Ariel J. Lang, Ph.D., M.P.H.; University of California San Diego Medical Center, PTSD/TBI INTRuST Clinical Consortium Award

The PTSD-TBI Clinical Consortium is a 5-year grant from the Department of Defense that was awarded through CDMRP, which is the Congressionally Directed Medical Research Program. Our grant funds a coordinating center, which is where I work, as well as 10 clinical trial sites around the country. And we were tasked with executing clinical trials to help to better understand how we might treat folks who have been impacted by post-traumatic stress disorder, traumatic brain injury, or their combination.

I'm the lead investigator for a trial that is looking at the performance of psychotherapy, one that's called Acceptance and Commitment Therapy. Acceptance and Commitment Therapy is an intervention that has received a lot of attention but has not necessarily been evaluated in veterans or in Active Duty military personnel in a rigorous way.

The value of this intervention is that it may be particularly useful for military personnel in that it may be fitting with military sort of philosophies. So in Acceptance and Commitment Therapy, we ask folks to reflect on the things that are really important to them and that may be their service to the country, it could be their values related to their family or their work, and we're asking them to look at the things that might be getting in the way of their behavior being concordant with those values.

And to the extent the way that they're acting doesn't fit with their values, we're asking them to reflect on that and to try to change their behavior in such a way that it is consistent with their values.

While it may not be necessarily any better than any other type of psychotherapy we have to offer, for some people that kind of a perspective may fit better. It may feel like more something that they want to do and that's very important in psychotherapy research.

For someone to really get the most out of psychotherapy, they have to feel like it's the right thing for them. You don't have to have much of an opinion about your pill, but when you're sitting with someone for week after week for an extended period of time doing psychotherapy it's most likely helpful if you feel like the things that you're being taught are consistent with your own values and the way you would see approaching a problem that you have.

We are doing a randomized clinical trial in veterans so we will be recruiting folks from various mental health clinics at VA Medical Centers across the country. We also will be doing the treatment in a group of Active Duty personnel at Walter Reed Army Medical Center. Although because we suspect that Active Duty personnel may in some ways have different needs or respond differently to psychotherapy, we're not attempting to randomize in that group and we're not attempting to really evaluate the effectiveness of the intervention in that group.

That group will more serve as a way for us to look at how comparable the response among Active Duty is to that among veterans, and then would be a springboard for a more detailed evaluation of Acceptance and Commitment Therapy or ACT in the Active Duty population.

When someone enrolls in our ACT trial, they'll begin with a pretreatment assessment battery, which is a very standard thing for a clinical trial. After that they will be randomized into one of two psychotherapies, ACT and our control psychotherapy. They will spend 12 weeks seeing a therapist either on-ideally we'd like them to be coming in twice a week, but we have some flexibility around that. And then they will be completing assessments again at the end of treatment and for up to a year after treatment. So we're interested in the degree of impact that the psychotherapies have on their symptoms during the course of the therapy as well as in how well those changes persist over time.

The value of the ACT trial will be to inform clinical practice around the country. If OEF-OIF veterans are returning, there's some question as to what is the best way to treat that person. So if my trial shows that ACT is an effective way to manage those folks then that provides an additional psychotherapy option. Similarly, some of our other trials will give more information about what kind of medications might be useful for those folks. So I think that my trial in particular and the group of trials presented by the consortium will inform care of our veterans and our Active Duty personnel.