One-Day Life Skills Workshop for Veterans With TBI, Pain and Psychopathology
Condition: Mild Traumatic Brain Injury; Distress-based Psychopathology; Chronic Pain
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Brain Concussion; Chronic Pain
Study type: Interventional

Summary: 
      Traumatic brain injury (TBI) is the signature wound of Veterans returning from the recent
      operations in Iraq and Afghanistan (i.e OIF/OEF/OND), with up to 20 percent experiencing
      persistent post-concussive symptoms. Among Veterans with mild TBI, the majority also
      experience significant distress, including depression and post-traumatic stress disorder, as
      well as persistent pain. Importantly, significant stigma is associated with seeking mental
      health care among Veterans; and poor management of multiple conditions results in increased
      morbidity and mortality, increased risk for suicide, and significantly decreased quality of
      life. Thus the challenge for treatment providers is to provide a unified and acceptable
      intervention for Veterans with these interdependent systemic comorbid concerns. The aim of
      this proposal is to develop, refine, and evaluate a 1-day trans-diagnostic (i.e., applies to
      more than one diagnosis) "life skills workshop" to help Veterans develop skills needed to
      pursue valued goals in the face of life's challenges.
    

Detailed description: 
      Traumatic brain injury (TBI) is the signature wound of Veterans returning from Operations
      Iraqi Freedom, Enduring Freedom and Operation New Dawn (OIF/OEF/OND), with up to 20 percent
      experiencing persistent post-concussive symptoms. Among those with a mild TBI (mTBI)
      diagnosis, the majority also suffers from stress-based psychopathology, including depression,
      post-traumatic stress disorder, and other anxiety disorders, as well as persistent pain. Poor
      management of multiple conditions results in increased morbidity and mortality, increased
      risk for suicide, and significantly decreased quality of life. Importantly, the association
      between seeking mental health care and stigma among Veterans is high. Veterans are often
      unwilling to seek mental health services due to concern that receiving such care would
      negatively impact their careers and the belief that they should be able to overcome
      psychological difficulties on their own. Furthermore availability of specialty services is
      limited for Veterans living in rural settings. Thus the challenge for treatment providers is
      to provide a unified, efficient, accessible, and acceptable intervention for Veterans with
      these interdependent systemic comorbid concerns. Acceptance and Commitment Therapy (ACT) is a
      trans-diagnostic (i.e., applies to more than one diagnosis) behavioral intervention aimed at
      helping individuals develop the skills needed to pursue valued goals and directions in the
      face of life's challenges. It provides a unified model of behavior change that has shown
      promise in treating depression and anxiety, as well as chronic medical conditions.
      Importantly, ACT has been effectively implemented in various treatment-delivery formats,
      including 1-day workshops. This flexibility in delivery format allows focus to be placed on
      how best to package and deliver the intervention to meet the needs of this Veteran patient
      population, to ensure treatment adherence, and also to increase chances of dissemination into
      clinical settings. Providing a 1-day ACT "workshop" for Veterans with mTBI, pain, and mental
      health problems will allow unitary comprehensive care for the range of emotional, physical,
      and cognitive symptoms experienced by these Veterans. Presenting the treatment as a
      "workshop" rather than "therapy" will also be better suited for the Veterans who may not be
      explicitly seeking specialized mental health care. Finally, a 1-day workshop ensures
      treatment adherence and completion, the lack of which is often the greatest obstacle to
      effective delivery of mental health services.

      The aims of this study are to:

        1. develop a 1-day (5-hour) "ACT on Life" workshop tailored specifically for Veterans with
           mTBI, stress-based psychopathology, and pain; a multi-disciplinary team of a clinical
           psychologist, neuropsychiatrist, cognitive psychologist, and anthropologist will provide
           expert input for use in producing the therapist intervention and patient manual;

        2. enroll 10 Veterans with mTBI, stress-based psychopathology, and pain in the "ACT on
           Life" workshop to obtain qualitative and quantitative feedback from Veterans about the
           intervention; use Veteran feedback to refine the treatment procedures and manuals; and
           examine feasibility and acceptability of the intervention; (this is called Pilot 1 and
           is the first time we recruited participants to obtain feedback on the intervention); and
           3) randomize 30 Veterans with mTBI, pain, and stress-based psychopathology to the
           refined "ACT on Life" workshop or to Treatment as usual (TAU) to examine the preliminary
           efficacy of the intervention on quality of life and functioning, stress-based symptoms
           of psychopathology, and pain interference (this is called Pilot 2 and quantitative
           feedback was obtained). The results section will reflect data from Pilot 2.
    

Intervention name(s): Acceptance and Commitment Therapy
Intervention type(s): Behavioral
Intervention description(s): Contextually focused form of cognitive behavioral psychotherapy that uses MINDFULNESS and behavioral activation to increase patients' psychological flexibility in areas such as ability to engage in values-based, positive behaviors while experiencing difficult thoughts, emotions, or sensations.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Acceptance and Commitment Therapy; mild Traumatic Brain Injury; Veterans; Post Traumatic Stress Disorder