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Telephone-based CBT Improves PTSD Symptoms among Returning Veterans

Objectives: Many service members do not seek care for mental health and addiction problems, often with serious consequences for them, their families, and their communities. This study tested the effectiveness of a brief, telephone-based, cognitive-behavioral intervention designed to improve treatment engagement among returning service members who screened positive for posttraumatic stress disorder (PTSD).

Methods: Service members who had served in Operation Enduring Freedom or Operation Iraqi Freedom who screened positive for PTSD but had not engaged in PTSD treatment were recruited (N=300), randomly assigned to either control or intervention conditions, and administered a baseline interview. Intervention participants received a brief cognitive-behavioral therapy intervention; participants in the control condition had access to usual services. All participants received follow-up phone calls at months 1, 3, and 6 to assess symptoms and service utilization.

Results: Participants in both conditions had comparable rates of treatment engagement and PTSD symptom reduction over the course of the six-month trial, but receiving the telephone-based intervention accelerated service utilization (treatment engagement and number of sessions) and PTSD symptom reduction.

Conclusions: A one-time brief telephone intervention can engage service members in PTSD treatment earlier than conventional methods and can lead to immediate symptom reduction. There were no differences at longer-term follow-up, suggesting the need for additional intervention to build upon initial gains.

Stecker, T., McHugo, G., Xie, H., Whyman, K., & Jones, M. (2014). RCT of a Brief Phone-Based CBT Intervention to Improve PTSD Treatment Utilization by Returning Service Members. Psychiatric Services (washington, D.c), 65, 10, 1232-7.

Telephone-Delivered CBT for Pain Management among Older Military Veterans

This study investigated the effectiveness of telephone-delivered cognitive-behavioral therapy (T-CBT) in the management of chronic pain with older military veterans enrolled in VA primary-care clinics. We conducted a randomized clinical trial comparing T-CBT with telephone-delivered pain education (T-EDU). A total of 98 military veterans with chronic pain were enrolled in the study and randomized into one of two treatment conditions. Study participants were recruited from primary-care clinics at an urban VA medical center and affiliated VA community-based outpatient clinics (CBOCs). Pain management outcomes were measured at mid-treatment (10 weeks), post-treatment (20 weeks), 3-month follow-up (32 weeks), and 6-month follow-up (46 weeks). No significant differences were found between the two treatment groups on any of the outcome measures. Both treatment groups reported small but significant increases in level of physical and mental health, and reductions in pain and depressive symptoms. Improvements in all primary outcome measures were mediated by reductions in catastrophizing. Telephone-delivered CBT and EDU warrant further study as easily accessible interventions for rural-living older individuals with chronic pain.

Carmody, T. P., Duncan, C. L., Huggins, J., Solkowitz, S. N., Lee, S. K., Reyes, N., Mozgai, S., … Simon, J. A. (January 01, 2013). Telephone-delivered cognitive-behavioral therapy for pain management among older military veterans: A randomized trial. Psychological Services, 10(3), 265-275.

 

Veterans with TBI and Suicidality

NewStudy-Graphic-72x72_edited-3Previous research has shown that, in recent years, there has been an increased rate of suicide in soldiers returning from war.  In addition, as many as 15-23% of returning soldiers have incurred traumatic brain injuries (TBI). A new study published in Rehabilitation Psychology aimed to identify risk and protective factors for suicide ideation or suicidal behavior among veterans who have experienced TBI.

Thirteen suicidal veterans in a TBI clinic completed 30 to 60 minute interviews that included structured questionnaires regarding suicidality, methods of coping/seeking support, and military service. Researchers identified a post-injury loss of sense of self, cognitive deficits secondary to TBI, and psychiatric and emotional difficulties as precipitating factors for suicide ideation or suicidal behavior. Social support, a sense of purpose and hopefulness, religion or spirituality, and mental health treatment were identified as protective factors.

This study helps to identify those precipitating factors that practitioners should target when working with a similar population. The authors note that concepts associated with perceived burdensomeness and thwarted belonging can be targeted using cognitive and behavioral strategies along with techniques that encourage the client to re-conceptualize his or her worth and meaning to others.

Reference:

Brenner, L. A., Homaifar, B. Y., Adler, L. E., Wolfman, J. H., & Kemp, J. (2009). Suicidality and veterans with a history of traumatic brain injury: Precipitating events, protective factors, and prevention strategies. Rehabilitation Psychology, 54, 390-397.

Cognitive Therapy is Helping Veterans

Guest Blogger: John Milwee, Psy.D., Veterans Administration therapist and Beck Institute alumnus

Veterans returning from the conflicts in Afghanistan and Iraq may face many challenges as they begin to reintegrate into their roles as parents, employees, friends, and neighbors. In recent months a great deal of media attention has been focused on those returning Veterans who suffer with symptoms of Post-Traumatic Stress Disorder (PTSD) associated with their combat experience. Alarming statistics are frequently reported that describe the number of these Veterans who, when untreated, commit suicide. Read more

Veterans with Post-traumatic Stress rate effectiveness of CBT when delivered remotely and in person

A recent study in Behavior Modification evaluated ratings submitted by veterans who were receiving cognitive behavioral therapy (CBT) via different delivery modes for post-traumatic stress disorder. The ratings measured competency and adherence to the CBT model when administering CBT through either telepsychiatric or same-room approaches. In telepsychiatry, a therapist and client communicate through resources such as the telephone and the Internet. It can also incorporate video-conferencing technology via satellite for real-time consultation in two different parts of the world. The researchers’ findings suggest that therapist competence and adherence to the CBT model is similar whether the treatment is delivered through telepsychiatry or conventional methods.

Study authors: B. C. Frueh, J. Monnier, A. L. Grubaugh, J. D. Elhai, E. Yim, R. Knapp