G.R.I.T. - Goal-directed Resilience Intervention Training
Condition: Chronic Post-Traumatic Stress Disorder
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      This research program has addressed three reactive adaptations evident in pain, PTSD, and
      obesity. In this project, the focus will be on PTSD as a model of stimulus-based reactive
      responses to unpredictability or threat, and the investigators propose to test the efficacy
      of the goal-directed skills training (GRIT) program for restoring predictive responding and
      homeostasis. The challenge of how best to cultivate psychological resilience in the face of
      stress, trauma, and social adversity among disadvantaged populations is a complex question
      best answered with a translational research approach. This research' intent is to help
      African American women who are dealing with stress after traumatic experiences. It will
      specifically study Post-traumatic Stress Disorder, a disorder that affects people who have
      experienced severe traumas. It is associated with a number of overwhelming emotional
      symptoms. These include sleep difficulties, depression and anxiety, flashbacks and nightmares
      of the traumatic events.

      The training is an 8-week skill building program that helps people use positive experiences
      from their past to cope with current difficulties. The investigators will collect blood
      samples for future research to understand how the body's stress response changes as a result
      of this training
    

Detailed description: 
      This project will utilize an intervention that is to encompass tenets of the New Wave
      therapies in two important respects:

        1. The project's emphasis is on capacity development. The project's focus reaches beyond
           symptoms to restore and build resilience strengths that nurture in the face of
           challenge. The concept of resilience first entered the psychological and psychiatric
           literature with the study of children suffering from stress and disadvantage who,
           nevertheless, were functioning well. Protective factors included the presence of caring
           adults and achievement at school . Bonds and achievement have remained the most
           persistent findings in decades of research .

        2. The investigator's aim is to restore and build capacities displaced by symptoms. This
           will be accomplished by identifying the lost capabilities in narratives of survival and
           identifying neuroscience models that capture symptoms and lost capacities as
           bio-behavioral response systems that become visible in extreme environments. Narratives
           of exceptional survival in extreme situations are characterized by engagement with their
           circumstances in ways that kept individuals well, by social relatedness, and by an
           efficient stress response . For example, while imprisoned in the Hanoi Hilton, Robert
           Shumaker built a dream house and counted the feet of lumber and number of nails that
           would needed. Fellow inmates also developed a tapping code to communicate with each
           other. Thus, Shumaker was engaged, was socially connected through tapping and, while
           engaged, was not hyper-responsive to the threat around him. The positive survival
           responses are a marked contrast to the symptoms of PTSD described earlier, such as
           hyperarousal or intrusive thoughts. What distinguishes resilient adaptation in extreme
           situations from PTSD is that the resilient activities are characterized by goal-directed
           actions while PTSD is characterized by stimulus-driven responses. The distinction of
           goal-directed versus stimulus-based responding is extensively developed in the
           neuroscience and cognitive literature. Action research has identified intention-based
           and stimulus-based actions in which self-initiated actions involve brain mechanisms and
           cognitive processes distinctly different from reflexive or responsive movement.

      Broadly conceived, humans have two types of responses to the environment: they act to achieve
      results or goals in the environment, thus changing the environment, or they respond to and
      accommodate the demands of the environment and are changed by it. This distinction has its
      parallels in other areas of human functions. Attention studies have identified voluntary
      control of attention (endogenous) that is goal-directed versus automatic reflexive control
      (exogenous) in which external objects or events claim a subject's attention. A number of
      cortical models are relevant to goal-directed action and stimulus-based responding, among
      them the work on intention and reactivity by Astor-Jack and Haggard or the studies of Hannus
      and colleagues on stimulus-driven and user-driven control of visual attention.

      Perhaps most relevant is the predictive and reactive control system (PARCS) developed by Tops
      and colleagues.

      These two basic bio-behavioral programs control behavior in different environments, the
      reactive program being most adaptive in unpredictable environments and the predictive program
      most effective in highly predictable environments. The reactive program is guided by
      momentary feedback from the environment and responses are close in time and space. The
      predictive program guides behavior in a feed-forward manner that plans for the future,
      simulates alternatives, and makes predictions. In PTSD, stimulus-based responding prevails
      and displaces goal-directed responding at multiple levels of functioning: cortical,
      endocrine, affective, cognitive - indeed, the entire bio-behavioral system of predictive
      responding.

      The abundant research on goal-directed action versus stimulus-based responding has few
      parallels in clinical psychology or psychiatry. Hints emerge in eudamonic well-being that is
      goal-directed and required for challenging situations and goal-relevant motivational
      constructs of self-efficacy or locus of control. This study draws on the extensive
      neuroscience framework to formulate a model of resilient and traumatic responses and proposes
      an approach that restores goal-directed responding that will simultaneously reduce the
      dominance of stimulus based symptoms of PTSD. This is a 5 year study with the anticipation of
      148 enrolled.
    

Intervention name(s): Intervention Training; Control Condition
Intervention type(s): Behavioral; Behavioral
Intervention description(s): After pre-testing and randomization, intervention participants will meet in small groups for 60 minutes/week over eight weeks for resilience training. Participants needing extra help will receive it at the end of each session. Controls will be on a minimal attention list, not being trained. After eight weeks, all participants will be post-tested.; While intervention participants receive resilience training, the control group will not receive training but will receive minimal attention of a bi-monthly telephone call to indicate to participants that they are still enrolled in the study. A monthly flyer will be mailed to them about wellness and PTSD in recent news coverage. Following completion of an intervention group, participants and controls will be scheduled for post-testing that will be identical to the pre-testing and will occur within two weeks after the final treatment session. After the post-testing and 3-month follow up testing, the controls will be offered the resilience training.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Other
Keywords: PTSD; Elevated Cardiovascular Disease risk; Resilience