in this study. Theoretical minimum value = 36; theoretical maximum value = 180. Higher scores indicate worse emotion regulation. | 22 participants completed the treatment. 20 participants returned for the post-treatment assessment. | Posted | Mean | Standard Deviation | score on a scale | Given 3 weeks after last MERA session. Assess emotion dysregulation in past month. |
|
|
|
| Primary | Emotion Regulation Questionnaire | ERQ is a 10-item self-report measure with 2 factors that assess specific emotion regulation strategies: cognitive reappraisal (6 items; changing the way one thinks about a situation) and expressive suppression (4 items; not expressing the emotion outwardly but feeling it internally). More effective emotion regulation is indicated by higher cognitive reappraisal scores and lower expressive suppression scores. Theoretical minimum score for cognitive reappraisal = 6; theoretical maximum score = 42. Theoretical minimum score for expressive suppression = 4; theoretical maximum score = 28. | 22 participants completed the treatment. 20 participants returned for the post-treatment assessment. | Posted | Mean | Standard Deviation | score on a scale | Given 3 weeks after last MERA session. Assess emotion regulation strategies used in past week. |
|
|
|
| Primary | Exit Interview - Ratings of Therapist and Treatment | The exit interview was created by the study team and has 3 questions that asks: 1.) how understanding the therapist was, 2.) how helpful the therapist was in learning skills, and 3.) how helpful MERA was in managing emotions. Scale for all questions:
| 22 participants completed the treatment. 20 participants returned for the post-treatment assessment. | Posted | Mean | Standard Deviation | score on a scale | Given 3 weeks after last MERA session. |
|
|
|
| Primary | Exit Interview - Use of Skills | The exit interview was created by the study team and has 8 questions that asks: 1.) "Are you using _____skill?". Scores = percentage of the sample that was using the skill during the week before the post treatment assessment. Percentages could range from 0% to 100% of the sample. Higher scores represent more of the sample using the skill. | 22 participants completed the treatment. 20 participants returned for the post-treatment assessment. | Posted | Count of Participants | Participants | Given 3 weeks after last MERA session. Assess emotion regulation strategies used in past week. |
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|
| 0 |
| 24 |
| 3 |
| 24 |
| 0 |
| 24 |
|
| Increase in symptoms | Psychiatric disorders | Systematic Assessment |
|
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| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
| D012919 | Social Behavior |
| D000068356 | Self-Control |
| Title | Measurements |
|---|---|
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| Title | Measurements |
|---|---|
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| Realistic thoughts |
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| Progressive muscle relaxation |
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| Visualization |
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| Recognizing emotions |
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| Increasing positive emotions |
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