G.R.I.T. - Goal-directed Resilience Intervention Training
| Status: | Not yet recruiting |
|---|---|
| Conditions: | Psychiatric, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 3/30/2019 |
| Start Date: | April 11, 2019 |
| End Date: | August 21, 2029 |
| Contact: | Priscilla Johnson, PhD, MSN |
| Email: | pjohnson@msm.edu |
| Phone: | 404-756-8827 |
Building Biobehavioral Goal-Directed Resilience Training Among African American Women (Project Grit)
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 a 6-week skill building program that helps people use positive experiences
from their past to cope with current difficulties. The investigators will collect blood and
saliva samples for future research to understand how the body's stress response changes as a
result of this training
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 a 6-week skill building program that helps people use positive experiences
from their past to cope with current difficulties. The investigators will collect blood and
saliva samples for future research to understand how the body's stress response changes as a
result of this training
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.
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.
Inclusion Criteria:
- African American ( self-identified)
- Diagnosis of PTSD
- Between the ages of 18-64 other illnesses due to aging, cognitive declines due to
aging, retirement change in life demands at age 65.
- Able and willing to provide consent
Exclusion Criteria:
- Active suicidality
- Active alcohol and substance use of moderate or severe levels of severity
- Psychosis
- Current severe disabling illness( recent surgery, impending surgery, extreme pain
interfering with participation)
- Unable to meet attendance requirements:limit of 1 missed session of the 5.
- Not engaged in other therapies for PTSD, cognitive behavior therapy, exposure therapy
and reprocessing therapy.
- Unable to participate in small group interactive setting.
We found this trial at
2
sites
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