Mental Health Care for Service Members and Their Families Across the Globe.

The U.S. Defense Department partnered with the International Initiative for Mental Health Leadership on effective leadership and operational practices for delivery of mental health (MH) as well as addiction services throughout the world for Service Members (SM) and beneficiaries. A Military Issues Work Group (MIWG) was established in 2011 to focus on challenges experienced by military SM and beneficiaries among countries. The MIWG found common concerns related to MH care delivery to rural and remote beneficiaries. Gaps in access to care were identified and prioritized to explore. This led to better collaboration and understanding of telemental health (TMH) practices and technology applications (apps) which increase access to care for rural and remote SMs and beneficiaries. An assessment of the number of SMs and dependents distant from MH care services in the USA was conducted, as well as an environmental scan for psychological health-focused mobile apps and TMH services geared toward SM, veterans, and beneficiaries. The MIWG is developing a compendium of existing military TMH programs and apps that address MH concerns and extant literature on use of technology to extend global access to care for military members and their families across the world.

Accelerating Psychological Health Research Findings into Clinical Practice Through the Practice-Based Implementation Network Model.

The benefits of new clinical research developments often take years to reach patients. As such, the Departments of Defense (DoD) and Veterans Affairs built the Practice-Based Implementation (PBI) Network as an infrastructure to facilitate more rapid translation of psychological health (PH) research into clinical practice changes to improve the quality of care for military and Veteran patients. To regularly identify research findings appropriate for enterprise implementation, the DoD PBI Network developed a model aligned with the Consolidated Framework for Implementation Research to select and pilot PH practice change. Within this model, practice change pilots were selected following a survey of field clinicians, a public call for proposals, annual meeting of implementation science subject matter experts, and final pilot selection by PH strategic leaders. These components facilitated commitment and engagement from Military Health System PH leadership, as well as clinicians, leading to increased stakeholder buy-in and efficiency with selecting and piloting PH practice change. The DoD PBI Network model has been refined for future PH research translation pilots. It serves as a first operational model for annual implementation of PH research findings in the DoD and may be of use to other entities engaged in practice change implementation.

Emotion dysregulation and negative affect: Laboratory and EMA investigations in smokers.

INTRODUCTION: Difficulties in emotion regulation are associated with addictive behaviors, including smoking. Difficulties in emotion regulation may underlie large, rapid changes in negative affect that can increase likelihood of relapse. We investigated the association between emotion regulation ability and negative affect in smokers assessed both in the laboratory and in the field using Ecological Momentary Assessment. METHODS: Adult community smokers (N = 44) carried a personal digital assistant (PDA) for two weeks and were instructed to complete assessments of negative affect multiple times per day. Participants were instructed that they could smoke as much or as little as they liked. The Difficulties in Emotion Regulation Scale (DERS) and the Positive and Negative Affect Schedule (PANAS) were completed at three lab visits. RESULTS: Participants with higher average DERS scores reported greater negative affect at lab visits. When a participant reported a DERS score at a lab visit higher than their individual average, they also reported higher negative affect at that lab visit. Participants with higher baseline DERS scores reported more labile negative affect during EMA than those with lower baseline DERS scores, and they also reported a higher maximum level of negative affect during EMA. DISCUSSION AND CONCLUSIONS: Overall, the findings suggest that changes in emotion regulation are associated with negative affect and that emotion regulation ability is related to both the intensity and lability of negative affect. A better understanding of momentary changes in emotion regulation and negative affect may lead to improved interventions for preventing substance use relapse.

Effect of Brief Mindfulness Practice on Self-Reported Affect, Craving, and Smoking: A Pilot Randomized Controlled Trial Using Ecological Momentary Assessment.

INTRODUCTION: Despite efficacious pharmacological and behavioral treatments, most smokers attempt to quit without assistance and fail to quit. Mindfulness practice may be useful in smoking cessation. METHODS: This ecological momentary assessment (EMA) study was a pilot parallel group randomized controlled trial of a brief mindfulness practice (Brief-MP) intervention on self-reported smoking behavior delivered to smokers on a Personal Digital Assistant (PDA) in the field. Adult community smokers (N = 44) were randomly assigned to a Brief-MP (n = 24) or Control (sham meditation; n = 20) group. Participants were instructed to smoke as much or as little as they liked. Participants carried a PDA for 2 weeks and were instructed to initiate 20 minutes of meditation (or control) training on the PDA daily, completing an assessment of cognitive and affective processes immediately afterwards. Additionally, they completed assessments at random times up to four times per day. Primary outcome variables were negative affect, craving, and cigarettes smoked per day, all self-reported. RESULTS: Thirty-seven participants provided EMA data totaling 1874 assessments. Linear Mixed Model analyses on EMA data revealed that Brief-MP (vs. Control) reduced overall negative affect, F(1, 1798) = 13.8, P = .0002; reduced craving immediately post-meditation, (Group × Assessment Type interaction, F(2, 1796) = 12.3, P = .0001); and reduced cigarettes smoked per day over time (Group × Day interaction, F(1, 436) = 5.50, P = .01). CONCLUSIONS: Brief-MP administered in the field reduced negative affect, craving, and cigarette use, suggesting it may be a useful treatment.