Enhancing Emotion Regulation During Driving in OEF/OIF Veterans

Not Applicable

Completed

Conditions: Driving Distress Secondary to Trauma During Deployment

Interventions: Behavioral: Cognitive reappraisal and breathing retraining
Behavioral: Control

Registration Number: NCT01336764

Lead Sponsor: Palo Alto Veterans Institute for Research

Brief Summary: Many U.S. military personnel are returning from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) deployments with histories of trauma while driving in military vehicles. The proposed project aims to develop and test a rehabilitative technology aimed at enhancing emotion regulation and reducing operator-related risk during civilian driving.

Detailed Description: The driving exercises to be used are based upon standard Veterans Affairs-based driver assessments which have a well-established safety record and have been applied to a wide-range of medically-related and post-deployment driving issues.

Specifically, the driving exercises will embed a test-intervene-test session plan within a structured hierarchy of four progressively more challenging civilian driving tasks administered on successive weeks. Participants will drive local roads and highways familiar to Veterans Affairs - Palo Alto Health Care System Certified Driving Rehabilitation Specialists (CDRS). These courses have known characteristics as regards civilian driving challenges and OEF/OIF-relevant "trigger" stimuli. Graduation from one course to the next will take place only with permission from the CDRS who has accompanied the participant on the prior exercise. Based upon their self-reports of driving-related distress, we expect such distress to arise during the driving exercises. At such times, participants will be instructed to park in the next available safe parking location. They will be induced to rapidly achieve reduced autonomic arousal through use of a graphics-rich biofeedback procedure and simultaneously engage in the generation and rehearsal of cognitive reappraisal scripts under the coaching of project therapist also in the vehicle. These individualized procedures are expected to quickly lower emotional reactivity to subjectively adverse driving events and conditions. The participant will then drive the course a second time. Each session will finish with a graphical comparison of pre- and post-intervention vehicle and control surface movement parameters, visual attentional control, autonomic arousal and subjective driving distress.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 22

Inclusion Criteria

Driving-related distress secondary to conditions of OEF/OIF deployment
Possesses valid driver's license
Owns vehicle registered in his/her name
Vehicle currently insured in his/her name
Drives regularly (e.g. to regularly scheduled activities such as work or school)
Drives to all driving rehabilitation appointments

Exclusion Criteria

Any moving violations since discharge from the military
Any central nervous system injury or disease
Psychotic disorder and/or any psychotic signs or symptoms
Current alcohol or substance abuse/dependence (required answer: "yes" or "no", only)
Severe Post-traumatic Stress Disorder (as indicated by a PTSD Checklist (PCL) score greater than 60)
Severe Depression(as indicated by a Beck Depression Inventory-II score greater than 28)
Amputation or restricted mobility of any limb

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Active	Cognitive reappraisal and breathing retraining	individual coping self-statements and stimulus guided paced breathing.
Control	Control	Coping self statements and breathing retraining will be replaced with undirected passive behaviors such as listening to music.

Primary Outcome Measures

Name	Time	Method
Reduced Heart Rate During Driving (Aggregated Over Sessions)	during 60-90 min driving intervention over the 3 intervention visits which were approximately one week apart	averaged over sessions

Secondary Outcome Measures