Cognitive Rehabilitation for Gulf War Illness
Condition: Gulf War Illness
Study type: Interventional

Summary: 
      There are almost 700,000 Gulf War Veterans (GWV) with 25-30% suffering from a devastating
      multi-symptom illness coined Gulf War Illness (GWI). GWV with GWI report significant activity
      limitations and chronic cognitive problems consistent with problem-solving deficits.
      Problem-solving is considered the most complex of cognitive abilities and is what enables us
      to conduct complicated behaviors such as setting goals, sequencing and multi-tasking. As a
      result studies have found that problem-solving deficits are prospectively related to a
      greater risk of disability. Despite published reports documenting these problems there are no
      treatments that target the problem-solving deficits of GWI. This proposal seeks to determine
      whether Problem-Solving Therapy, a patient centered cognitive rehabilitation therapy, can
      reduce disability by compensating for problem-solving deficits.
    

Detailed description: 
      Gulf War Illness (GWI) is a complex multi-dimensional illness which causes as much disability
      as other major medical diseases. Previous clinical trials (i.e. cognitive behavioral therapy
      and graded exercise) for GWI have sought to improve disability by increasing activity
      regardless of symptom presentation. These previous trials for GWI have shown limited efficacy
      and poor adherence. An innovative treatment approach is to target a specific component of
      GWI, namely problem-solving ability, known to be associated with disability.

      Impairment in problem-solving ability affects Gulf War Veterans (GWV) with GWI and is
      prospectively related to greater risk of disability. This impairment is also related to
      poorer adherence to medical regimes, making it difficult for GWV to manage other aspects of
      GWI. Problem-solving is considered one of the most complex of cognitive abilities and is
      related to complicated behaviors such as setting goals, sequencing and multi-tasking. Despite
      published reports documenting these deficits there are no treatments that target the
      problem-solving deficits of GWI in order to reduce disability.

      The investigators propose a targeted treatment, Problem-Solving Therapy, to compensate for
      the problem-solving deficits of GWI and thereby reducing disability. Problem-Solving Therapy,
      a top down approach, teaches patients skills to overcome problems like cognitive dysfunction
      or physical symptoms that impact problem-solving. Compensating for problem-solving deficits
      would reduce disability and provide information on the effect of treating one component of
      GWI on other symptoms of GWI. This is the first trial of cognitive rehabilitation therapy for
      GWI.
    

Intervention name(s): Problem-Solving Therapy; Health Education
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Problem-Solving Therapy is a treatment approach that teaches patients strategies to address real-life problems.; Health Education provides didactic information about Gulf War Illness
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Veterans; neuropsychology; fatigue; Chronic Multisymptom Illness; Gulf War Illness; behavioral treatment