Improving Quality-of-life and Depressive Symptoms for OEF/OIF Combat Veterans: Assessing the Benefits of Interactive, Internet-based Psychotherapy and Peer-to-peer Support

Background: Current military involvement in Afghanistan (Operation Enduring Freedom - OEF) and Iraq (Operation Iraqi Freedom - OIF) has created unforeseen burdens on the mental health and well-being of US service women and men. Although OEF/OIF service members and veterans are at high risk of developing sub-threshold combat stress and depressive symptoms or full disorders in the post-deployment period, only a small fraction ever receive care. The VETS PREVAIL Intervention, which combines Cognitive-Behavioral-Therapy-based (CBT-based) coping skills training with peer-to-peer support and counseling, was specifically designed to offer the returning OEF/OIF service member or veteran an accessible and confidential first step to care.
Evaluation Study: RISE Consulting, lead by Dr. Benjamin W. Van Voorhees, MD, MPH, was contracted to supervise a pilot study of potential benefit, feasibility and safety of the VETS PREVAIL Intervention. The study would consist of a single group pre/post comparison study of N=50 recent OEF/OIF veterans in the frame work of a phase 1 clinical trial (phase 1). Feasibility (adherence and satisfaction), evidence of clinical benefit would be evaluated through changes in the following clinical self-report measures: i) symptoms of depressed mood (Center for Epidemiologic Studies Depression Scale, CES-D), ii) post traumatic stress disorder (Post Traumatic Stress Disorder Checklist-Military, PCL-M), and iii) functional status (Short Form 12, SF-12), as well as changes in key attitudes toward mental health care seeking (intent to seek treatment, mental health self-efficacy and stigma).

开始日期2009-09-01

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Prevail Health Solutions LLC

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2020-04-01·Contemporary Clinical Trials4区 · 医学

The efficacy of written exposure therapy versus imaginal exposure delivered online for posttraumatic stress disorder: Design of a randomized controlled trial in Veterans

4区 · 医学

Article

作者: Henderson, Jason ; Sloan, Denise M ; Miller, Madeleine L ; McLean, Carmen P ; Gengler, Richard

Adapting evidence-based treatments for online delivery has potential to significantly increase the reach of effective care to Veterans with posttraumatic stress disorder (PTSD). This paper describes the rationale for and methods of a randomized controlled trial comparing the efficacy and efficiency of written exposure therapy versus imaginal exposure for PTSD delivered in a novel online and variable length format. Participants will be 300 Veterans seeking treatment for clinically significant symptoms of PTSD. Participants will be randomly assigned to either written exposure or imaginal exposure via verbal recounting and will complete between 4 and 8 online therapy sessions facilitated by trained peer support specialists. Treatment is terminated before session 8 if the PTSD symptom improvement criterion is met. Assessments will be conducted at baseline, post-treatment, and at 3-month follow-up. The primary hypotheses are that written exposure therapy will be noninferior to imaginal exposure with respect to treatment efficacy and efficiency. Secondary hypotheses relate to identifying and comparing potential mediators of PTSD treatment outcome, including trauma-related cognitions and emotion regulation.

Psychological Trauma: Theory, Research, Practice, and Policy2区 · 心理学

Web-based trauma intervention for veterans has physical health payoff in randomized trial.

2区 · 心理学

Article

作者: Walt, Lisa ; Holmgreen, Lucie ; Hobfoll, Stevan E ; Stevens, Natalie R ; Gengler, Richard

OBJECTIVEPTSD and depression are related to perceived physical health impairment in veterans, but little is known about the effects of psychological treatment on impairment. We examined the impact of an interactive online treatment for veterans with trauma-related distress, including (a) whether treatment effects include reduced perceived physical impairment, and (b) how these treatment effects are related to symptoms of PTSD and depression.METHODA randomized controlled trial assessed the impact on perceived physical health impairment of interactive online treatment for veterans with symptoms of PTSD and depression. Veterans were randomized to either the Vets Prevail program (n = 209), or a no-treatment control (n = 94) completing measures of depression and PTSD symptomology as well as perceived physical health impairment at 6 and 12 weeks following baseline assessment We conducted a series of multiple and single mediation analyses to examine how the effects of Vets Prevail on these outcomes are related.RESULTSCompared with control, Vets Prevail was (a) associated with significant reductions in perceived physical health impairment, and (b) this relationship was mediated by reductions in symptoms of PTSD, but not depression. Further analysis showed that perceived physical health impairment also mediated the relationships between intervention and PTSD and depression symptoms.CONCLUSIONSFindings indicate that Vets Prevail reduces perceptions of physical health impairment by reducing PTSD symptomology. It is also possible that treatment initiated more complex, bidirectional relationships such that improvements in psychological distress and in perceived physical health impairment reinforced each other over time. Findings demonstrate that Vets Prevail may help veterans overcome traditional barriers to care and achieve improvements in multiple areas of functioning. (PsycINFO Database Record

Journal of Consulting and Clinical Psychology

Vets prevail online intervention reduces PTSD and depression in veterans with mild-to-moderate symptoms.

Article

作者: Walt, Lisa ; Gengler, Richard ; Stevens, Natalie R ; Hobfoll, Stevan E ; Blais, Rebecca K ; Hobfoll, Stevan E. ; Stevens, Natalie R. ; Blais, Rebecca K.

OBJECTIVEDespite heightened rates of depression and posttraumatic stress disorder (PTSD) among in Iraq/Afghanistan veterans, the majority of distressed veterans will not receive mental health care. Overcoming barriers to mental health services requires innovative approaches to broaden the reach of evidence-based treatment. The current study examined the efficacy and acceptability of an innovative and dynamic online cognitive-behavioral therapy intervention for PTSD and depression called Vets Prevail.METHODA randomized clinical trial conducted between 2011 and 2013 assessed changes in PTSD and depression in veterans with mild-to-moderate distress. Veterans randomized to Vets Prevail (n = 209) were aged 34.2 ± 7.6 years, mostly male (81.3%), and nonminority (73.7%). Veterans randomized to adjustment as usual (n = 94) were aged 34.7 ± 8.9, mostly male (81.9%), and White (67.0%). Veterans completed the PTSD Checklist-Military Version and the Center for Epidemiological Studies Depression scale (10-item version) postintervention and at 12-week follow-up.RESULTSVeterans in the Vets Prevail condition reported significantly greater reductions in PTSD, t(250) = 3.24, p = .001 (Mreduction = 5.51, SD = 9.63), and depression, t(252) = 4.37, p = .001 (Mreduction = 2.31, SD = 5.34), at 12-week follow-up compared with veterans in the adjustment as usual condition (PTSD Mreduction = 1.00, SD = 7.32; depression Mreduction = 0.48, SD = 4.95), with moderate effect sizes for PTSD (Cohen's d = 0.42) and depression (Cohen's d = 0.56). Exploratory analysis shows that Vets Prevail may be effective regardless of combat trauma exposure, gender, and ethnic minority status.CONCLUSIONVets Prevail circumvents many barriers to care and effectively addresses the dire mental health needs of veterans.

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