# The impact of modifiable psychosocial factors on Veterans’ long-term trajectories of functioning and quality of life: Promoting recovery by targeting mindfulness and psychological flexibility

> **NIH VA I01** · OLIN TEAGUE VETERANS CENTER · 2020 · —

## Abstract

Posttraumatic stress disorder (PTSD), depression, alcohol use disorders (AUD), traumatic brain
injury, and chronic pain frequently co-occur among post-9/11 war Veterans and are associated
with functional impairment and suicide risk. Yet, no treatment exists [that was specifically
designed] to promote functional recovery in Veterans experiencing any combination of these most
common mental and physical wounds of war. This is the re-submitted proposal for a second
competitive renewal to fund Phase 3 of Project SERVE (Study Evaluating Returning Veterans’
Experiences). In Phase 1 (RX000304-01A1), we identified risk and resilience factors for
deployment-related mental health conditions regardless of whether those factors were modifiable.
In Phase 2 (RX000304-04A1), we refined our approach by focusing on modifiable predictors drawn
from the treatment outcomes literature. The over-arching aim of this programmatic line of
research is to inform the development of evidence-based prevention and treatment
programs designed to assist returning Veterans with achieving optimal functioning upon
reintegrating into civilian life. This vision comes to fruition in the proposed Phase 3, which
proposes both to extend the longitudinal study (Aim 1) and to adapt, refine, and pilot test an
intervention to promote functional recovery (Aim 2). The 2-year longitudinal study (N = 500) will
examine novel factors (e.g., mindfulness, perceived burdensomeness, thwarted belongingness,
moral injury) and established treatment targets (psychological flexibility, self-compassion, emotion
regulation) in relation to latent class trajectories of functional impairment, and as predictors of risk
for self-directed violence (SDV; i.e., suicide risk), which is a top priority for VA and RR&D. In the
prior Phases, we established psychological inflexibility as a robust risk factor for mental health
problems, functional impairment, and SDV. Thus, in Aim 2, using a Successive Cohort Design, we
will adapt, refine [based on Veterans’ feedback], and pilot-test an adapted evidence-based
intervention, Acceptance and Commitment Therapy (ACT) that targets psychological flexibility to
promote functional recovery (ACT-FX). We previously demonstrated the promise of ACT, a
transdiagnostic, mindfulness and acceptance-based behavior therapy aimed at improving
functioning by increasing psychological flexibility with Veterans with co-occurring PTSD-AUD. We
will test the feasibility and acceptability of ACT-FX, [an individually-tailored intervention to promote
functional recovery related to these commonly co-occurring conditions as compared to mental
health treatment as usual (TAU) in 60] Veterans with moderate-to-severe functional impairment.
Our ultimate goal is to help shift chronically impaired Veterans to a recovery trajectory. Integrating
data from the longitudinal study (Aim 1) with data from the treatment study (Aim 2), we will conduct
a preliminary test of whether ACT-FX is associated with functionally i...

## Key facts

- **NIH application ID:** 10020207
- **Project number:** 5I01RX000304-10
- **Recipient organization:** OLIN TEAGUE VETERANS CENTER
- **Principal Investigator:** SUZANNAH K CREECH
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2010-06-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10020207

## Citation

> US National Institutes of Health, RePORTER application 10020207, The impact of modifiable psychosocial factors on Veterans’ long-term trajectories of functioning and quality of life: Promoting recovery by targeting mindfulness and psychological flexibility (5I01RX000304-10). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10020207. Licensed CC0.

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