Syracuse VAMC, USA.
J Pastoral Care Counsel. 2020 Jun;74(2):99-107. doi: 10.1177/1542305020919684.
Outcome literature has shown poor treatment engagement in efficacious, evidence-based post-traumatic stress disorder (PTSD) programs among returning veterans with combat-related psychological symptoms and calls for the development of motivational, preparatory exercises that circumvent stigma-related barriers and are delivered before or during the orientation phase of treatment. The psychological states of hope, meaning, and guilt have been found to impact motivation for treatment and the development and maintenance of post-trauma pathology and symptom severity. Given a chaplain's less stigmatized role, as compared to mental health providers, and proficiency in assessing these states and providing interventions that mediate change, often before a veteran is enrolled in a PTSD treatment program, this paper introduces a brief, chaplain-led, preparatory exercise called the "Warrior's Journey Intervention" (WJI). This narrative based, meaning-making exercise is designed to improve motivation for treatment and mitigate post-trauma symptoms by impacting hope, meaning, and guilt through use of a universally shared, metaphoric story of trauma recovery. A case study will demonstrate use of the intervention, observe its effects, and analyze mechanisms of change. Research is recommended at the end of the article to test the hypothesis that the intervention promotes motivation for treatment and reduces symptoms of PTSD and Moral Injury (MI). A standardized manual for the exercise is available from author.
结果文献表明，在有战斗相关心理症状的退伍军人中，有效的、基于证据的创伤后应激障碍（PTSD）治疗方案的治疗参与率较差，因此需要开发一些动机性、预备性的练习，以避免与耻辱感相关的障碍，并在治疗的定位阶段之前或期间提供这些练习。希望、意义和内疚等心理状态会影响治疗动机，以及创伤后病理和症状严重程度的发展和维持。鉴于与心理健康提供者相比，牧师的角色耻辱感较低，并且在评估这些状态和提供中介改变的干预措施方面很熟练，这些干预措施通常在退伍军人参加 PTSD 治疗计划之前进行，因此本文介绍了一种简短的、由牧师领导的预备性练习，称为“勇士之旅干预”（WJI）。这种基于叙事的、有意义的练习旨在通过使用普遍共享的创伤恢复隐喻故事来影响希望、意义和内疚感，从而提高治疗动机并减轻创伤后症状。案例研究将演示干预措施的使用、观察其效果，并分析变化机制。文章末尾还建议进行研究，以验证干预措施是否能促进治疗动机并减轻 PTSD 和道德伤害（MI）的症状的假设。练习的标准化手册可向作者索取。
